These are the findings of a study by a group of researchers at the pharmaceutical firm Eli Lilly. I haven’t read the study, only the press coverage to which this link points, but their findings are summarized thus: “Of the 866 patients who stopped treatment, 36% (315/866) did so because the treatment was felt not to be effective or because their symptoms worsened. Only 12% of patients who stopped treatment early did so because of adverse events such as dizziness, fatigue, vomiting or weight gain.” They make the point that discontinuation due to patient perception of poor response tends to occur early in the course of treatment and that patients who experience an early response were 80% more likely to complete treatment.

I would point out the likelihood of significant bias in this industry-sponsored study. Eli Lilly are the manufacturers of Zyprexa [olanzapine], one of the most-used ‘atypical’ [new-generation] antipsychotic medications which were touted as wonder drugs solving all the substantial toxicity issues of the older generation of antipsychotics, until we recognized that worrisome side effects such as drastic weight gain and glucose intolerance were common with this newer generation of agents. It is in Lilly’s interest in selling antipsychotic medications, of course, to establish, as the current study concludes, that side effects are not as worrisome as they are usually considered and that treatment should be more aggressive from the outset. But of course patient discontinuation early in the course of treatment is not likely to be from concern about side effects, because the worrisome metabolic changes caused by these medications are insidious and slow to develop!

I agree with the need for treating terrifying psychotic symptoms with alacrity to relieve distress and establish a treatment alliance. Certainly a schizophrenic patient beset by tormenting voices or paranoid ideation will not stick with treatment that does not offer rapid relief. However, I suspect the crucial variable which the study does not address is that patients who do not perceive that their treatment is effective are often patients with one particular symptom of severe psychotic illness — anosognosia, the denial of illness and lack of recognition of need for treatment at all. A patient cannot recognize benefit from a medication treatment if s/he does not recognize the symptoms and the need for treatment in the first place. Psychiatrists are very familiar with psychological denial, but I also think anosognosia has a neurologically-based, organic component as part of the brain dysfunction in schizophrenia and other psychotic illnesses, although this is controversial within my field.

In any case, it is emphatically not drug treatment, aggressive or not, which treats this symptom. Instead of funding research trying to sell more drug doses, Eli Lilly should be endowing a foundation for the dying art of talking to the sickest of our patients, creating and maintaining a relationship allowing skillful and sustained entry into the world of a terrified and tormented soul. This is itself the most important healing tool.

Those English; always masters of understatement!

There are several aspects of this effort to ‘cure’ worth examining further. To be blunt, this is an example of one of those studies where a distinction will not likely make a difference. While recipients of ‘the pill’ (the beta blocker propranolol) show lower scores on physiological arousal measures in PTSD, that is very different than changing the meaning of the experience or the distress associated with remembering it, stopping the person’s life from being dominated dysfunctionally by the consequences of their trauma, etc. — true measures of ‘cure.’ There is a big difference between trying to prevent the memories of a trauma from being encoded in the first place, at the time of the experience, in the distinctive chaotic and unmanageable way in which we think traumatic memories are laid down; and trying to affect the reexperiencing. This is about as much a cure as saying that you are ‘curing’ a broken bone by giving enough of a painkiller so that it no longer hurts when the sufferer moves the limb. Or curing a brain tumor by giving enough aspirin that the patient no longer feels any headaches. You get my drift.

Moreover, the study seems based on the implicit notion that the distress experienced when a trauma victim remembers the events, e.g. when talking about them in therapy, re-encodes the memories traumatically and plays a role in their reinforcement and perpetuation. To the contrary; this flies in the face of the fact that ‘the talking cure’ — talking about the trauma and reexperiencing it in measured ways with a therapist skilled in helping the sufferer master the modulation of the memories and their impact — is part of the solution rather than part of the problem; in fact, it is the only therapeutic approach with ‘curative’ benefit to PTSD patients.

The modest positive clinical results achieved with blunting the physiological arousal, however do have one benefit. They get more research funding for these bastions of trauma research. The war in Iraq, in which US forces face with futility an interminable insurgency in which civilians are indistinguishable from enemy combatants, there are no front lines and no distinction between safe zones and the war front, is a factory for the manufacture of PTSD, exactly as was the Vietnam War which marked the founding of the modern industry of psychiatric treatment of and research into PTSD. Traumatology was a languishing backwater of psychiatric study and treatment, despite the consciousness-raising perspective of the women’s movement into the exploitation and power differentials in sexual and domestic relationships, until revitalized and animated by joining with the arguably very different area of study of returning Vietnam veterans. Researchers who can plausibly claim they have a chance of treating the epidemic of traumatized vets returning from Central Asia will have it made for the rest of their research careers.

Unlike the futility of treating with beta blockers months or years afterward, modulating the physiological arousal associated with traumatic experience may prevent memories from being encoded in the damaging and inaccessible traumatic mode in the first place, but you cannot exactly get medication to people rapidly enough to make that difference in most trauma sitautions — rapes, car crashes, witnessing violent crimes, natural disasters, industrial accidents, etc. The one situation in which this is possible is with soldiers going into battle. There is much DoD-funded research interest in prophylactic measures with beta blockers and other therapeutic agents, which if successful will turn our forces even more into automatons insulated from any compunctions about or consequences of their actions.

As implausible as the promise of a ‘cure’ held out by the present study is, it does serve as an opportunity to underscore that a traumatic memory is not just a memory of a traumatic event. PTSD develops when certain — but not any — devastatingly disturbing experiences in some — but not any — individuals swamp the human organism’s coping strategies so thoroughly that it is put into a state of physiological arousal outside the bounds of what our machinery evolved to handle, beyond the evolutionary preparedness of the organism and its usual ‘flight or fight’ stress mechanisms. Even the proverbial scenario of the caveman confronted by the sabertooth tiger is within the bounds of expectable human experience.

This ‘outside the bounds’ factor used to be one of the diagnostic criteria for psychiatrists to classify a patient as having PTSD, but it has been dropped in subsequent iterations of the diagnostic criteria. The concept of PTSD has been broadened to the point where it is meaningless when applied by naive clinicians or patients interested in a convenient explanation for their distress or dysfunction. This has been particularly puissant in the sexual trauma arena. Trauma clinics and victim support groups are shared cheek-by-jowl by patients on the one hand who have undergone unendurable experiences of repeated brutal inhuman sexual violations, often under conditions of virtual captivity by people violating the basic trust of their parental or caretaker roles; and on the other hand those who once experienced a single inadvertent brush of the hand or suggestive glance from a babysitter or neighbor. PTSD has become synonymous with being ‘bummed out once in awhile by something negative that once may or may not have happened to me’. Of course, trauma is in the eye of the beholder, true PTSD sufferers have no choice about organizing their life around the terror, while many carrying the diagnosis, or their caregivers, have in effect opted in. This unwarranted expansion of the PTSD concept to the point where it is utterly meaningless is driven by ‘secondary gains’ for both clinicians and patients that have nothing to do with maximizing therapeutic efficacy.

Addendum (looking for feedback): do FmH readers like these extended pieces on mental health-related news? Longtime readers know I have a few pet peeves in the field I air over and over again, the bastardization and cooptation of the PTSD concept being one of them. You have heard them from me before, and I do tend to get pretty didactic and polemic. Not that there are many comments about any of my posts, but the silence is deafening after one of these psychiatric diatribes. They are of some use to me in blowing off steam, but do you get anything out of them? Among other things, I mean them as an insider’s cautionary tales for those of you who are consumers of mental health services. Of course, I may not get any feedback in response to this query because my readers may have not have gotten this far, having long since stopped reading this post far above…

Addendum II: Thanks to walker for reminding me about Warnock’s Dilemma, described thus by Wikipedia: “Warnock’s Dilemma, named for its progenitor Bryan Warnock, points out that a lack of response to a posting on a mailing list, Usenet newsgroup, or Web forum does not necessarily imply that no one is interested in the topic,” and goes on to posit six other possible explanations for reader nonresponse.

There are several aspects of this effort to ‘cure’ worth examining further. To be blunt, this is an example of one of those studies where a distinction will not likely make a difference. While recipients of ‘the pill’ (the beta blocker propranolol) show lower scores on physiological arousal measures in PTSD, that is very different than changing the meaning of the experience or the distress associated with remembering it, stopping the person’s life from being dominated dysfunctionally by the consequences of their trauma, etc. — true measures of ‘cure.’ There is a big difference between trying to prevent the memories of a trauma from being encoded in the first place, at the time of the experience, in the distinctive chaotic and unmanageable way in which we think traumatic memories are laid down; and trying to affect the reexperiencing. This is about as much a cure as saying that you are ‘curing’ a broken bone by giving enough of a painkiller so that it no longer hurts when the sufferer moves the limb. Or curing a brain tumor by giving enough aspirin that the patient no longer feels any headaches. You get my drift.

Moreover, the study seems based on the implicit notion that the distress experienced when a trauma victim remembers the events, e.g. when talking about them in therapy, re-encodes the memories traumatically and plays a role in their reinforcement and perpetuation. To the contrary; this flies in the face of the fact that ‘the talking cure’ — talking about the trauma and reexperiencing it in measured ways with a therapist skilled in helping the sufferer master the modulation of the memories and their impact — is part of the solution rather than part of the problem; in fact, it is the only therapeutic approach with ‘curative’ benefit to PTSD patients.

The modest positive clinical results achieved with blunting the physiological arousal, however do have one benefit. They get more research funding for these bastions of trauma research. The war in Iraq, in which US forces face with futility an interminable insurgency in which civilians are indistinguishable from enemy combatants, there are no front lines and no distinction between safe zones and the war front, is a factory for the manufacture of PTSD, exactly as was the Vietnam War which marked the founding of the modern industry of psychiatric treatment of and research into PTSD. Traumatology was a languishing backwater of psychiatric study and treatment, despite the consciousness-raising perspective of the women’s movement into the exploitation and power differentials in sexual and domestic relationships, until revitalized and animated by joining with the arguably very different area of study of returning Vietnam veterans. Researchers who can plausibly claim they have a chance of treating the epidemic of traumatized vets returning from Central Asia will have it made for the rest of their research careers.

Unlike the futility of treating with beta blockers months or years afterward, modulating the physiological arousal associated with traumatic experience may prevent memories from being encoded in the damaging and inaccessible traumatic mode in the first place, but you cannot exactly get medication to people rapidly enough to make that difference in most trauma sitautions — rapes, car crashes, witnessing violent crimes, natural disasters, industrial accidents, etc. The one situation in which this is possible is with soldiers going into battle. There is much DoD-funded research interest in prophylactic measures with beta blockers and other therapeutic agents, which if successful will turn our forces even more into automatons insulated from any compunctions about or consequences of their actions.

As implausible as the promise of a ‘cure’ held out by the present study is, it does serve as an opportunity to underscore that a traumatic memory is not just a memory of a traumatic event. PTSD develops when certain — but not any — devastatingly disturbing experiences in some — but not any — individuals swamp the human organism’s coping strategies so thoroughly that it is put into a state of physiological arousal outside the bounds of what our machinery evolved to handle, beyond the evolutionary preparedness of the organism and its usual ‘flight or fight’ stress mechanisms. Even the proverbial scenario of the caveman confronted by the sabertooth tiger is within the bounds of expectable human experience.

This ‘outside the bounds’ factor used to be one of the diagnostic criteria for psychiatrists to classify a patient as having PTSD, but it has been dropped in subsequent iterations of the diagnostic criteria. The concept of PTSD has been broadened to the point where it is meaningless when applied by naive clinicians or patients interested in a convenient explanation for their distress or dysfunction. This has been particularly puissant in the sexual trauma arena. Trauma clinics and victim support groups are shared cheek-by-jowl by patients on the one hand who have undergone unendurable experiences of repeated brutal inhuman sexual violations, often under conditions of virtual captivity by people violating the basic trust of their parental or caretaker roles; and on the other hand those who once experienced a single inadvertent brush of the hand or suggestive glance from a babysitter or neighbor. PTSD has become synonymous with being ‘bummed out once in awhile by something negative that once may or may not have happened to me’. Of course, trauma is in the eye of the beholder, true PTSD sufferers have no choice about organizing their life around the terror, while many carrying the diagnosis, or their caregivers, have in effect opted in. This unwarranted expansion of the PTSD concept to the point where it is utterly meaningless is driven by ‘secondary gains’ for both clinicians and patients that have nothing to do with maximizing therapeutic efficacy.

Addendum (looking for feedback): do FmH readers like these extended pieces on mental health-related news? Longtime readers know I have a few pet peeves in the field I air over and over again, the bastardization and cooptation of the PTSD concept being one of them. You have heard them from me before, and I do tend to get pretty didactic and polemic. Not that there are many comments about any of my posts, but the silence is deafening after one of these psychiatric diatribes. They are of some use to me in blowing off steam, but do you get anything out of them? Among other things, I mean them as an insider’s cautionary tales for those of you who are consumers of mental health services. Of course, I may not get any feedback in response to this query because my readers may have not have gotten this far, having long since stopped reading this post far above…

Addendum II: Thanks to walker for reminding me about Warnock’s Dilemma, described thus by Wikipedia: “Warnock’s Dilemma, named for its progenitor Bryan Warnock, points out that a lack of response to a posting on a mailing list, Usenet newsgroup, or Web forum does not necessarily imply that no one is interested in the topic,” and goes on to posit six other possible explanations for reader nonresponse.

“As the civil rights leader’s widow struggles to recover from a stroke, their offspring fight over selling the King Center, which she founded…

As readers of FmH know, I have treated ADHD for a long time in my psychiatric practice but have been appalled by its burgeoning and unsystematic, laughably faddish overdiagnosis. It is now a wastebasket diagnosis comprising some children with a characteristic set of hardwired neurocognitive deficits in the regulation of attentional processes (who deserve the diagnosis); some with other psychiatric causes of inattention, distractibilityor impulsivity (warranting other psychiatric diagnoses), some children at the mercurial, impulsive or energetic end of the temperament spectrum; and some children whose difficulty paying sustained attention, avoiding distraction or maintaining decorum are shaped by sociocultural rather than internal influences. These latter two groups of ADHDers really do not warrant a psychiatric diagnosis at all.

While I have no affinity for diagnosis by aura, I think Carroll and Tober may be overcompensating for the overpathologizing with an equally silly lionization of the ‘ADHD child’. On the other hand, I do think that some children come to be seen as having attention deficit disorder in the classroom because the stultifying curriculum does not hold their interest and they are all over the map seeking stimulation. In my children’s school system, the townwide parent interest group for gifted and talented children is full of the parents of children with different, and often difficult, learning styles, and it is no accident.

Some of his readers have looked at the situation with packet sniffers and confirmed that if you turn off the mini-store function, iTunes does not upload any information, and Steve Jobs says that Apple discards any personal information the Ministore transmits to Apple.

Doctorow gives the credit for breaking this story to Marc at since1968.com, and makes note of this typology of silly apologists for Apple’s behavior:

• “It’s not spyware if Apple does it.”
• “Stop hyperventilating, iTMS is only collecting the songs you play. Where’s the harm?”
• “It’s your duty to monitor your outbound traffic..”
• “Corollary: You should expect that companies will take your information without asking, and it’s your duty to sniff and counter as desired.”
• “Privacy is dead, stop acting like companies are immoral for spying on you.”

I often get a version of some of these whenever I raise privacy concern about any sort of corporate behavior — either it is my responsibility to try to protect my privacy, or I should give it up and recognize that the battle is long since lost. I’ll be damned if I roll over and accept the latter; as to the former, I agree that it is my responsibility, when the data is collected transparently. For instance, to avoid their building a consumer database on me, I never sign up for the frequent buyers’ discount programs at large corporate chains at which I am forced to shop, since there are virtually no independent pharmacies, supermarkets, pet shops or stationery stores around anymore. (I am fortunate enough not to be faced with the same dilemma at Barnes and Noble or Borders, since I can frequent one of two wonderful independent bookstores and never shop the chains at all.) Likewise, as Marc’s discussion suggests, if I rip a CD into iTunes, it queries Gracenote for the tags on the tracks, but it tells me it is doing so.

This New York Times filmmaker portrait has an unfortunate headline. They do not mean that his debut film is ‘bombing’ or ‘tanking’, merely that it is about ‘virus bombs.’ Intentional or unintended ambiguity??

While panic-stricken coverage focuses on the dire pandemic awaiting us, there are suggestions that avian flu may not be as deadly as currently thought and that many mild cases may be going undetected. (New York Times )

More: Bird flu might be less deadly than feared: “Many mild or symptom-free H5N1 infections may have gone undetected in humans, meaning the real fatality rate is lower, a Vietnamese study suggests.” (New Scientist)

Dramatic contentions by the New York Times that the healthcare establishment has little incentive to control diabetes because treating the devastating consequences is so much more lucrative. “It’s almost as though the system encourages people to get sick and then people get paid to treat them,” one observer is quoted as saying starkly. However, I don’t think this is as nefarious as the sensationalistic spin suggests. It has been a perennial struggle to get the industry to fund wellness and preventive care, and there are complicated reasons why it does not happen, but they do not include powerful interests explicitly making sure that people do not get better because it is more profitable to treat them when they are sicker. Healthcare, of course, has long been dominated and defined by physicians who specialize in treating illness rather than maintaining health. Modern medicine has scored monumental success with intensive interventions in acute problems and in general flounders in approaching the more chronic insidious degenerative and lifestyle-related health problems that become more and more prominent on the healthcare landscape in the industrialized world. And the focus on the quick fix rather than the subtle holistic process is something endemic to the Western mindset. So I’m afraid the type of problem highlighted by this Times exposé will not be fixed by sensationalistic investigative reporting, legislative reforms or judicial proceedings as much as consciousness-raising and philosophical debate.

The New York Times posts intricate speculation that the writer who so starkly portrays prostitution, drug addiction and homelessness is a concoction both in public persona and authorship. But can it ever be said that an author is exactly who we think they are from reading them (and would we want that?).

Related:

Mysterious lightning characterized three powerful hurricanes this season. I was actually surprised to learn that lightning is unusual in hurricanes, although the reason makes sense once you understand what makes lightning in the first place:

A NASA flyover of Hurricane Emily measured electric fields comparable to those seen over massive land-based thunderstorms. While flyovers were not done of Rita and Katrina, electric discharges were detected by remote land-based sensors. The investigators dismiss the tempting concept that the sheer violence of these three category 4 and 5 storms was responsible for the generation of the electrostatic fields, since the phenomenon has not been observed in other equally violent storms. They conclude that they have alot to learn… (NASA)

Somehow, I think this would be less satisfying and productive than recommendations already available, culled from a much larger database by a far more sophisticated and subtle analytical process! For instance, communities like Audioscrobbler, to which my listening history is automatically uploaded by a plug-in in my mp3 client, will show me music I haven’t yet heard that listeners with similar taste listen to. (I love it that by dragging a slider I can control how obscure or popular the recommendations will be, too.)

Several of the artists on the recommendation list I know to be on the mark, in that I have heard of them and gotten the sense they are up my musical alley, although I have not yet had a chance to listen to them. Several others are names I had yet to discover, precisely the purpose of the recommendation system. I am open to your assessments of them (am I going to like Neutral Milk Hotel? Built to Spill? Destroyer, which sounds like the name a heavy metal band would choose for themselves?) or any other recommendations you might have, based on your appraisal of whom I listen to, by the way…

The only problem I find with Audioscrobbler is that I download alot of music from mp3blogs to try it out, which thus will appear to Audioscrobbler as part of my listening habits although not necessarily stuff that I end up liking. To counteract that, I sometimes keep iTunes playing my playlist of highest-rated favorites even when I am away from the computer to exert a corrective influence on my Audioscrobbler statistics. Weird, huh?

One of the vexing issues in understanding and treating depression is that, although antidepressant medications change the levels of neurotransmitters implicated in depression almost immediately, they do not have clinical effects for several weeks or even several months. Somehow, a change in serotonin levels, say, has to be accompanied by a change in the way the brain responds to the increased serotonin. Now a group led by Paul Greengard at Rockefeller University has found a protein that seems to regulate neurons’ response to serotonin.

In a mouse model for depression which has proven reliable in the past at probing various neurochemical aspects of human depression (the “learned helplessness model”), the protein p11 upregulates the numbers of serotonin-1B cell surface receptors so the cells are more sensitive to available serotonin. The evidence for its pivotal role includes demonstrating that p11 increased in mice in parallel to their response to varied treatments for depression; that mice bred to be genetically p11-deficient are more depressed, have less serotonin activity, and show less response to antidepressant medication; and that mice bred to have high levels of p11 show extra levels of serotonin receptors and do not exhibit depression-like behavior.

The mileage in improving understanding and possibly treatment of psychiatric disorders is all going to come from turning the focus from the neurotransmitter-and-receptor based understanding we have had for the past half-century to an understanding of the involved intracellular processes. I am not sure p11 is ‘the’ answer, since the more we look the more reductionistic we find any given model to be.

However, as I said above, p11 seems to help answer the vexing issue of finding a neurochemical process that mirrors the time course of clinical response to depression treatment. The next generation of psychopharmacology might involve therapeutic drugs that manipulate p11 directly — rather than indirectly through alterations in neurotransmitter levels — to treat depression more efficiently. If a genetic deficiency in p11 turns out to be one of the vectors for hereditary vulnerability to depression, gene therapy to augment the brain’s supplies of p11 could be a preventive measure. I would also of course want to know what else, if anything, p11 does in brain cells, to understand what we could be meddling with in tryng to manipulate it directly.

It is also worth noting that Greengard, whose work I have followed since I knew his son in medical school, shared the Nobel Prize in medicine in 2000 for work which presaged this finding. It seems pretty unusual to award a Nobel Prize so contemporaneously that the Nobelist still has the potential for monumental scientific discovery ahead of him/her.

My question is, how will this turn into action to stop the Alito accession to the Court? This is alot of blowing smoke unless it translates into Democratic resolve. I don’t see Republican fractionation over issues such as ethics and corruption, domestic spying, or the continued viability of the occupation of Iraq translating into support for opposition to the Alito nomination, and nobody’s backs seem up against the wall in the face of decorous Democratic hints that they might filibuster.

But… if he existed:

It is not a new phenomenon — viz. ‘spin’ — but the fact that we want to encapsulate the concept in a word gives it the prominence that it deserves after six years of a dysadministration living in its own distorted reality and trying so hard to foist it off on the rest of the world.

From Steve Silberman, my favorite Wired writer, this piece about the reinvention of the science of lie detection through the use of functional MRI (fMRI) shows us on the crux point of transformation in hte security industry, the judicial system and our notions of privacy. The science is far ahead of the polygraph and proponents suggest so should its acceptability in the courtroom, given the fact that findings are based on peer-reviewed research and precedents such as DNA testing. The central scientific premise is that lying takes mental effort, because a person knows the truth and has to suppress it to deliberately dissemble, and that that is detectable on fMRI, which is a graphic way of watching regional cerebral metabolism (in technicolor); readers of FmH know I have long been enamored of fMRI-based insights into the localization of brain functions. The central legal battle shaping up with constitutional and privacy-rights advocates is that the technique is construed as threatening to “replace the jury as the lie detector”. Well worth reading; stay tuned, since I hope to be tracking the controversy here as it continues to unfold.

Related:

Add to that the proportion of roadside bombing/IED deaths attributable to inadequate armoring on U.S. military vehicles and perhaps half of the 2200-plus families of American GIs lost in Iraq ought to realize that the murderers of their sons and daughters are Americans.

Then there are the other half of the grieving families who should consider that, in another sense, all the deaths in Iraq have been needless deaths (even if you believe in the necessity for ‘just war’ at all), based as this war has been on craven deception, cowardice and criminal intent on the part of the Bush cabal.

And we should keep in mind as well that the tens or hundreds of thousands of Iraqi civilian victims don’t have any armour.

Will Sharon’s Opponents Pray for His Welfare? — Rabbi Shmuley Boteach (Beliefnet)

(uComics via acm)

Related?

I don’t tend to like David Letterman, whom I find by turns too smug and too silly. It is very hard to watch him in the face of a very visceral distaste I feel. Yet I am warmed by the forthright stand he took toward Bill O’Reilly the other night, about which the internet is all abuzz. I have heard excerpts on talk radio. This post, from newsbusters.org (“exposing and countering liberal media bias”), emphasizes his criticism of Bush and of Cindy Sheehan’s detractors, but it appears to me that his ire was most reserved for O’Reilly in particular. O’Reilly is such a supreme egotist that I can imagine the thrill of guesting on Letterman set him up for this; he has only himself to blame:

This collection of poems, stories and essays from Ken Macleod comes out in a limited edition in Feb., 2006. Macleod is an explicitly leftist and Scottish science fiction (etc.) writer;

‘Leftist’, ‘Scottish’, and ‘science fiction writer’ are, needless to say, three things close to my soul and, if at all possible, I will try to get my hands on a copy of this book.

The 2006 Consumer Electronics Show starts now in Las Vegas. Expect reports to clog the tech web…

As I read this, after Sharon’s first, much more minor stroke last month, his doctors found that he had a small atrial septal defect (ASD), a hole between the two upper chambers of his heart. This could have disturbed the blood flow enough in his heart that it caused a clot which circulated to his brain, causing that stroke by blocking some branch of his cerebral circulation. For this reason, he was slated for a procedure to repair the ASD.

Unfortunately for Sharon, he was anticoagulated (started on a “blood thinner”) to prevent recurrent clots; this is standard practice. But this new, massive stroke today was not an occlusive stroke caused by a clot but rather a hemorrhagic one, caused by a bleed into his brain tissue. One can imagine that the outcome was likely influenced by his being on an anticoagulant.

Toward the end of his life, my father had exactly the same sequence of events — an occlusive stroke from which he recovered fully; anticoagulation; and then eventually a more significant hemorrhagic stroke. In his case, he recovered fully from the latter as well, with months of intensive post-stroke rehabilitation. My father did not need neurosurgery to evacuate the hematoma (the accumulation of blood in the head) or repair the ruptured vessel that was the source of the hemorrhage. Sharon’s bleed was far more extensive than my father’s. I doubt he is going to be making executive decisions about Israel or anything else very soon, if at all…

Of course, I am not really a doctor, I just play one on my weblog (grin; some would maintain that psychiatrists are indeed not really physicians!). I have at least one neurologist friend who reads FmH and would be more suited to the role of armchair consultant and commmentator on Sharon’s course. I could never get my father’s doctors to talk about the possible role the anticoagulation had played in the brain bleed, for obvious reasons. I am sure Sharon’s doctors will be no more forthcoming on the point. How common a scenario might this be?

Update: (thanks to Dennis) neurological news analysis runs along the same lines as my interpretation above. (New York Times )

My number cruncher reports that the busiest day of last year for FmH was 12/9/05 (stats here) with over 600 page views that day (as opposed to the more usual 300-400; I have posted before to marvel about the utter rigid regularity of that figure over FmH’s lifetime). Can any reader figure out why? Does anyone recall if someone somewhere on the net pointed to me that day or something?

It also looks to me from the chart that there was another day in early September right up there with over 600 page views, by the way. Oh well, these things happen, I guess…

If you have ripped your CD tracks into iTunes and have no further use for the disks, consider trading them for an iPod. I don’t known anyone who has used this service yet, but Millennium Music offers to give you an iPod (a different model depending on how many CDs) if you ship your CDs to their South Carolina location. Disks have to be in saleable condition with jewel cases and original artwork. They are essentially valuing your CDs at a little more than $2 apiece, e.g. giving you a 1 GB Shuffle worth $149 for 65 disks or a 60 GB iPod worth #399 for 175 disks. As I recall from my days of culling my collection and carting the surplus around to used CD stores, this is in the ballpark of what one used to get in that way. Big open question is how they assess the quality of your discs in crediting you.

I just happen to have an old extra desktop machine sitting around and think I might try this. I have never ventured very far from Microsoft OS’es until now but, from prior comments, I know that at least some of you reading this work under Linux. I would welcome any suggestions on which Linux/Unix to install.

As anyone who has been reading FmH for any length of time knows, one of my pet peeves is the undertreatment of depressive disorders by the modern medical establishment, which then goes on to blame the antidepressants which have either been inadequately prescribed or inadequately supervised. The critical first months of treatment for acute depression require frequent physician visits and attention beyond the time or expertise of the primary care physicians who have been convinced by the antidepressant manufacturers that the condition is trivial and trouble-free to treat like any other primary care condition.

Related: As previously noted here, The Edge‘s 2005 question “What do you believe is true even though you cannot prove it?” is now a book.

Google Maps index of “sighting reports, as they happen”.

Google Maps index of “sighting reports, as they happen”.

This is a reprise and an amplification of a New Year’s Day post from FmH in years past:

Years ago, the Boston Globe ran a January 1st article compiling folkloric beliefs about what to do, what to eat, etc. on New Year’s Day to bring good fortune for the year to come. I’ve regretted since — I usually think of it around once a year (grin) — not clipping out and saving the article. Especially since we’ve had children, I’m interested in enduring traditions that go beyond getting drunk [although some comment that this is a profound enactment of the interdigitation of chaos and order appropriate to the New Year’s celebration — FmH], watching the bowl games and making resolutions.

A web search brought me this, less elaborate than what I recall from the Globe but to the same point. It is weighted toward eating traditions, which is odd because, unlike most other major holidays, the celebration of New Year’s in 21st century America does not seem to be centered at all around thinking about what we eat (except in the sense of the traditional weight-loss resolutions!) and certainly not around a festive meal. But…

“Traditionally, it was thought that one could affect the luck they would have throughout the coming year by what they did or ate on the first day of the year. For that reason, it has become common for folks to celebrate the first few minutes of a brand new year in the company of family and friends. Parties often last into the middle of the night after the ringing in of a new year. It was once believed that the first visitor on New Year’s Day would bring either good luck or bad luck the rest of the year. It was particularly lucky if that visitor happened to be a tall dark-haired man.

“Traditional New Year foods are also thought to bring luck. Many cultures believe that anything in the shape of a ring is good luck, because it symbolizes “coming full circle,” completing a year’s cycle. For that reason, the Dutch believe that eating donuts on New Year’s Day will bring good fortune.

“Many parts of the U.S. celebrate the new year by consuming black-eyed peas. These legumes are typically accompanied by either hog jowls or ham. Black-eyed peas and other legumes have been considered good luck in many cultures. The hog, and thus its meat, is considered lucky because it symbolizes prosperity. Cabbage is another ‘good luck’ vegetable that is consumed on New Year’s Day by many. Cabbage leaves are also considered a sign of prosperity, being representative of paper currency. In some regions, rice is a lucky food that is eaten on New Year’s Day.”

The further north one travels in the British Isles, the more the year-end festivities focus on New Year’s. The Scottish observance of Hogmanay has many elements of warming heart and hearth, welcoming strangers and making a good beginning:

“Three cornered biscuits called hogmanays are eaten. Other special foods are: wine, ginger cordial, cheese, bread, shortbread, oatcake, carol or carl cake, currant loaf, and a pastry called scones. After sunset people collect juniper and water to purify the home. Divining rituals are done according to the directions of the winds, which are assigned their own colors. First Footing:The first person who comes to the door on midnight New Year’s Eve should be a dark-haired or dark-complected man with gifts for luck. Seeing a cat, dog, woman, red-head or beggar is unlucky. The person brings a gift (handsel) of coal or whiskey to ensure prosperity in the New Year. Mummer’s Plays are also performed. The actors called the White Boys of Yule are all dressed in white, except for one dressed as the devil in black. It is bad luck to engage in marriage proposals, break glass, spin flax, sweep or carry out rubbish on New Year’s Eve.”

Here’s why we clink our glasses when we drink our New Year’s toasts, no matter where we are. Of course, sometimes the midnight cacophony is louder than just clinking glassware, to create a ‘devil-chasing din’.

In Georgia, eat black eyed peas and turnip greens on New Year’s Day for luck and prosperity in the year to come, supposedly because they symbolize coppers and currency. Hoppin’ John, a concoction of peas, onion, bacon and rice, is also a southern New Year’s tradition, as is wearing yellow to find true love (in Peru, yellow underwear, apparently!) or carrying silver for prosperity. In some instances, a dollar bill is thrown in with the other ingredients of the New Year’s meal to bring prosperity. In Greece, there is a traditional New Year’s Day sweetbread with a silver coin baked into it. All guests get a slice of the bread and whoever receives the slice with the coin is destined for good fortune for the year. At Italian tables, lentils, oranges and olives are served. The lentils, looking like coins, will bring prosperity; the oranges are for love; and the olives, symbolic of the wealth of the land, represent good fortune for the year to come.

A New Year’s meal in Norway also includes dried cod, “lutefisk.” The Pennsylvania Dutch make sure to include sauerkraut in their holiday meal, also for prosperity.

In Spain, you would cram twelve grapes in your mouth at midnight, one each time the clock chimed, for good luck for the twelve months to come. The U. S. version of this custom, for some reason, involves standing on a chair as you pop the grapes. In Denmark, jumping off a chair at the stroke of midnight signifies leaping into the New Year. In Rio, you would be plunging into the sea en masse at midnight, wearing white and bearing offerings.

In China, papercuttings of red paper are hung in the windows to scare away evil spirits who might enter the house and bring misfortune. In Thailand, one pours fragrant water over the hands of elders on New Year’s Day to show them respect.

Elsewhere: pancakes for the New Year’s breakfast in France; banging on friends’ doors in Denmark to “smash in” the New Year; going in the front door and out the back door at midnight in Ireland; making sure the first person through your door in the New Year in Scotland is a tall dark haired visitor. Water out the window at midnight in Puerto Rico rids the home of evil spirits. Cleanse your soul in Japan at the New Year by listening to a gong tolling 108 times, one for every sin. It is Swiss good luck to let a drop of cream fall on the floor on New Year’s Day.

Some history; documentation of observance of the new year dates back at least 4000 years to the Babylonians, who also made the first new year’s resolutions (reportedly voews to return borrowed farm equipment were very popular), although their holiday was observed at the vernal equinox. The Babylonian festivities lasted eleven days, each day with its own particular mode of celebration. The traditional Persian Norouz festival of spring continues to be considered the advent of the new year among Persians, Kurds and other peoples throughout Central Asia, and dates back at least 3000 years, deeply rooted in Zooastrian traditions.Modern Bahá’í’s celebrate Norouz (“Naw Ruz”) as the end of a Nineteen Day Fast. Rosh Hashanah (“head of the year”), the Jewish New Year, the first day of the lunar month of Tishri, falls between September and early October. Muslim New Year is the first day of Muharram, and Chinese New Year falls between Jan. 10th and Feb. 19th of the Gregorian calendar.

The classical Roman New Year’s celebration was also in the spring although the calendar went out of synchrony with the sun. January 1st became the first day of the year by proclamation of the Roman Senate in 153 BC, reinforced even more strongly when Julius Caesar established what came to be known as the Julian calendar in 46 BC. The early Christian Church condemned new year’s festivities as pagan but created parallel festivities concurrently. New Year’s Day is still observed as the Feast of Christ’s Circumcision in some denominations. Church opposition to a new year’s observance reasserted itself during the Middle Ages, and Western nations have only celebrated January 1 as a holidy for about the last 400 years. The custom of New Year’s gift exchange among Druidic pagans in 7th century Flanders was deplored by Saint Eligius, who warned them, “[Do not] make vetulas, [little figures of the Old Woman], little deer or iotticos or set tables [for the house-elf] at night or exchange New Year gifts or supply superfluous drinks [another Yule custom].” (Wikipedia)

The tradition of the New Year’s Baby signifying the new year began with the Greek tradition of parading a baby in a basket during the Dionysian rites celebrating the annual rebirth of that god as a symbol of fertility. The baby was also a symbol of rebirth among early Egyptians. Again, the Church was forced to modify its denunciation of the practice as pagan because of the popularity of the rebirth symbolism, finally allowing its members to cellebrate the new year with a baby although assimilating it to a celebration of the birth of the baby Jesus. The addition of Father Time (the “Old Year”) wearing a sash across his chest withthe previous year on it, and the banner carried or worn by the New Year’s Baby, immigrated from Germany. Interestingly, January 1st is not a legal holiday in Israel, officially because of its historic origins as a Christian feast day.

Auld Lang Syne (literally ‘old long ago’ in the Scottish dialect) is sung or played at the stroke of midnight throughout the English-speaking world (although I prefer George Harrison’s “Ring Out the Old”). Versions of the song have been part of the New Year’s festivities since the 17th century but Robert Burns was inspired to compose a modern rendition, which was published after his death in 1796.

Should auld acquaintance be forgot
and never brought to mind?
Should auld acquaintance be forgot
and days of auld lang syne?
For auld lang syne, my dear,
for auld lang syne,
we’ll take a cup of kindness yet,
for auld lang syne.

Should auld acquaintance be forgot
and never brought to mind?
Should auld acquaintance be forgot
and days of auld lang syne?
And here’s a hand, my trusty friend
And gie’s a hand o’ thine
We’ll tak’ a cup o’ kindness yet
For auld lang syne

However you’re going to celebrate, my warmest wishes for the year to come… and eat hearty! [thanks to Bruce Umbaugh for research assistance]

These documents need publishing: “The UK government has been quick to deny that we practice, or tolerate the practice of torture. So it is perhaps not suprising that they are determined that you should not see the following documents…” (Blairwatch)

Christmas fun with 250 lbs. of Silly Putty in-house at Google.

I have already long since blinked to this collection of essays from modern thinkers convened by John Brockman at The Edge website. It serves as an antidote to blind dogma in that the essays thoughtfully dissect the ways in which belief is different than certainty and the implications of sustaining it under conditions of uncertainty. Thank you, John Brockman, for that. Now it is a book.

Ever wondered if you are tone-deaf? The Distorted Tunes Test can help you ascertain, by seeing if you can distinguish tunes that are played off-key from those rendered correctly. (National Institute on Deafness and Other Communication Disorders)

Unravelling the Myths of the Suicide Bomber, according to inveterate skeptic Michael Shermer:

This is construed as an empirical test of the controversial and, in its strongest form, discredited Whorf hypothesis, which suggests that the structure and lexicon of a peroson’s native language shapes the perception and understanding of the world. It is more reasonable that linguistic underpinnings make certain concepts or percepts more or less easily grasped. And divergent worldviews and models occur far more readily from influences other than linguistic differences, between people reared with nominally the same native tongue.

It strikes me that this research has some bearing on the ‘fringy’ psychological technic called neurolinguistic programming (Wikipedia ) proposed in the ’70’s by Richard Bandler and John Grinder, which attempts to match communication to the perceptual style, cerebral dominance characteristics, etc. of listeners for maximum receptivity. Although it was heavily colored by New Age pap about ‘unlimited potential’ and the like and billed as a set of strategies for ‘therapeutic magic’. Eventually deprecated as a serious psychotherapeutic tool, it has continued to intrigue (and draw customers) in fields like business management, sales, coaching and seduction (!). NLP claims have been roundly criticized for being unsupported by empirical evidence, yet apart from the pop-science trappings and the reductionist popularization, I have always suspected that Bandler and Grinder had touched on more than a grain of truth.

Funny, what the Wikipedia article does not touch upon is the debt that NLP owed to ‘Ericksonian hypnosis,’ a far more psychologically credible but obscure set of therapeutic techniques developed by psychologist Milton Erickson (1901-80). He operationalized the belief, which I share, that the psychotherapy session is a sort of entry into a joint trance state. Usually, the therapist is not aware of that aspect of the psychotherapy encounter, but Erickson said it could be recognized and explicitly, although subliminally, used in therapeutically powerful ways.