Mark Morford writes… (San Francisco Chronicle)

For those who can still celebrate small miracles — the ivory-billed woodpecker, thought extinct for sixty years, has been spotted in a secluded patch of Arkansas wetlands. And don’t try to tell me it doesn’t matter in the scheme of things…

Also:

Only one of my readers, I suspect, will have any idea how I came to this. But enjoy it. A translation is here. [thanks, molly]

Ed Fitzgerald is correct, in responding below to my post on obstructionism and a principled opposition, that we should take a look at what Senate minority leader Reid is really proposing to do if the Republicans act on their threat to end judicial filibustering. It is essentially an end to the traditional deference that the minority party has shown to the majority on the floor of the Senate. Bowers explains it in this way:

In a followup post, he gives a taste of the nature of the bills the Democrats would bring forward. I share the response of several commenters on Bowers’ weblog that this is what the Democrats should be doing regardless of whether the Republicans ‘go nuclear’. If this is what is meant by ‘obstructionism’, then full speed ahead and damn the torpedoes.

Unfortunately, some of the old boys on the Democratic side of the aisle don’t have the stomach for a real fight. The ever-deferential Joe Biden (recal how deferential he was to Clarence Thomas at his confirmation hearing?), for example, proposes a compromise in which the Democrats would forestall the GOP anti-filibuster maneuver by letting some most of the contested judges be confirmed.

Biden aside, are we looking at the coalescence of the ‘principled’ part of the opposition recipé for which I was calling? One crucial question, if this moves along, is whether the Democrats can make it work for public opinion in 2006 and 2008. Webloggers like Fitzgerald and Josh Marshall argue that the Democrats will not be vilified for this sort of obstructionism, that it in important regards does not amount to a government shutdown in the eyes of the public (social security checks will keep coming, the national parks and government offices will remain open, etc.) are underestimating the GOP mastery of newspeak and spin and thier seeming lock on the American hearts and minds. Why, just look below at their largely successful effort (with the co-optation of the mainstream press), when it turned out that the ‘nuclear option’ phraseology they had coined wasn’t selling well to the public, to blame the Democrats for the term.

But, while I certainly think proposing progressive legislation in areas of social and economic policy is certainly what the Democrats should be doing, this is only a part of the picture. Yeah, yeah, yeah, these bills will help the working poor, etc., but as much as anything, they are a political maneuver to back the GOP into a corner by forcing Senators to vote against popular legislation. While rhetorical points may be won by these machinations, I still think that a principled opposition has to find a way to stop the lasting damage the Bush zealots are doing in the meanwhile. Taking the fight to the wire on American unilateral warmongering, on selling out clean air and water to corporate interests, handing a victory in the culture wars to the American Taliban and undoing seventy years’ commitment to the social welfare of the less fortunate has to start now. Otherwise, as I said (and as FmH readers who think I am wasting my time on partisan politics remind me), facilitating the Democratic victory in 2006 and 2008 will just be buying us business as usual.

Some people, among them unfutz’s ed fitzgerald, are encouraging the sort of stalwart opposition we seem to be seeing from the Democrats, particularly in the Senate. I’m just hoping it doesn’t come back to bite us. A principled opposition party, such as many of us yearn to see the Democrats become, has to be just that, principled. I worry that the Democrats could lost the ‘purple’ counties by appearing to be merely partisan. ‘Just say no’ makes the opposition seem more, rather than less, like Republican-lite, for those whose political memory goes back far enough that they recall how Clinton was treated. And there is no doubt that, with a Machiavellian genius like Rove at the helm, the Republicans will milk every bit of mileage they can out of a track record that looks like pure obstructionism. The Senate Ethics Committee, for example, is dangerously close to that already, with the Democrats refusing to convene to do the committee’s work because of the rule change that threatened to prevent the investigation of Tom Delay’s latest indiscretions. If the government is morally bankrupt, make that a central plank of a boldly stated platform rather than just refusing to come to work.

If the Democrats don’t base their desperate obstructionism on a platform, then they will be repeating one of the major mistakes they have made in the last two unsuccessful bids for the White House. More use should be made of the more principled spokespeople in the Senate like Obama and Boxer, who can articulate firmly what lines are being drawn in the sand and why. Battles should be picked, and I think the main criterion ought to be to distinguish trivial concerns that will do circumscribed damage and be reversed as soon as the Democrats take power again from those (unfortunately too numerous) policies that lead to irreversible damage to the US and the world. For example, while I think the Bolton nomination is about to go down in flames of its own accord, having him represent the US in the UN is not going to lead to the dismantling of the UN in the three years maximum he would be there, and his asininity is certainly not going to adversely affect the US standing in the international community, which is under no illusions that could be assuaged by any amount of diplomacy about the outrageousness of our foreign policy. It might be good to have Bolton there; have an asshole represent the assholes.

I think the three looming issues around which the opposition should muster are, on the domestic side, the threat to the integrity of the courts; on the international side, our saber-rattling provocations of Iran; and, environmentally, the self-serving Republican stance on global warming. I know readers probably have their own lists; my point is that battles should be picked on principle rather than willy-nilly for the sake of the fight.

And, in his next post, fitzgerald argues that there is no possibility of bipartisanship or the normal business of politics now, because the current political process has nothing to do with policy-making any more. That, and the perception (which I share) that the Republicans are trying to reverse a half-century of social progress and roll the country back to a pre-New-Deal state, is the basis for his paean to obstruction, obstruction, obstruction. But I am not arguing for working with the Republicans, I am talking about working with the voters. Asking that we choose our battles is not about being strategic about which ones can be won on the floors of the House and Senate but which ones can be won in the arena of public opinion. It is far more important to be far craftier in that sphere than the back-room machinations.

Some people, among them unfutz’s ed fitzgerald, are encouraging the sort of stalwart opposition we seem to be seeing from the Democrats, particularly in the Senate. I’m just hoping it doesn’t come back to bite us. A principled opposition party, such as many of us yearn to see the Democrats become, has to be just that, principled. I worry that the Democrats could lost the ‘purple’ counties by appearing to be merely partisan. ‘Just say no’ makes the opposition seem more, rather than less, like Republican-lite, for those whose political memory goes back far enough that they recall how Clinton was treated. And there is no doubt that, with a Machiavellian genius like Rove at the helm, the Republicans will milk every bit of mileage they can out of a track record that looks like pure obstructionism. The Senate Ethics Committee, for example, is dangerously close to that already, with the Democrats refusing to convene to do the committee’s work because of the rule change that threatened to prevent the investigation of Tom Delay’s latest indiscretions. If the government is morally bankrupt, make that a central plank of a boldly stated platform rather than just refusing to come to work.

If the Democrats don’t base their desperate obstructionism on a platform, then they will be repeating one of the major mistakes they have made in the last two unsuccessful bids for the White House. More use should be made of the more principled spokespeople in the Senate like Obama and Boxer, who can articulate firmly what lines are being drawn in the sand and why. Battles should be picked, and I think the main criterion ought to be to distinguish trivial concerns that will do circumscribed damage and be reversed as soon as the Democrats take power again from those (unfortunately too numerous) policies that lead to irreversible damage to the US and the world. For example, while I think the Bolton nomination is about to go down in flames of its own accord, having him represent the US in the UN is not going to lead to the dismantling of the UN in the three years maximum he would be there, and his asininity is certainly not going to adversely affect the US standing in the international community, which is under no illusions that could be assuaged by any amount of diplomacy about the outrageousness of our foreign policy. It might be good to have Bolton there; have an asshole represent the assholes.

I think the three looming issues around which the opposition should muster are, on the domestic side, the threat to the integrity of the courts; on the international side, our saber-rattling provocations of Iran; and, environmentally, the self-serving Republican stance on global warming. I know readers probably have their own lists; my point is that battles should be picked on principle rather than willy-nilly for the sake of the fight.

And, in his next post, fitzgerald argues that there is no possibility of bipartisanship or the normal business of politics now, because the current political process has nothing to do with policy-making any more. That, and the perception (which I share) that the Republicans are trying to reverse a half-century of social progress and roll the country back to a pre-New-Deal state, is the basis for his paean to obstruction, obstruction, obstruction. But I am not arguing for working with the Republicans, I am talking about working with the voters. Asking that we choose our battles is not about being strategic about which ones can be won on the floors of the House and Senate but which ones can be won in the arena of public opinion. It is far more important to be far craftier in that sphere than the back-room machinations.

This is a whitewash, plain and simple…and with a scapegoat, who doesn’t have access to the ‘Eichmann defense’ that she was only following orders, because her superiors did not have to give orders. The exoneration of Sanchez and others (and, by implication, the real culprits up to and including Rumsfeld and Bush) is on the wrong grounds — while they may not be guilty of failing to prevent or stop abuses (if you even believe that), they created a permissive culture in which specious goals of fighting ‘terrrrrrrism’ justify any barbaric means.

“And not only that, but he [Justice Kennedy] said in session that he
does his own research on the Internet? That is just incredibly
outrageous.”

— House Majority Leader Tom DeLay

Not since Strom Thurmond’s and Jesse Helms’ departures has the retirement of a reactionary Republican given me such a frisson.

I have conflicting thoughts about this news. First, I welcome the continuing trend toward recognizing that the emperor has no clothes in mental health care. I found it big news when research strongly supported the counterintuitive conclusion the critical incident debriefing and other emergency intervention techniques after traumas may not prevent survivors from developing post-traumatic stress. In fact, they may increase the risk. Similarly, we now learn that couples therapy may not save troubled relationships.

But is that evidence it is ineffective? In a great many cases, talking about a couple’s problems frankly may hasten the end of a doomed relationship, which is in my opinion as legitimate a purpose of couples therapy as saving a relationship at all costs. After all, the therapist is not making the decision about whether the marriage lives or dies; s/he is just facilitating the couple getting to what they really want.

[What I want to know is where in the world the 15% Dixie crept in from? — FmH]

We in psychiatry use alot of anticonvulsant drugs for modulation of mood and impulses. I can see it now; they are going to make the same methodological mistakes they have made in concluding that antidepressants exacerbate suicide risk, about which I have written here in detail.

After I used the acronym in one of my posts earlier today, a reader wrote to say he is new to the world of ‘blogging’ and wondered what it stood for. (It means “in my humble opinion,” for those of you who didn’t know.) I think I use that abbreviation fairly often here; it’s become habitual for me as an ironic comment on my tendency to sound over-authoritative when I shoot my mouth off. When I typed it today, I had a premonition that it would only be a matter of time before someone relatively new to the net would ask for a translation. This post is for you.

It’s not just a ‘blogging’ term. It is one of a number of time-honored abbreviations from the early days of bulletin boards (BBS’s), chatrooms, usenet groups and email. These days, these acronyms are experiencing a resurgence with text messaging. Other common ones include “BTW”, “YMMV”, “RSN”, “PITA”, “LOL”, “ROFL” “TTFN”, “AFAIK” “WYSIWYG” ,”OTOH”, “RTFM”, and I’m sure you know “FUBAR”, right? Some are pretty obvious, others less so, Here are a couple of compendium lists where you can go to catch up on your chatroom abbreviations:

http://searchsmb.techtarget.com/sDefinition/0,,sid44_gci211776,00.html

And:

http://groups.msn.com/JerseyBeans/acronymsorwhatdoeslolmean.msnw

TTFN
(IITYWTMWYBMAD?)

So say the headlines. As I predicted when I wrote about John Paul’s death, I expected more of the same. But Cardinal Ratzinger has been the papal confidante, theoretician and policy maker all these years; in other words, he wrote the playbook. So wasn’t it really more that John Paul followed his lead? The only question is whether this is more like Dick Cheney or Karl Rove succeeding Bush. The headlines also say that “Latin Americans react with joy and a tinge of disappointment.” More likely disappointment with a tinge of joy, IMHO, at Ratzinger’s ascension rather than any of the Latin American contenders. They do embody half the world’s Catholic numbers, after all.

One of the things I will watch with fascination during Ratzinger’s papacy — the predictions are that he will make it a priority during his papacy to address the so-called ‘silent apostasy’ of European Catholics, whose overall numbers, church attendance and observance are rapidly decaying. How will a Eurocentric Church deal with the fact that European worshippers are AWOL, if not MIA, and the only souls for capture are second-class, third-world ones, the indigenous attempts of whose own Church leaders to meld the social with the spiritual needs of their flocks with more sensitivity and appropriateness are either slighted or actively opposed from Rome?

It is going on ten years since the death of Jerry Garcia and going on forty years since the inception of the Grateful Dead. The New York Times takes the occasion of the release of Phil Lesh’s memoir, Searching for the Sound, for a very improbable reflection on the band’s legacy, clearly not written by someone who has revelled in their music. Seth Mnookin’s essay draws what might be a specious parallel between two aspects of the Dead he reads in Lesh’s book. First, while he admits that the initial two-thirds of the book are an exultant rendition of the Dead’s early years, when its soaring improvisational reach and mind-melding connection with its listeners was forged in an acid bath, Mnookin is quite taken with Lesh’s confessional about ‘the destructive effects of addiction’ in the band’s later years, particularly Garcia’s heroin addiction and Lesh’s own alcoholism. ‘During the late 1970’s and early 1980’s, his alcoholism, Garcia’s budding heroin addiction, and mountains of freely available cocaine turned a once-cohesive unit into a group whose main form of communicating became playing music with, and sometimes at, one another onstage.’ Some kind of moralist, it seems, Mnookin is all to ready to attribute the stultification of the band’s exuberant group mind to the drug use. (If he is going to do that, at least abit of exposition about the contrast he sees between the hallucinogen high and the downs of alcohol and heroin, and some speculation about why the change from one to the other occurred, is in order.)

According to Mnookin’s reading of the book, Lesh’s second central idea in reshaping the Dead legacy seems to be to conceive of their music as repertory, “like a Shakespeare play or a Beethoven quartet.” Never mind how hubristic that sounds. What strikes me is how central a betrayal of the central tenets of the Dead experience it is. There was never anything very important about their songs; most Deadheads lived for the stretches of their music, chiefly in the second sets of their concerts, that came when they voyaged far away from the songs that served as launch points, deep into the space between, untethered and (no matter where they started from and ended up) never the same twice. The stultification of the Dead’s music set in precisely when they started seeing their body of work as repertory to be recreated from concert to concert, IMHO because they — particularly Garcia — became too clumsy and addled to do much else. Identifying the precise point is debatable but it was certainly apparent by the mid- or late-80’s; I myself was bored by what the Dead were doing were no longer doing by the late ’70’s or early ’80’s.

Lesh seems to be saying that, if the Dead could no longer do it (because of the destructive effects of their drug use), at least the music lives on for itself. But even if Lesh ultimately felt betrayed by — and perhaps never gave up wanting to recreate — what became of the unique interplay of personalities that had made music together for years, the recent attempts to recreate the Dead’s magic with different personnel seem even more pitiful than the Dead’s trying to recreate their own early magic in their later years. I have attempted to listen to the post-Garcia ‘Other Ones’ and ‘The Dead’, and all I can do is cringe. The Dead today are an aging Grateful Dead cover band. The music, too, was gone, Phil, when the Dead’s magic went down the tubes. All the best, most transcendent things in life (and I classify the music of the Grateful Dead at their peak in that category) are transitory, and attempts to hang on to them after they pass little more than pitiful. It’s like Terry Schiavo — why not finally withdraw life support and end the persistent vegetative state?

You can read some more about my longterm relationship with the Dead here.

A School of Visual Arts Grad Remakes the Pill Bottle: “By the time an object, or an apartment, or a company hits the half-century mark, it’s usually been through a redesign or two. Yet the standard-issue amber-cast pharmacy pill bottle has remained virtually unchanged since it was pressed into service after the second World War. (A child-safety cap was added in the seventies.) An overhaul is finally coming, courtesy of Deborah Adler, a 29-year-old graphic designer whose ClearRx prescription-packaging system debuts at Target pharmacies May 1.

Adler grew up in a family of doctors in Chappaqua, New York, but escaped medicine for an M.F.A. at the School of Visual Arts. She was inspired to return, at least tangentially, after her grandmother Helen accidentally swallowed pills meant for her husband, Herman. The drugstore prescription bottle, it occurred to Adler, is not just unattractive, it’s actually dangerous. Statistics back her up: According to a recent poll conducted for Target, 60 percent of prescription-drug users have taken medication incorrectly.” (New York [via Amy’s Robot])

I like the flattened shape so it doesn’t roll and so that the entire label can be seen at once. It is quite smart to include a color-coded ring so one knows at a glance which family member’s medication it is. Adler has also considered including a magnifying strip, and a label that develops a big red ‘X’ across it when the medication expires.But the best innovation is, IMHO, the simplest, which is to print the name of the medication in the blodest, largest, most legible typeface. I have never been able to understand why even I, whose eyesight is unimpaired when I wear my reading glasses [g], has a challenge searching a conventional prescription label to find the name of the drug, and why the format from different pharmacy chains is different.

Did dreaming evolve because rehearsal confers an evolutionary advantage? (Human Nature Review)

“The search for extraterrestrial intelligence (SETI) could be taking the wrong approach. Instead of listening for alien radio broadcasts, a better strategy may be to look for giant structures placed in orbit around nearby stars by alien civilisations.

‘Artificial structures may be the best way for an advanced extraterrestrial civilisation to signal its presence to an emerging technology like ours,’ says Luc Arnold of the Observatory of Haute-Provence in France. And he believes that the generation of space-based telescopes now being designed will be able to spot them.” (New Scientist)

Arnold does not make a compelling case, to my way of thinking, about why a civilization would go to the trouble (oops! it might be no trouble for them…) of doing this rather than merely broadcasting their presence. His argument seems to arise from nothing so much as that our telescopes have recently gotten powerful enough to spot a planet-sized object transiting a star.

Book Review: Curious Minds: How a Child Becomes a Scientist. Edited by John Brockman. xii 236 pp. Pantheon Books, 2004. $23.95.

Psychiatrist Peter Kramer is very tired of one objection raised to his notorious 1993 book, Listening to Prozac. Kramer had raised concerns that Prozac and the other SSRIs would usher in an era of ‘cosmetic psychopharmacology’, modifying personality traits in people who had never experienced a frank mood disorder. The book considered the ethical and policy implications and wondered how physicians should prescribe such drugs. (I have always agreed with Kramer’s concerns and both of have practiced long enough to see his worst fears come to pass, IMHO.) Kramer reflects on the question one variant of which was almost invariably asked when he gave talks on the themes of Listening to Prozac. “What if Prozac had been available in van Gogh’s time?” Especially in light of the compelling evidence of the last decade that depression is a progressive disorder and a neurodegenerative one which destroys nerve pathways as well as damaging the cardiovascular and endocrine systems, Kramer is compelled to remind us that the tortured artist’s genius must be envisioned to be despite rather than because of his/her mental illness. “Beset by great evil, a person can be wise, observant and disillusioned and yet not depressed. Resilience confers its own measure of insight. We should have no trouble admiring what we do admire — depth, complexity, aesthetic brilliance — and standing foursquare against depression.” (New York Times Magazine)

Who needs broadband when you have got the new American Taliban theocracy?

‘At this point,’ he says, ‘I’m a mass murderer.’ (Baltimore Sun)

If you ever need to write files to PDF format, you don’t need to pay for the exorbitant Adobe Acrobat.

Levitt has a weblog too.

“Researchers Find That Chocolate Compound Stops Cancer Cell Cycle in Lab Experiments”

I am not exactly sure why this should surprise us.

The researchers’ assumption has been that the personality attributes are early manifestations of the brain changes (essentially, loss of dopaminergic neurons in deep brain areas) in the Parkinson’s disease process. But it also seems possible to me that decades of anxious pessimism can help bring about that neuronal loss and ssentially cause Parkinson’s Disease. The more we look in psychiatry and neuroscience, the more we find that there is a reciprocal, not just a one-way, relationship between brain changes and behavior changes. So… don’t worry. Literally, don’t.

I have written before here about the sousveillance movement, literally ‘watching from below’, the opposite of surveillance. Actually, the more interesting discussion in this article is on implementations of Michel Foucault’s notion that surveillance is not as much an action as a concept, that behavior is altered not by being watched but by the idea that one may be being watched. Many of the smoked plastic domes in stores that savvy consumers assume contain surveillance cameras may be empty. And of course many of the monitors displaying what the cameras scrutinize are unmanned.

Along these lines, I wish more earthlings realized that everything we do is being scrutinized by the aliens. On the other hand, one version of that concept, the fundamentalists’ version, that God is watching each of you all the time and knows everything you do, say or think, seems significantly accepted, and a heck of a lot of good that has done.

“Montage-a-google is a simple web-based app that uses Google’s image search to generate a large gridded montage of images based on keywords (search terms) entered by the user. Not only an interesting way of browsing the net, it can also be used to create desktop pictures or even posters (see examples below – more coming soon).”

Remember the recent Postcards from Buster flap? Now, in what certainly appears to be a continuing trend toward Republican appeasement, the Corporation for Public Broadcasting has removed president and CEO Kathleen Cox after nine months in office. Her interim replacement is the former FCC chief operating officer “whose primary legacy is his longtime lobbying to relax the rules regulating corporate media expansion.” (Salon)

Unlike a Google search on the phrase “follow me here”, my PubSub feed, which delivers to me weblog references to “Gelwan” or “Follow Me Here”, has very little referring to my writing these days. It is mostly full of links to folks who are saying “now follow me here…” as they spin out some tortuous logic or questionable argument. Should I have copyrighted the phrase?

While we are on the topic of the writer’s perennial preoccupation with how much atttention s/he is attracting, there are many many more comments being entered on my posts here these days. I am not sure why that is, but I am loving it. Keep it up! (It seems it is a function of the efforts of just a few faithful and loquacious readers. What about the rest of you?)

California Moves to Ban Alcohol Inhalation Devices. This probably belongs in the ‘What-Will-They-Think-Of-Next’ Dept., or is it the ‘Hell-in-a-Handbasket’ Dept. (to which I seem to be increasingly resorting recently)? (CNS News)

This Virginia anaesthesiologist/weblogger writes:

Guilty. The Rabid Right may have lost the court battles on Terry Schiavo, but they have just begun to fight against judges whose decisions offend their sensibilities. And don’t underestimate what they can do. (Washington Post)

Columbia University political scientist Kenneth Waltz thinks nuclear proliferation can make us safer. Nonproliferation made sense in a world dominated by the balance of terror between two superpowers, but now in a unipolar world, a nuclear deterrent in the hands of smaller nations can disrupt the destabilizing ambitions of a reckless arrogant superpower. (Boston Globe)

Is this a new version of the slaveowners’ argument that their slaves should be grateful for how well they treated them, rather than simply agitating for their freedom?

Why is being ill now embraced as a positive part of the human experience? Frank Furedi:

Furedi, an English sociologist, discusses medicalization, the ‘normalization of illness’ (we are all seen now as being potentially ill), the growing use of the language of illness and health to make sense of increasingly ambiguous human experience, and the politicization of health (politicians’ growing preoccupation with healthcare and the healthcare crisis, which I think stems largely from the growing political power of the pharmaceutical industry and its stranglehold over healthcare). His summary theme is the interesting, and telling, point (with which I agree) that the normalization of illness is a cultural fact. Proeccupation with health, and the fact that more and more of us are thinking of ourselves as sick, sicker, and sicker for longer, is the real source of the healthcare crisis, and it is not going to be solved in the public policy sphere.

“Since anyone can write a Weblog, why is the blogosphere dominated by white males?” (MSNBC/Newsweek) Steven Levy puts this concern in the same frame as the issue of affirmative action in the MSM*, which is on everyone’s minds these days as law professor Susan Estrich takes Michael Kinsley to task for not running more pieces by women and people of color at the LA Times op-ed page. Levy thinks the problem of building more diversity into the weblogging world is one caused by its decentralization. But he never gets beyond grappling with what is essentially the wrong question. Concerns from minority writers that, just as they are gaining some legitimacy on the op-ed pages, their voices are being drowned out on the web pages by white men talking to largely white audiences is only legitimate to the extent that you think weblogging is a form of journalism, which it is not. Weblogging is far more like writing letters to your friends about some of the things that interest you.

*We’re all supposed to know by now that this refers to the “mainstream media”, right?

From the fantastic New Scientist Back Page – The last word: “It’s an unfortunate question I know, but why does human excrement smell so badly? I realise cows eat different foods, but their excrement is far less offensive. Why is ours so awful?”

Call me a curmudgeon but my first reaction is — what are we going to learn five, ten or fifteen years down the line about the side effects of this??

Thanks to Dan Hartung for pointing me to this proposal to change the name of Borderline Personality Disorder. Diagnostic categories in mental health work both impose a tyranny and an opportunity, even when used with elegance and precision, which, as readers of FmH know, I have long felt is rare in modern psychiatric practice. DSM-IV, the latest edition of the American Psychiatric Association’s Diagnostic and Statistical Manual, the bible of acceptable psychiatric diagnoses and their criteria, has defined a number of personality disorders on a separate ‘diagnostic axis’ than the major mental disorders. I have long taught about how to understand and treat borderline personality disorder, which is the most controversial of these axis II disorders. Even though I feel classifying someone with that label with precision serves a useful purpose in clinical communication as a shorthand for a number of characteristics a clinician might expect to find in treating them, the term is often applied freely to anyone who ‘feels like a borderline’, in other words patients when they are angry toward us, have self-destructive tendencies, are irritating and challenging to treat, or inspire dislike, anger, disdain, avoidance or hatred in their treaters. This makes the diagnosis meaningless, a sort of acting out by the clinician which defeats our best efforts at both clinical clarity and avoiding pejoratives. A masterful modern psychiatrist, George Vaillant, used to give a lecture to psychiatric trainees entitled something like “The Beginning of Wisdom: Never Call Anyone a Borderline.” Others, such as the essayist linked here, feel that because the way the term is used is often pejorative, we should change it. I think that is a fruitless proposition. Since whatever replaces the term ‘borderline’ will continue to reference a class of patients who have some attributes we find disagreeable, any sufficiently disagreeable patient will be diagnosed with that label in the same off-the-cuff manner. Whatever term it is will lose its clinical precision and assume the same disparaging connotations the current term has. Even if the language is new or different, a pejorative is a pejorative. People can readily recognize cursing or name-calling even in a foreign language they do not speak.

There is nothing special about psychiatric pejoratives either. Consider for a minute how powerful our vernacular terms for excrement are, and how rapidly they generalize as references not precisely to deposits of stool but to anything for which we have sufficient distaste or contempt.

But hold on; if the name of the condition were more precisely reflective of its description, if it were more ‘experience-near’, could that itself encourage greater accuracy and precision every time we used it? So say some proponents of a name change. They certainly have a point that, if it is worth describing this condition for purposes of clinical communication, it is worth describing it well, and ‘borderline personality disorder’ is a poor choice of name. For one thing, objections are raised to the ‘borderline’ moniker, which is a historical anachronism hearkening back to an outmoded, discredited and useless notion that these patients were on the borderline between neurosis and psychosis.

And objections also arise to calling it a personality disorder. The original notion was that the main axis, axis I, of DSM (-IV and its predecessors) listed the mental conditions that had a biological origin, in other words illnesses or diseases. In contrast, axis II contained a catalogue of different personality styles which endured over a person’s life and which, taken to an extreme and rigid extent, caused distress or dysfunction in the person’s life and thus warranted being called personality disorders. On axis I were intended to be placed disorders which were treatable with biological approaches such as medicines, whereas one approached personality problems with psychotherapy. In a sense, axis II was a concession and a shrinking pied á terre for the increasingly disenfranchised psychoanalysts, who were rapidly losing the battle for the future of psychiatry to the biological psychiatrists.

However, the placement of borderline personality disorder on this axis II has seemed increasingly problematic, as many psychiatrists have come to see its core features more as on a continuum with axis I mental illnesses in the areas of mood, impulse and thought disorders. And the enormous expenditure of psychiatric effort on trying to treat these extremely distressed and vexing patients has included alot of medication treatment. Although this is a controversial assertion, many find the borderline condition vey responsive to medication treatment. (I myself think borderlines can be judiciously medicated to their benefit, but usually they are blasted with everything in the pharmacological armamentarium at once in desperation and frustration — both the patient’s and the prescriber’s).

In a larger sense, the hard and fast distinctions between biologically- and personality-based distress in general are melting down, and many of the other personality disorders on axis II are subject to pharmacological as well as psychotherapeutic approaches with some degrees of success. So, many of us find the entire distinction between axis I and axis II (not just the issue of the placement of the borderline condition on the latter and thus whether it should be callled a personality disorder) to be specious and clinically meaningless. Furthermore, if there is a rationale for describing personality structure and style alongside mental illness, many have come to feel that a pigeonholing (categorical) approach might not be as good as a dimensional one. (Take the descriptive power of the Meyers-Briggs test, for example.)

Another reason for a Diagnostic and Statistical Manual is to facilitate research into mental health conditions. It should go without saying that if the members of a diagnostic category are heterogeneous, no meaningful research conclusions can emerge from studying them as if they had something in common. So sloppily diagnosing very different sorts of people as ‘borderlines’ (or whatever else you might want to call the condition) will result in inconclusive findings when research is done to try to figure out what is wrong with them. This inconclusiveness then feeds back into the discussion as to whether the diagnostic category is meaningful. When, all along, it is not so much a matter of what you call them as how carefully, accurately and precisely you apply the existing diagnostic criteria, no matter what the condition is called.

“Rats can’t vomit. They can’t burp either, and they don’t experience heartburn. Rats can’t vomit for several related reasons…”

Imagination Gets Its Due. My family and I have been quite taken by Foster’s Home for Imaginary Friends, an animated series about — what else? — a home full of people’s unwanted imaginary friends, as well as a few sympatico humans. Here is an essay about research establishing the perhaps-surprising prevalence of imaginary friends among a group of 100 7-year olds. The reearchers are among a contingent of psychologists who feel the role of imagination and fantasy in child development has been underestimated, and that it is fundamental. his counters a recent trend suggesting that children’s underestimated ability to build reality-based theories and models of the world around them is their essential cognitive tool; that they are more like little scientists than little dreamers. I think a false dichotomy is being posited. The genius of the French developmental psychologist Jean Piaget was to understand that children’s cognitive development can be understood in terms of alternating stages of extension and consolidation. A reality-based grasp of the world is the platform upon which imaginative and fantastical elaboration is built, and the fantasies in turn extend the child’s viridical understanding and modelling. It sounds abit like what the artists among us do in adult culture, and it is not surprising that at least one of the ‘imagination psychologists’ has been interested in studying this more directly:

One way to think about what happens in my own sort of work is that the therapist becomes similarly engaged in creating an imaginary version of the client. Many of these have a haunting presence beyond the therapy hour or even the termination of the therapy. And, likewise, the client’s imaginative creation of an idealized version of the therapist as an imaginary companion (I hesitate to say ‘playmate’) is instrumental to the changes brought about by the psychotherapy. The therapist wants to yield the power to control the narrative emerging in the therapy to the therapy patient, and it is often the made-up version the therapist imaginatively creates who takes over the job of composing the patient’s life story.

Jesse Kornbluth:

“World mourns,” or something similar, most of the headlines say. Of course, I’m no Catholic, and I say this with all due respects to the feelings of my Catholic and other readers who may have felt in some sense that they have lost a spiritual leader of theirs. He was certainly a very pious man and probably a very nice person. But I’m sorry, I just cannot feel all that griefstricken about the death of the Pope. His greatness, such as it was, seemed to lie in having been some mixture of captive and facilitator of the reactionary ideology of a rapacious establishment that does little good for the world, in the process facilitating third world overpopulation and poverty, the epidemic spread of AIDS and unwanted pregnancy, and generally oppressing people on the basis of their gender, their sexual preferences and their level of susceptibility to guilt. I grieve for them; their funerals are far less lavish.

John Paul’s greatest papal role models were apparently a pope from the sixth century and nineteenth-century Pope Pius IX, who was disparaged by many as anti-Semitic but whom he beatified. It was during Pius’ reign that the Church had promulgated the doctrine of papal infallibility, which John Paul cherished. His conservative authoritarianism has polarized both the Church and the world’s view of Catholicism. He is celebrated for his inclusionism; he had to reach outside the Western world, where the Church’s grip is seriously eroded. He was the ‘rock star’ pope, a charismatic showman who did not so much embrace as seduce. He will be remembered for peddling the Church’s dogma by personal appearance, by travelling alot. You can’t blame a man for that; I wish my job involved more international travel. But it is not an achievement in itself, any more than there was any inherent heroism in being the first Polish Pope. Catholic intellectualism fared poorly indeed under this pope. He is credited with contributing to the downfall of Communism, which is quite a stretch in any sense other than that he came from a former Communist country. His greatest legacy, and it is a dubious one at that, may have been to hold the line against liberation theology. To put it simply, this was a papacy in which faith was stood to oppose both justice and thoughtfulness.

Especially because over ninety percent of the cardinals electing the next pope were appointed by him, he is likely to be succeeded by another who largely fits the very same mold, ad infinitum. The Catholic Church grows quickly bankrupt in the Western World. The next Pope, if not from the developing world himself (could the Church seriously entertain the idea of a non-white yet?) must be someone appealing to the heathens in the fertile Third World waiting to be converted and exploited for the continued sustenance and survival of the Church.

How much of a sober appraisal of the impact of Catholicism and the true significance of its leader for the latter quarter of the twentieth century, the only Pope half the world’s people have ever known, will we get in the orgiastic media frenzy covering his death?

A reader pointed me to this weblog by Alex Marshall, a New York writer who thinks about design, sociology, urban design and its politics. Not everybody’s cup of tea, but thoughtful. He posts only several times a month, but recent items have included:

• Cities of Gloom
• Looking Good, Working Bad
• Build It and They Will Come
• Living the Balanced Life
• Car Alarms Suck
• Do Europeans Do It Better?
• Roads vs. Rails

[thanks, lawrence]

I can’t really see how the autopsy can settle the question of whether Schiavo was in a persistent vegetative state or not, as her husband hopes. (Yahoo! News)

Just last week, I was reading reports that some geologists think the massive December 26th Indonesian quake that triggered the catastrophic tsunamis had not relieved the tension in that seismically active area but, counterintuitively, made a subsequent earthquake more likely. Now come reports of a ‘great’ quake, estimated at magnitude 8.5-8.7 on the Richter Scale, along the same fault. (CNN) What amazes me is that authorities are essentially guessing that there will be no appreciable tsunami from this quake because no one has reported one yet. That is the best we can do.

New England Journal of Medicine editorial on the Terry Schiavo case by Dr. Timothy Quill, in .pdf format. As Quill points out,the medical facts are incontrovertible. The deprivation of oxygen to her brain after a 1990 cardiac arrest caused by complications of her eating disorder has left Terry Schiavo in a persistent vegetative state, in which,

Schiavo’s parents’ objections to terminating life support seem to be dually based. Against the consensus of all relevant medical parties, they sentimentally refuse to accept the diagnosis of persistent vegetative state which, after fifteen years, is irrefutably irreversible. But that they appear not to understand or accept this is understandable; Dr Quill says he is not surprised that some might interpret her “apparent alertness and movement as meaningful”. But, at every stage in the subsequent morass of legal proceedings, courts have ruled that, by the standard of “clear and convincing” evidence, the diagnosis of persistent vegetative state is warranted.

But this is not just a difference of opinion on diagnosis or prognosis. The Schindlers also have attempted to subvert the central legal and ethical principle by which decisions about terminating life support must be made when the patient herself is incapable of expressing a preference and has not left any advance directives. This is the so-called standard of substituted judgment. The family member with decision-making authority is obligated to make not the decision that is best for the family or the one that they want for their loved one but the one, as best can be inferred, that the patient would want for herself. As Dr. Quill describes it,

I myself think the principle of substituted judgment is normally honored more in the breach than in the observance. However, this is frequently not a problem when the interests of the decision-making party and of the patient are essentually congruent and there is no substantial dissent from other stakeholders. Only in such a rancorous case as Schiavo’s must the courts become involved. And here they have; and have ruled that the evidence Michael Schiavo has presented about his wife’s own preferences meets the standards, and makes prolongation of life both “unethical and illegal.” Dr. Quill concludes by hoping that Schiavo’s case reinvigorates our determination to put aside distractions and self-interests that interfere with this purified focus on what the patient wishes. It probably bears mentioning again, as Dr. Quill does, that Schiavo is not suffering with the withdrawal of feeding, as she no longer has the mental activity to experience distress. Dying in this way can be a “humane, natural process (humans died in this way for thousands of years before the advent of feeding tubes).”

But this case is more than just a challenge to us to rededicate ourselves to upholding the ethical and legal principle of substituted judgment. The tragedy is more compounded than Dr. Quill’s editorial conclusions would suggest. As I have written before, part of the problem is the limited definition of death to which we cling as a society. Despite lip service to the concept of ‘brain death’, our commonsense notion of death requires the cessation of all biological activity. As a resident early in my career I had a macabre moonlighting job in which I was called in to a nursing home to pronounce death; it is the doctor’s task in ‘pronouncing’ to be sure there is no heartbeat, respiration etc. But, especially with the rapid growth in sophisticated neurological tools and tests for assessment of brain activity, this is an increasingly inadequate notion of death. The Schindlers’ objections at every stage that she might recover, and her supporters’ talk about Michael Schiavo and the medical establishment ‘killing’ her, certainly makes sense if one thinks she is still alive and the withdrawal of life support is shortening her life. But, conceptually, she might better be thought of as no longer alive. It is just that the process of her dying has so far been measured in decades instead of the more usual span of moments, and all that we are doing is needlessly prolonging her dying further, prolonging the meaningless heartbeat in an assemblage of organs, tissues, protoplasm … not in a person. I find the lack of recognition of this distinction troubling and not just a little pitiful.

Senate Majority Leader and physician Bill Frist claims to be confident that Terry Schiavo is not in a persistent vegetative state from viewing a digital video of her. It is a relief that he is in the Senate where the ethical standards are far more lax than they are with respect to diagnosing sight unseen in the practice of medicine. Here is a proposal to compile readers’ digital pictures or videos of their medical problems and send them to Frist to diagnose and recommend treatment. He could single-handedly contain the nation’s healthcare cost crisis with his far more thrifty manner of practicing! Aren’t there some other physicians in Congress who could pitch in and finally fulfill the civic duties they took on when they ran for office? ‘Howard Dean might have brought us the “ah-ha!” moment in politics and the Internet. Dr. Frist is now pleased to present us with the “Kodak” moment.’ [via boing boing]