This item has a particular puissance for me here in Boston, where there is mounting community concern over Boston University’s plan to build a Biosafety-Level-4 laboratory in a crowded urban neighborhood, especially after the recent news that three BU researchers were infected with a lethal strain of tularemia they mistakenly thought was harmless. And this was reportedly not the first biosafety lapse at the BU lab. Proponents of highly risky science have always argued by cost-benefit ratio, but even if we can be assured that the probability of a risk is vanishingly low, aren’t there cases in which the potential magnitude of a disaster is almost infinitely high? In other words, when does the product of a number whose limit is zero and another whose limit is infinity tend toward zero, and when toward infinity? Moreover, the probability of risk often, to my mind, relies on the hubristic assumption that people and procedures can be infallible, when thre reality is quite the contrary — time and again, it seems, if a mistake can occur, it will.

Over the past year or so, German pranksters have placed miniature American flags in 2-3000 piles of dog excrement in public parks in what has been construed as a graphic protest against US policy in Iraq and, more recently, against Bush’s reelection. Police seek to catch the culprits red-handed (or… would it be brown?) even though “legal experts say there is no law against using faeces as a flag stand and the federal constitution is vague on the issue.” (Ananova)

Boing Boing’s David Pescovitz comments on an Ananova story about a man who has puzzled medical experts by being unable to sleep for the past twenty years. There are a series of follow-up posts listing novels about insomniac characters (many of whom seem to be private eyes). I would love to see some more detailed medical investigation of real-world insomniacs. Although the ultimate necessity of spending an average of a third of our lifespan asleep remains a mystery, we are garnering knowledge about the variety of necessary functions it serves, both in terms of cognitive housekeeping and tissue repair and restoration of physiological equilibrium. How does this guy function, on both interpersonal, psychological, and physiological levels?

I’m not sure, in any case, about the veracity of the Ananova story, given that there’s a machismo about not sleeping (perhaps because sleeplessness turns us into the worst caricature of macho??) and I often run into people who boast that they need less sleep than the rest of us. There is something culturally consonant about sleep deprivation, too, as society is more and more frenetic and productivity-driven. Performance in many fields (especially medicine; more about that below) seems to be measured at least partly by how long and how far and how fast one can go on. People in general sleep less than they used to, and we are intrigued by ‘alertness agents’ like modafinil (about the value of and concerns about which I have written here), which appear to treat fatigue and compensate for sleep deprivation with fewer consequences than stimulants of the amphetamine family.

There is also a separate but related allure of the wee small hours per se. I guess it is true of many children who are curious about what mysterious and magical things might happen after they are asleep, as I was. There was always a frisson, when I went to the zoo or the natural history museum, at seeing the somehow more eerie nocturnal creatures. And, in the 1931 film, one of my childhood favorites, Dracula’s ecstatic celebration of “the children of the night” as the air was suffused with the distant howls of wolves always sent a delicious chill up my spine. I began trying to stay up late as soon as I could tell time. I would sneak my transistor radio — if any of you know what those were — into bed and put it under my pillow (it was especially exciting when I finally got an earphone for it) and try to stay awake to break the magical barrier of midnight; it was a long time before I succeeded. Since then, I have always been a night owl, as you can tell from the timestamps on many of my posts here at FmH. I have never gotten over the romance of the middle of the night, both the stillness and aloneness, the cold hard clarity of a world reduced by starlight and moonlight to nocturnal hues, and the seedy quality of the covert activities that transpire, in reality or imagination, in the dark, beyond the ring of illumination thrown by our streetlights. Many of the insomniac characters in literature seem to enjoy walking deserted city streets in the middle of the night, and so too did I. There is an element of transgressing boundaries, the thrill of doing something forbidden, in being up when no one else is, when no one is supposed to be. One of the subliminal attractions of being sleeepless may also be that one challenges the Big Sleep, pushing to transgress the ultimate boundary at the end of life. It is a medical truism, by the way, that Death comes for people disproportionately in the wee hours. Perhaps I have always wanted to be staring her in the eye when she arrives. Sensuality, too, if of course intimately associated with the nocturnal.

“I’ll sleep when I’m dead,” Warren Zevon and others have said. One can cheat death too by packing more into life, I have thought, by spending more of one’s living hours as waking hours. For most of my life, I felt that I did not have the time to waste on sleeping, and (here comes that macho boast?) felt that I could get away for many days running with shorting myself on sleep if there was something compelling to read, write or watch instead. There is a sort of machismo associated with being able to function while sleep-deprived during medical training, when the sleep deprivation is, of course, outrageous and, I am convinced, gratuitous. Training directors, or caricatures of them, supposedly reason that decision-making skills are shaped, and character built, by sleep deprivation, and that “if it was good enough for me when I trained, it’s good enough for the new generation of whiners.” When there is an egregious medical error, like that which caused the celebrated death of Libby Zion in New York some years ago, there is anguished handwringing about the liability and morbidity caused by our proclivity for sleep-depriving medical house officers making life-or-death decisions, but it never seems to change anything. The real incentive the system has to make residents do round-the-clock shifts, of course, is not a training need at all; it is the easiest way to use the indentured servitude of medical residency to meet the manpower needs of a modern healthcare facility.

My acceptance of sleep deprivation during my medical school years had an added momentum, though. When I went through medical school, I was hellbent on not ‘becoming’ a doctor, in the sense of that being all there was to my identity forever after. It needed to be just one of the things I did in my life, not my defining attribute. That created an added impetus to stay up late to do other things after keeping up with the literature in my field, writing consultation reports, etc. And after my wife and I started a family, I also took to my parenting responsibilities by carving out the wee small hours for my other pursuits after a full day of being present and active as a father as well as a doctor.

There is an intimate relationship between sleep disruption and depression, as we know in psychiatric practice. Depressions come in sleepless and hypersomnic varieties. Part of the difference is surely biological, but people are also built differently in terms of their characteristic coping strategies. Some people are escapists, and may sleep more in an effort to avoid distress. (They also seem to be the ones, in my experience, who can can entertain thoughts of suicide for the purposes of relief or escapism, among the various purposes that suicide can serve in my patients’ psyches.) But, even for people who try to use sleep as an escape mechanism, I have long suspected that sleep can promote depression, and there is a body of literature supporting me, even speculating that some sort of depressogenic neurochemical is produced during sleep. Depressed patients often feel most depressed upon awakening and their mood improves as the day proceeds (so-called “diurnal mood variation”). If they take a daytime nap, they often face another period of renewed depression after they get up from the nap. Even if it is not biological, you can imagine how difficult it is to face depressing realities immediately upon awakening from a period of blissful ignorance. The possibility that sleep promotes depression has led to speculation that some people may be sleep-depriving themselves as a sort of inadvertent self-medication for depressive tendencies. In other words, is the sleeplessness of some depressions a consequence of, or an attempt at compensation for, the depressed mood? Noting that I tend to push my bedtime further when my mood is bluer, I have wondered as well. It may also be that those are the times it is more urgent to do more for myself.

It took me literally several decades to realize that burning the candle at both ends was making me far more impatient and irritable than I needed or wanted to be, and that sleep-depriving myself was not a free lunch. This dawned on me at approximately the same time as, studying the physiological necessity of sleep and the psychiatric consequences of sleep disruption, I began to take note of medical research showing that sleep deprivation shortened organisms’ lifespans. So, ironically, cheating death by shoe-horning more wakefulness into a fixed lifetime turns out not to be as simple as I had assumed. Of course, it is also well-known that sleep deprivation reduces cognitive efficiency in certain empirically measurable respects. So even if one is up more, one may end up paying for that quantity of waking hours with quality. Moreover, I realized, sleep deprivation is cumulative; the commonsense notion that you can pay back your deficit by ‘sleeping in’ the next weekend doesn’t work. If you are supposed to sleep eight hours a night, let’s say, you can’t go three nights in a row with four hours a night and then erase the damage with a twenty-hour night’s sleep.

One of the other skills I developed as a medical resident on call was the ability to rapidly return to sleep after I had dealt with a challenge in the middle of the night. It was never as extreme for me as for some of my colleagues, however, who could seemingly conduct their on-call duties without waking up fully at all. One of my friends, a surgical resident, eventually learned that she was managing many of her patients’ problems — always clinically appropriately, to hear her tell it — over the phone in the middle of the night without remembering what she had done when her surgical team did morning rounds on the patients the next day. She finally arranged for the hospital operator who paged her to listen in on the calls and take notes about what orders she issued. She would swing by the switchboard in the morning, before rounds, and use the notes as a cribsheet when reporting on the care she had given the night before. (I don’t know if this was a liability or an adaptive strategy to her work as a surgeon; she has since gone into a different field of medicine. Dream on…)

So now I want to sleep more. Now that I realize it is not necessarily desireable to short myself so much on sleep, when I am awakened in the middle of the night by my beeper going off from the hospital, I want to get back to sleep again as soon as I have dealt with the call. But, in middle age, I am finding, ironically, that I can no longer get back to sleep rapidly. If I am awakened, I am typically going to be up for at least a couple of hours. Of course, I could do something boring and soporific with the time, to hasten my return to sleep, but it still sticks in my craw to waste wakefulness. So some of the middle-of-the-night FmH entries you will see these days are, in a sense, under duress. Enjoy them anyway; I do. I still do some of my clearest thinking in the holy stillness, or at least so I imagine.

Andrew Sullivan on Abu Ghraib:

I had missed this essay, originally published on the front page of the New York Times Book Review. I have long been a proponent of a take similar to Sullivan’s about how the rhetoric about the war and the duplicitous shaping — from the top — of the American attitide about Iraqis, terrorists, and other poorly differentiated spooks created a culture in which these atrocities could happen. I differ with Sullivan on one account, which is his assertion that those who “unwittingly made this torture possible” were not as guilty as those who inflicted it. First of all, it is hard for me to see how it was “unwitting.” And secondly, decisions from the president and the upper echelon of his administration henchmen not only “made the torture possible” but essentially mandated it. Early in the essay, Sullivan is unsure whether to take solace in the fact that the torture occurred in a free society where the chilling evidence of it was able to come to light.

I am afraid that the pieties about the persistence of freedom in America are gross self-deception. Free expression and inquiry are the merest, illusory, window-dressing on a society that permits such atrocity as a matter of policy, fails to make a meaningful inquiry into or condemnation of the abuses, and reelects those responsible, enabling them to claim a ‘mandate’ for business as usual. What did the American people do other than stand by and shake their heads in the face of the war crimes committed in their name, and allow ourselves to be sated by the punishment of some sacrificial lambs? The failure to make the atrocities, and the similar demonization of those we hold prisoner in Guantanamo, Afghanistan (and God knows what other places around the world we have not even heard of), a core campaign issue was scandalous. The moral failures involved must be kept in the forefront of American consciousness if those who act in our name are to be prevented from permitting and encouraging further atrocities.

Not one damn mention of his name here today, you will notice.

Circadiana is a new weblog devoted to sleep and chronobiology, for your late might surfing enjoyment. [via MetaFilter]

Salon‘s reviewer finds Gladwell’s Blink more entertaining than important. I beg to differ; this is sort of like how hypnotism, while elucidating profound and basic principles of human cognition and volition, has often been thought of as a mere parlor game. The extent to which we can stand to learn alot about our implicit assumptions, about how we often make decisions on very different bases than we think we do, and how we can learn to accept and utilize such intuitions, cannot be underestimated. An important segment of the review, for example, is a convincing argument, supported by much social psychological research (perhaps my social psychologist friend Dennis Fox will have some amplifying comments if he reads this on his return from the Middle East), that our racial biases go deeper than we suspect, even if we are convinced we are not racist. (Of course, although it has social psychological implications, at base this is a cognitive-psychological exploration.)

As walker reminded me, there is a website where you can take Implicit Assumption Tests to root our your hidden biases and automatic preferences, but be careful. For those who, unlike mental health professionals, have not embraced the idea of the ubiquity of unconscious influences on our perceptions, appraisals and choices, it can be quite alarming to recognize how far away from the ideal of rationality and control over our thinking we really operate. That is the impact I hope Gladwell’s book may have, now that he is a hip sexy trendsetter author.

…and it’s orange! (Yahoo News!)

“Ever wonder what happened to: Eddie The Eagle? The chick who shot Andy Warhol? That ‘Mikey’ kid from the Life Cereal commercial? Well you’ve come to the right place, this is where we track the has-beens, the flash-in-the-pans and those pseudo-celebrities who were all too annoying during their 15 measly minutes.”

Our government becomes more and more an outlandish caricature of a ludicrous semblance of a contemptible simulacrum of democratic process. [Sorry, I seem to be compelled to use the same adjectives over and over again. Probably the only one in the previous sentence that doesn’t really apply is ‘democratic’…]

Meek, mild (and white) Brooklyn resident Russell Jones encounters the Ol’ Dirty Bastard. (New Yorker)

They have also

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This is circulating widely via email. I’m reposting it here in FmH’s role as a community bulletin board (or, some might say, a spam amplifier).

A collection of links to amateur videos of the tsunami, of variable quality. Since I do not watch TV news, I hadn’t experienced the visual impact until I watched some of these. There is a link at the page to donate to Red Cross disaster relief, if you haven’t already given all you can.

“Adam’s only chore in the Garden of Eden was naming the beasts and birds. The book of Genesis doesn’t tell us whether he found this task difficult or burdensome, but today the need to name and number things has become a major nuisance.” (American Scientist via abby)

Sen. Barbara Boxer explains “why she felt compelled to object to the certification of Ohio’s electoral votes.” (AlterNet)

Astronomy Picture of the Day: “A mere 6,000 light-years distant and sailing through the constellation Vela, star cluster RCW 38 is full of powerful stars. It’s no surprise that these stars, only a million years young with hot outer atmospheres, appear as point-like x-ray sources dotting this x-ray image from the orbiting Chandra Observatory. But the diffuse cloud of x-rays surrounding them is a bit mysterious… (A) source of energetic electrons, such as shockwaves from exploding stars (supernova remnants), or rotating neutron stars (pulsars), is not apparent in the Chandra data. Whatever their origins, the energetic particles could leave an imprint on planetary systems forming in young star cluster RCW 38, just as nearby energetic events seem to have affected the chemistry and isotopes found in our own solar system.”

Oh, White Noise is not from the Don DeLillo novel??

And could this — ‘surreality’; ‘celebreality’ — be the death throes of reality TV? Not to make too much of this over-the-top, unbelievable spectacle, but in a country that can elect George W. Bush president, it is no wonder they think they can get away with exploiting the American public’s credulity to this extent. Nothing can be taken as an insult to our national intelligence any longer…

An array of brain-boosting medications — some available and others in development — promise an era of better thinking through chemistry. New potential mind-enhancing drugs may bring more powerful, more targeted and more lasting improvements in mental acuity than the rudimentary cognition boosters — e.g. amphetamines — with which many are familiar from college all-nighters or long-haul drives.

The last two decades’ neuroscience discoveries about localization of brain functions and delineation of the roles of various neurotransmitters, with the ‘deep pockets’ of the US military’s vested interest in enhancement of pilots’ and soldiers’ combat functions under stress and fatigue, have created an unprecedented climate for the development of these agents. Aging baby boomers are an enormous potential market for the brain enhancing chemicals.

Modafinil, whose approved indication is to treat narcolepsy, may be the first ‘smart drug’. It is not clear by what mechanism it combats fatigue, but it appears to enhance mental functioning even in healthy nonfatigued subjects, with little in the way of complications or side effects. Research subjects who have takenmodafinil pay closer attention and use information more effectively than subjects given a placebo. Faced with conflicting demands, people on modafinil shift from task to task and alter their cognitive strategies more efficiently.

Some speculate that the use of cognition-enhancing drugs will become as commonplace as having a cup of coffee, ushering in an era of ‘cosmetic neurology’. But neuroscientists say two factors could prevent total capitulation to the allure of smart drugs. First, their performance may not live up to expectations. This is a common phenomenon in science — a statistically significant effect is not necessarily significant enough in the real world. And, second, ‘There is no free lunch.’ Again, as is often true in clinical drug development, the extent of complications from the real-world use of these drugs may not be apparent from the outset. A drug that causes users to remember too much detail could clutter the brain with irrelevancies. Sharpening attention might cause excessively intense focus, making it more difficult to shift attention with new demands. In short, someone who notices or remembers everything may end up understanding nothing.

One skeptical psychologist commented:

“The brain was designed by evolution over the millennia to be well-adapted because of the lives we lead. Our lives are better served by being able to focus on the essential information than being able to remember every little detail. We meddle with these designs at our peril.” (LA Times)

A Neurobiological Diagnosis With Aesthetic, Cultural and Philosophic Implications (University of London, Saturday 15th, and Sunday 16th, January 2005) :

If you have any interest in this, you can scroll down the page and read the abstracts of the conference presentations. Neurologist Peter Brugger, for example, “(tries) to delineate the scope of a proper ‘phantomology’ (Stanislaw Lem) whose aim is to study the virtual reality of bodily awareness – from phantom limb to phantom body.”

Harvard psychoanalyst Arnold Modell finds the creation of the unreal phantom limb intriguingly analogous to the process of the construction of the (equally unreal) self and its agency. And neuropsychologist Chris Frith sees the phenomenon as a paradigm of the brain’s mechanisms for the active construction of reality.

Artist Andrew Patrizio asks, “Am I, like others, (ab)using the phenomenon like many other intellectual and cultural activists? Phantom limbs are typical of many flowing and contested scientific discourses around at the moment, whose very elusiveness and ambiguity seems attractive in a multi-disciplinary kind of way. Rather than studying phantom limbs per se, I am currently asking – Does the exhibition as a format deal well with such subjects of an unsolved nature? Would my interest as a curator diminish if an explanatory model were accepted? How are artists working with the mystery, symbolism and science of phantom limbs, erecting a platform for creativity without dismantling the enigma?” Patrizio propounded an artistic expression of the phantom limb phenomenon by having an exhibition which hung no art (stipulating artists from whom works would not be borrowed).

Artist Nicola Diamond considers bodily expression as a culturally specific form of language and wonders how phantom limb would be experienced cross-culturally; there is little evidence of the phenomena in cross-cultural work. Novelist Stuart Brisley relates phantom limb to body dysmorphic disorder. Photographic artist Janet Sternberg finds phantom limb a potent metaphor as well. “Each of us has the condition, someone or something no longer with us who nonetheless continues — for better and for worse — to feel part of us.”

And UCLA philosopher Eleanor Kaufman explores Maurice Merleau-Ponty’s phenomenology of perception through the apposition of phantom limb — a sensation that an absent body part is still present — and one of my professional interests, anosognosia — the sensation that a present body part is absent. (I find the neurological phenomenon of anosognosia an analogy for some aspects of my patients’ constricted awarenes of themselves and the world.)

From the New York Times science section, this article explained much about which I had been curious. It starts out with the commonplace:

But it rapidly goes to the astounding:

And:

And, although others dispute the science behind this prediction:

You know how, once you notice something, all of a sudden you see it everywhere? I just stumbled upon this fascinating weblog written by an EMT working for the London Ambulance Service, and now I notice that numerous and disparate people are linking to it.

Remember the analysis of photos showing bulges in his suit suggesting that Bush was being fed his debate lines through a wireless link? This site concludes that Bush’s equipment is actually a ‘Lifevest’ wearable defibrillator. Like his father, Bush may have atrial fibrillation, a cardiac arrhythmia that can cause syncopal episodes (fainting spells; recall the famous Bush ‘pretzel-choking’ episode in January, 2002?) as well as cerebrovascular accidents (strokes or mini-strokes), some of which might account for Bush’s apparent cognitive deficits and psychological instability. One sign of a possible stroke is a facial droop, which Bush appears to demonstrate at times and which may, it is suggested, be the reason we find him sneering. [I think however it is more likely that Bush sneers because he is simply a haughty, inadequate and contemptuous man… — FmH]

For good measure, the post throws in some speculation about hyperthyroidism (Graves’ Disease) — which is the likely cause of his father’s atrial fibrillation — and Wernicke-Korsakoff’s Syndrome — essentially cognitive deterioration from chronic alcohol abuse — that I find less compelling. The piece also invokes the scurrilous ‘psychoanalysis’ of Bush by Washington analyst Dr. Justin Frank, about which I have previously posted. I joined many others in the psychiatric community in condemning Dr Frank’s conclusions about Bush’s psychopathology as irresponsible and unethical but — hear me out here — there is a good rational for raising concerns about behavioral observations, given that the President’s actions are in the public domain. The post makes an interesting case that some of these observations could be accounted for by cerebrovascular cognitive impairments.

As the poster concludes, only Bush’s doctors know for sure. As I have said before, just as the results of the President’s annual physical exam are made public, so too should a comprehensive annual ‘mental status’ evaluation bearing on his emotional and cognitive functioning. Despite doctor-patient privilege, the potential consequences of behavioral or cognitive impairment of the man in the Oval Office demand that the Presidential physicians level with the public about aspects of his health that could affect his public functions. Barring that, their responsibility demands at least that they privately steer him out of office if they find him substantially impaired. Who here has any confidence that the fact that the people around Bush have not done so indicates that he is not in fact impaired and that we can rest easy that his hand is on the trigger?

A US physicist fed up with having to revise his course schedule due dates every year proposes a 364-day year, which means every date falls on the same day of the week every year. A ‘leap-week’ unattached to any month is added every five to six years. Many months would have different lengths than they now do. To answer expected criticism from people whose birthdays are ‘stuck’ on an undesireable day of the week, he gives us all permission to celebrate our birthdays on the weekend before or after their actual date. (New Scientist)

The article is actually talking about just one crazy idea on one weblog; but, hey, The New York Times knows a trend when they see one, and don’t stand in their way! The article does laud, however, the self-correcting nature of weblogging reality, in which the accumulation of readers’ comments is (usually) precipitated by a crackpot post. Except, of course, on FmH, which operates off in its own little corner of the universe in defiance of consensus reality, unperturbed…

This is my annual reprise of an FmH New Year’s Day post from 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:

“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. A similar 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.

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.

However you’re going to celebrate, my warmest wishes for the year to come!

Has anyone read Mary Douglas’ classic, Purity and Danger? It is a treatise on the ways in which what is considered impure or contaminated is socially determined. The boundaries between purity and impurity serve symbolic purposes to maintain social order and coherency. The uncleanliness of the corpse is one of those things. The assertion after every mass disaster about needing to bury the dead rapidly to avoid disease is so automatic and unquestioned that it has always seemed to me that the public health need it meets is more likely in the emotional realm than the infectious disease one.

One of the progenitor weblogs is back!

Google has established a page of links to agencies providing disaster relief in the wake of the tsunami. There is a link to it front and center on their search page, if you haven’t already noticed. Rumor has it they have already raised $5 million from putting up this page. In general, online giving to tsunami relief has been of an unprecedented magnitude, far outstripping donations after 9-11 for example. People need to realize that the devastated areas will have relief needs for years to come, so give much but give often.

This ingenious article from the British Medical Journal is a formal case presentation, such as we write as a matter of course in medicine, of Gollum, discussing the differential diagnosis — psychiatric or medical? — of his behavioral disturbance. As it is a collaboration by a number of medical students and a lecturer from the Department of Mental Health Sciences of the Royal Free and University College Medical School in London, you can predict where their conclusions will lie.

This Scientific American piece reviews research challenging the commonsense notion that self-esteem is good for you and that low self-esteem is the root of many problems in functioning. Quite the converse may be true; I have previously written about the insidious effects of our society’s encouragement of narcissism, and the skeptical research findings here support a revisionist approach. This has many implications for us who are mental health practitioners. I have followed thinking on the evolutionary value of depression, for example; under certain circumstances, a pessimistic, unambitious stance may be adaptive, self-protective… and more realistic. Should it necessarily be abolished with treatment in all instances?

Video game skills make surgeons more precise, and sophisticated game technology may be entering both the surgical curriculum and the operating room itself. (Wired)

I suggested in my earlier piece on Yuschenko’s poisoning that the assertion that those who perpetrated the dioxin poisoning were seeking to kill him rapidly is a red herring issue. That dioxin does not induce death throes rapidly does not mean it is not an incredibly toxic and, untimately deadly, chemical. The hidden agenda in this specious argument against its ‘politicization’ is an ignorant attempt to undermine public policy meant to address environmental toxins.

“Why should animals help out stricken humans – does it prove that altruism is a natural instinct?” (Guardian.UK)

“The Polymeal: a more natural, safer, and probably tastier (than the Polypill) strategy to reduce cardiovascular disease by more than 75%.” (British Medical Journal)

Explanations invoke the often-noticed ability of animals to sense danger. At first blush, you don’t need to invoke a ‘sixth sense’ here; it is easy to imagine animals’ alarm when the earth moves beneath their feet in an earthquake. But what would lead them to expect a tidal wave and move to higher ground? Certainly it could not be accounted for on the basis of natural selection, as such a disaster does not happen frequently enough to exert selective pressure. There are more things in heaven and earth…

“Emergence of society may have spurred growth. The sophistication of the human brain is not simply the result of steady evolution, according to new research. Instead, humans are truly privileged animals with brains that have developed in a type of extraordinarily fast evolution that is unique to the species.” (Guardian.UK)

“What does the fashion for books about the state of the English language tell us? People care about their language because it forms part of their identity, and part of the resistance to changes in English is a resistance to change itself. But correct usage is not an elite affectation; it is a badge of competence,” says Richard Jenkyns (Prospect).

Because of changes in the logical directory structure at my webserver, you will get unpredictable results if you use the older form of the URL for FmH, of the form “http://world.std.com/[some subdirectories here]/followme.html”.

Please check your bookmarks, blogrolls, etc., and make sure you are using either of the following two (equivalent) URLs instead:

• http://gelwan.com/followme.html
• http://theworld.com/~emg/followme.html

I would prefer it if you would use the “…gelwan.com” version, as that will still work if I change hosts at some point in the future, rather than requiring a redirect.

Urge Bush to Increase Aid for Tsunami Victims:

Death Toll Climbs to 63,000 (Yahoo!)

A Third of the Dead in Undersea Quake Are Said to Be Children: “Survivors arranged for mass burials and searched for tens of thousands of the missing in countries thousands of miles apart.” (New York Times )

[I cribbed most of these from another site where the author had the temerity to copyright the list. More concerned about getting a feather in their cap for righteousness than disseminating the information broadly and sharing it freely, I guess…]

The year’s best jazz recordings, per Fred Kaplan. Slate

Former CIA analyst “Ray McGovern picks up the story that American papers have been slow to grasp: China and Russia have agreed to conduct joint military activities, in China, in 2005.” (Tom Paine)

“Thirty movers and shakers in British culture look back on an eventful year” in the arts. (Guardian.UK)

Guard Reports Serious Drop in Enlistment: “In the latest signs of strains on the military from the war in Iraq, the Army National Guard announced on Thursday that it had fallen 30 percent below its recruiting goals in the last two months and would offer new incentives, including enlistment bonuses of up to $15,000.” (New York Times ) Unfortunately, enlistment bonuses or not, all this is going to lead to is acceleration of the stop-loss program and pressure for a draft…

A reader sent me this very different take on Yuschenko’s disfiguring ailment by Justin Raimundo. He claims we should not accept uncritically the universal conclusion from the press that Yuschenko was poisoned, especially because it comes from the administrative director of the Viennese clinic where he was evaluated, not the medical director, who resigned during the furor after reportedly having his life threatened for disputing the conclusions his boss had announced. Raimundo has little besides this circumstantial evidence, his instincts that something was funny about the ‘poisoned-by-the-bad-guys’ scenario, his mistrust of the mainstream media, and the assumptions he cites of several others to the effect that the story is anti-Russian propaganda spread by reactionary elements in the U.S. Just because a story fits the worldview of the powers-that-be doesn’t a priori mean it is false, it seems to me, although it makes it far more likely [grin]…

A similar assumption that the mainstream media version is either “misinformation or disiinformation” appears here, although his piece is colored by the weblog’s a priori agenda of showing that the US press does not understand Europe.

Then there is this medical weblog which argues against the dioxin-poisoning assertions on two grounds. First, the weblogger does not think dioxin makes a good murder weapon because it takes so long to kill. This assumes the aim of the poisoner was assassination, which is not at all a given. Things in Slavic politics are inevitably more Byzantine and complex than we would assume them to be; perhaps grotesque disfigurement, making a mockery of visibility and popularity, and a slow gruesome death better serve someone’s needs…

Second is the medical dictum that ‘an uncommon presentation of a common disease is more likely than a common presentation of an uncommon disease’. The weblogger suggests that Yuschenko’s presentation is much more consistent with alcoholic pancreatitis and an alcohol-induced eruption of the skin disease rosacea than with the characteristic chloracne rash of dioxin poisoning. But like all good medical rules of thumb, this one must be evaluated thoughtfully. I think the explosive onset of Yuschenko’s disfigurement (if we are to take it as true that the ‘before’ and ‘after’ photos are only two years apart) would be such a stratospherically uncommon presentation of a common disease that the chloracne hypothesis is actually indeed more likely (although, I emphasize as a psychiatrist, it is a long time since I studied any toxicology). Now I do not know much about Viktor Yuschenko’s private life, but I hope that the assumption that medical complications of alcohol are a likely scenario for him reflects more than just a stereotypical prejudice about the likelihood that a Slavic male is a problem drinker…

Finally, let us be reminded that those who accuse others of being credulous leave themselves open to the same charge of credulity. Despite Raimundo’s take on it, it was not only the Austrian clinic that has concluded Yuschenko was dioxin-toxic. An independent analysis by a Dutch toxicologist found massive levels of dioxin in his tissue samples — “the second-highest level of dioxin poisoning ever recorded in a human – more than 6,000 times the normal concentration” (Guardian.UK), if the Guardian‘s reporting is not suspect.

Somewhere in my whirlwind tour through this issue, I saw a reader comment contrasting the mainstream’s readiness to embrace the poisoning theory in Yuschenko’s case with the scorn heaped on suggestions that Arafat was poisoned by the enemies of the Palestinians. I agree that the truth of a matter can be as easily obscured as elucidated by the reportage (and the weblogging) it receives; I would be interested in your comments on either or both of these issues.