Enforcement of Civil Rights Law Declined Since ’99, Study Finds (New York Times)

Today, from a distance, I saw you

walking away, and without a sound

the glittering face of a glacier

slid into the sea. An ancient oak

fell in the Cumberlands, holding only

a handful of leaves, and an old woman

scattering corn to her chickens looked up

for an instant. At the other side

of the galaxy, a star thirty-five times

the size of our own sun exploded

and vanished, leaving a small green spot

on the astronomer’s retina

as he stood on the great open dome

of my heart with no one to tell.

— Ted Kooser

These are difficult to believe but they are real. Read more about them here and here. [thanks to rebecca blood]

“The Book Review recently asked a handful of poets and critics to respond to this question: What book of poetry, published in the last 25 years, has meant the most to you personally — the book you have found yourself returning to again and again? We asked them not to select reissues, or volumes of a poet’s ”selected” or ”collected” work. Here are their responses…” (New York Times [thanks to wood s lot])

While, as my posts reacting to the election defeat indicate, I agree that this is a time for, figuratively if not literally, street-fighting, I hope that stridency like this does not herald a return to the rhetoric of certain segments of the ’60’s movement who were intent on being radicaler-than-thou and dismissive of anyone who did not conform their activities to their notion of what was to be done. I personally think, in contradistinction to the lead-in above, that writing a weblog is a valid part of ‘taking action on the pressing issues of our day’ and may even qualify as ‘street fighting.’ Of course, it can also be simply intellectual masturbation. The danger is that empty lip service to being a change agent may actually help bolster the status quo. Please help me to maintain an honest distinction.

“BloggerCorps matches bloggers with activists and non-profit groups who want to blog and need help getting started….

The authors (a wide-ranging group comprised mainly of bloggers, activists, and tech organizations who work with non-profits) will post announcements on behalf of organizations who need help starting blogs or building blogging communities. The posts will be categorized according to the organization’s geographical location, and in some cases its main focus issue. Bloggers interested in helping that particular organization can express their interest in the comments section attached to that post. The organization will then decide which of the volunteers it wants to follow up with. All arrangements will be made directly between organizations and bloggers. Bloggercorps will not mediate. We are not raising money to put people on planes so in most cases the idea is to match organizations located in a particular place with bloggers living in the same place. If situations arise in which organizations cannot find volunteers living in their area, we may be able to point them to foundations or philanthropic organizations who might be in a position to help fund travel for blogger-volunteers. But we won’t do your fundraising work for you.

Sounds like a wonderful idea; count me in. Although FmH is primitive from a coding standpoint, I have been doing this for long enough to understand the mechanics.

I still wonder why there has been no serious discussion of the possibility that the tape was a Bush administration concoction given its convenient timing, its anonymous origins, and its congruence with the Republican fear-based campaign techniques. I raised the possibility that it was the often-touted ‘October surprise’ in my initial reactions to its appearance.

Oliver Willis’ Brand Democrat project

“Scientific experiments claiming that distant intercessory prayer produces salubrious effects are deeply flawed…” — Michael Shermer (Scientific American) Whenever I link to one of Shermer’s profoundly skeptical observations, I get at least several angry responses from readers who dismiss my thinking as being hopelessly limited. I don’t mind; I think that this is an especially important time to subject faith to reasonable examination. Readers of FmH will know that I hardly limit myself to what is “scientifically” proven; I think scientific knowlege is a socially conditioned belief system like any other, producing important distortions and limitations in our understanding of reality. There are many sources of light that project the flickering shadows on the wall of the cave.

I tend to believe most paranormal phenomena involve a balance of a basis in fact and a basis in human credulousness. I agree with Shermer that distance prayer is one of the more in-credible claims from a scientific perspective, but also with the claims of adherents that such phenomena may not be amenable to scientific examination. However, I think most paranormal phenomena are ultimately comprehensible as manifestations of intuition. We have ways of knowing things about which we know very little, yet they are ultimately comprehensible mental faculties. Empathic resonance and mind-body connectivity go a long way to understanding “extrasensory” perceptions. My difficulty with fitting distance healing into this perspective is that the recipient does not know s/he has been prayed for. I have the same difficulty with the studies several decades ago that claimed to show that therapeutic touch made a difference to plant growth.

And, as a reader commented to me in a private email (entitled “not an angry response”), distance prayer may be more beneficial for the sender than the recipient, but that it is nothing to scoff at because it increases the sender’s compassion. Most of the most meaningful spiritual practice is dedicated to cultivating compassion, no matter in which system it is embedded. And that, by the way, is why Bush’s brand of faith-based evangelism is not by any stretch of the imagingation a valid spiritual position.

“Will the inevitable decrease in prescriptions ultimately lead to more teenage suicides?” asks The New York Times Magazine. Readers of FmH know I have covered the controversy over antidepressants and suicide in detail. I won’t belabor the points I have already made, except to summarize that, even though they do sometimes make their users more uncomfortable, any excess suicidality in users of the antidepressants should not be attributed to the drugs but to the way they are prescribed. Part of the art of prescribing is monitoring and managing side effects; we do not restrict ourselves only to medications that are trouble-free, but weigh the relative risks and benefits with our patients in making the decision to prescribe a given medication and following the patient once they are taking it. All well and good, if everyone has access to accurate data on the effects of a medication, but drug company minimization and concealing adverse information from both consumers and prescribers has made that impossible. The pharmaceutical manufacturers sitting on top of this cash cow have marketed the drugs as trouble-free and persuaded prescribers that little care was necessary to follow those taking the drugs under their supervision. Over the past two decades, this marketing strategy succeeded by shifting the bulk of SSRI prescribing from the psychiatrists who have traditionally followed depressed patients, have the training to assess the subtleties of antidepressant side effects and the subtleties of assessing suicidality, and the time to do so in their patient visits, to generalists, internists and primary care clinicians who have none of those assets.

The ‘black box’ warning about suicide risk in pediatric use of these medications was premature and unwarranted. Most data shows that antidepressants not only do not enhance suicide risk but that they decrease it. Here is a Google Scholar search into whose citations you can drill down if you have further interest. One of the effects of the cavalier attitude about prescribing the new generation of antidepressants has been a tremendous expansion of the indications for which they are used and a lowering of the threshold for using them, especially in children. Many speculate that the adverse publicity will make many parents skittish about having their children on antidepressants. With any luck, this reluctance will take its toll primarily on the more dubious uses of the medications and not on the most severe childhood depressions for which the medications remain urgently necessary, justifying any added risk if used carefully, and without which use there would be an expansion of childhood and teenage suicides. While I am not a child psychiatrist, given my strong interest in this issue I have had many conversations with my child-psychiatrist colleagues, including some of the most authoritative and well-respected pediatric psychopharmacologists in the Boston area, with whom I am privileged to collaborate at times. The good news is that they are not seeing the feared chilling effect; parents seem no more reluctant to approve antidepressant therapy for their children in need than before the furor began. Of course, they may not be a representative sample of antidepressant prescribers. By and large, the child psychiatrists I have queried are not the ones who would be prone to prescribe in a cavalier manner, with inadequate followup, or for dubious indications. But the premise of the Times Magazine‘s article — that there will inevitably be a decline in antidepressant prescribing since the FDA warnings — is not at all a given, as I see it.

“Will the inevitable decrease in prescriptions ultimately lead to more teenage suicides?” asks The New York Times Magazine. Readers of FmH know I have covered the controversy over antidepressants and suicide in detail. I won’t belabor the points I have already made, except to summarize that, even though they do sometimes make their users more uncomfortable, any excess suicidality in users of the antidepressants should not be attributed to the drugs but to the way they are prescribed. Part of the art of prescribing is monitoring and managing side effects; we do not restrict ourselves only to medications that are trouble-free, but weigh the relative risks and benefits with our patients in making the decision to prescribe a given medication and following the patient once they are taking it. All well and good, if everyone has access to accurate data on the effects of a medication, but drug company minimization and concealing adverse information from both consumers and prescribers has made that impossible. The pharmaceutical manufacturers sitting on top of this cash cow have marketed the drugs as trouble-free and persuaded prescribers that little care was necessary to follow those taking the drugs under their supervision. Over the past two decades, this marketing strategy succeeded by shifting the bulk of SSRI prescribing from the psychiatrists who have traditionally followed depressed patients, have the training to assess the subtleties of antidepressant side effects and the subtleties of assessing suicidality, and the time to do so in their patient visits, to generalists, internists and primary care clinicians who have none of those assets.

The ‘black box’ warning about suicide risk in pediatric use of these medications was premature and unwarranted. Most data shows that antidepressants not only do not enhance suicide risk but that they decrease it. Here is a Google Scholar search into whose citations you can drill down if you have further interest. One of the effects of the cavalier attitude about prescribing the new generation of antidepressants has been a tremendous expansion of the indications for which they are used and a lowering of the threshold for using them, especially in children. Many speculate that the adverse publicity will make many parents skittish about having their children on antidepressants. With any luck, this reluctance will take its toll primarily on the more dubious uses of the medications and not on the most severe childhood depressions for which the medications remain urgently necessary, justifying any added risk if used carefully, and without which use there would be an expansion of childhood and teenage suicides. While I am not a child psychiatrist, given my strong interest in this issue I have had many conversations with my child-psychiatrist colleagues, including some of the most authoritative and well-respected pediatric psychopharmacologists in the Boston area, with whom I am privileged to collaborate at times. The good news is that they are not seeing the feared chilling effect; parents seem no more reluctant to approve antidepressant therapy for their children in need than before the furor began. Of course, they may not be a representative sample of antidepressant prescribers. By and large, the child psychiatrists I have queried are not the ones who would be prone to prescribe in a cavalier manner, with inadequate followup, or for dubious indications. But the premise of the Times Magazine‘s article — that there will inevitably be a decline in antidepressant prescribing since the FDA warnings — is not at all a given, as I see it.

This is from a gossip rag — unsubstantiated but comforting? The Bush twins and their secret service escorts were apparently turned away from a popular NYC restaurant with the news that no tables would be available… for the next four years. A rousing cheer went up from the patrons of the eatery. (Gawker)

Joni Mitchell interviewed by Elvis Costello, with reverence, in Vanity Fair.

The USA Patriot Act makes it illegal for a library to tell its users if their browsing, surfing, etc. habits are being monitored. But it doesn’t, technically, make it illegal for you to tell them they are not being watched. (I would love to watch the sophistry on both sides if there is ever a test case of this one in the courts…) Here is a collection of signs to post, or to keep you posted. From celebrated Rutland VT librarian Jessamyn West, one of my heroes. The signs have been provided to libraries throughout her state. Perhaps you should take copies to your local librarian…

This would just be another curiosity, the grounds for some horror flick or the like, if they weren’t another canary-in-the-cage species, a harbinger of massive environmental change.

Owen’s [ also not found in nature ] reached its fifth anniversary the same week FmH did, but with a very different outcome. I will miss you. R.I.P.

“A new vaccine could prevent the majority of cases of cervical cancer, suggest the results of a major trial. The vaccine protects against the virus that causes cervical cancer, which kills almost a quarter of a million women worldwide each year.” (New Scientist)

Kaplan describes how — in what should be starting to sound like a familiar pattern in light of Bush’s recent Cabinet choices — Goss “auditioned for his current job by doing political hackwork for the president”, as a hired gun to discredit Kerry and to scoff at the Valerie Plame scandal. Although ensconced bureaucrats always raise the hue and cry whenever an outsider takes control of their agency, rarely is it such a political hack. Kaplan finds it more worrisome that the directorate of the CIA is “a political arm of the Oval Office” than even at Justice or State, because of the CIA’s importance in providing the administration with ‘disinterested analysis.’

But we already have abundant evidence that that is not what Bush and Cheney are interested in, and Goss’ role will be one of refining their ability to live in la-la land for the next four years.

The French Paradox: “Despite a diet stuffed with cream, butter, cheese and meat, just 10 per cent of French adults are obese, compared with our 22 per cent, and America’s colossal 33 per cent. The French live longer too, and have lower death rates from coronary heart disease – in spite of those artery-clogging feasts of cholesterol and saturated fat. This curious observation, dubbed ‘the French paradox’, has baffled scientists for more than a decade. And it leaves us diet-obsessed …smarting.” (Guardian.UK)

The FDA is far too cozy with the drug companies, critics assert, and I tend to agree. It is only going to get worse under an emboldened second Bush administration, since the Republican strategy for American prosperity goes no further than removing regulatory barriers to untrammelled corporate profitability.

The problem is not that Vioxx, or any other drug, has risks — physicians customarily balance risks and benefits in collaborating with their patients on prescribing decisions — but that the process withholds data about the risks from both practitioners and the public. The recent furor over childhood antidepressant use and suicide is the same. One solution would be to separate the FDA’s drug approval machinery from its post-approval drug safety monitoring role, but the fist-in-glove relationship with the industry would likely contaminate the latter’s functioning as well. A better way to address the problem would be to develop a trustworthy independent review board on drug safety issues, beyond the reach of industry gladhanding, sort of like the Underwriters’ Laboratory for household appliances.

“The tool that lets viewers control the TV will soon sport ‘billboards’ and track viewing habits.” (LA Times)

“Not a single major voice has been raised in the American media against the ongoing destruction of Fallujah. While much of the world recognizes something horrifying has occurred, the US press does not bat an eye over the systematic leveling of a city of 300,000 people.” (World Socialist Web Site via Cursor)

Also: “Speaking on condition of anonymity for fear of U.S. military reprisal, a high-ranking official with the Red Cross in Baghdad told IPS that ”at least 800 civilians” have been killed in Fallujah so far.

His estimate is based on reports from Red Crescent aid workers stationed around the embattled city, from residents within the city and from refugees, he said.

…The official said that both Red Cross and Iraqi Red Crescent relief teams had asked the U.S. military in Fallujah to take in medical supplies to people trapped in the city, but their repeated requests had been turned down. ” (Inter Press Service News via Cursor)

“The UN has warned that Afghanistan could become a ‘narco-state’ after opium cultivation rose by two-thirds this year. A UN report released on Thursday urged the US and Nato forces to fight drugs as well as Taleban insurgents.” (BBC)

[Props to adam for sending me this piece by Mel Gillies, first posted at Mathew Gross’ weblog and worth reprinting in full. This will make most sense to anyone who has worked with, or tried to intervene with, victims of domestic abuse, but the analogy is important to the rest of us as well. There is enough focus on the pathology of the dysadministration to go around; this is an attempt to grapple with the pathology of those of us at its mercy. It neatly complements my insistence that the Democrats’ lost grip on the direction of American politics and social policy calls for a bolder, more distinctive assertion of its identity and potential, not the cowed regression toward the insipid and meaningless least common denominator that some Democrats advocate. — FmH]

New C.I.A. Chief Tells Workers to Back Administration Policies. (New York Times ) This missive can be understood on many levels. It is not difficult to understand that, given the purges Goss has embarked upon at the CIA over the seven weeks since his arrival, disloyalty to the dysadministration will continue to be dealt with by dismissal. Secondly, during the first administration, Bush and Cheney built alternative ‘pipelines’ to receive the selective intelligence they wanted to hear to fit their agenda, in so doing alienating the CIA and relegating its analysis function to obsolescence. Now Goss is making sure that the dysadministration does not have to bypass CIA channels, since they will be in accord with Bush policy. Tensions between the new CIA leadership and senior career intelligence officers have never been so poor; it will be fascinating to watch as they intensify even further under Goss and make the CIA even more irrelevant than it has already become…

GOP Pushes Change to Protect DeLay’s Post even if he is indicted on corruption charges, as appears likely. (Washington Post)

I am excitedly anticipating the new Malcolm Gladwell book.

We usually think a snap judgment is worse than one which is thoroughly considered. I fall into that trap; one of the most frequent complimentary adjectives I use in my posts here on FmH is “thoughtful”. Yet as someone who often makes snap judgments, I am reassured to think both that this process can be superior to a more deliberate thoughtful approach in some instances and that it can be refined further. It will be fascinating to read Gladwell’s take on this. Of course saying a Gladwell book is about snap judgments is like saying DNA is about eye color.

This MSNBC page reporting on a US Marine’s killing of a wounded and apparently unarmed Iraqi prisoner inside a mosque in Fallujah includes a link to NBC’s ’embedded’ journalist Kevin Sites’ video of the murder. And here is Sites’ weblog (“dispatches from a life in conflict”), which does not yet log the incident. [via boing boing]

“Most of the political debate in this country does not occur behind podiums but in backyards, bus stops and ball parks. This blog is an effort to give you – or at least those of you who agree with us – the arguments you need to convince others that you’re right.” [via Rafe Coburn]

Condi brings a record of failure to the State Dept. (Center for American Progress) A seriously flawed national security advisor, considered by some one of the weakest ever in that role, her sole asset is her loyalty to Bush, “whose sentences she can finish.” (New York Times)

Rice, recall, was inattentive to terrorism czar Richard Clarke’s urgent warnings about the severity of the terrorist threat prior to 9-11, and she was one of the primary perpetrators of the misleading dysadministration spin — a.k.a. lies — justifying the Iraq invasion. Since then, she has been a prime facilitator of the scare-’em-to-death stranglehold by which the dysadministration has sucked in the voters, perpetuating the notion of an imminent terrorist threat. Another former security advisor, Zbigniew Brzezinski, has roundly criticized her for her egregiously politicizing a previously credible advisory role. Also recall her smarmy and evasive testimony to the 9-11 commission after the dysadministration lost the battle to prevent her from testifying altogether.

Come to think of it, she is actually very good at her job, only it is not really that of a security adviser. She should much more properly be described as an insecurity adviser par excellence.

Bush’s new appointments have the flavor of circling the wagons, surrounding himself with his closest circle of advisors. I think the narrowing of viewpoints this will inevitably precipitate is dire news, as if there wasn’t enough already. Throughout the first administration, Bush and, perhaps more so, Cheney, were adept at filtering out concepts and evidence that did not fit preconceived notions and agendas. (It was this filtering out of what they did not want to hear at the top, rather than the faulty intelligence which is commonly blamed, that shaped the threat assessments leading to the invasion of Iraq.) Bush boasted that he makes his decisions by gut instinct instead of thinking. Now, the barriers to a completely thoughtless exercise of power are being swept away even more completely.

Separated at birth? Kevin Murphy’s first-rate weblog, Ghost in the Machine, shares a birthday with FmH. Happy fifth anniversary, Kevin.

Follow Me Here is five years old today, and I wish a happy weblogiversary to all of you reading this. When I started this, I actually set five years as a mental milestone to reassess whether this remained worth doing. I am pleased to say that I generally enjoy putting FmH out on the web more and more. I have found a voice I like here and am confident it has some value to my readers. Thank you for your continued support and encouragement. Sometime during the past year, I passed half a million page hits on FmH; here’s to the next half million. I look forward to many more years in your face.

The poet wrote me with some history of the poem, which I had posted after being given it by her sister, with whom I work.

“This poem was written in November, 2002, before the US invaded Iraq. It was read at several Peace Rallies, open mic poetry readings, and for a cable show in Hull, Massachusetts. It was also passed out at the January 2002 Peace March on Washington, and was handed directly to Representative Cynthia Mckinney and actress Jessica Lange.”

I hadn’t expected that the poem had been written prior to the re-election, for some reason.

“Wal-Mart amasses more data about the products it sells and its shoppers’ buying habits than anyone else, so much so that some privacy advocates worry about potential for abuse.” (New York Times) But, apart from the privacy concerns, you avoid shopping at Wal-Mart already despite the cost savings, right? There’s the fact that their enormous market share supports sweatshop labor; their union-busting exploitation of their employees; their leadership in the trend to lock after-hours workers into their stores, preventing emergency egress; and their destruction of indigenous businesses wherever they open…

Family values? Massachusetts has ’em in spades: “If blue states care less about moral values, why are divorce rates so low in the bluest of the blue states? It’s a question that intrigues conservatives, as much as it emboldens liberals.” (New York Times ) My wife and I, here in Massachusetts, were just struck by the fact that, contrary to our expectations, more than 80% of the gradeschool classmates of our two children come from two-parent families (although, scandalously, in some of those families the two parents are of the same sex!).

“Nothing kills Democratic candidates’ prospects more than guns. If it weren’t for guns, President-elect Kerry might now be conferring with incoming Senate Majority Leader Daschle.” — Nicholas Kristof (New York Times op-ed)

“By promising to appoint strict constructionists, Mr. Bush has embraced the mantra of every Republican president since Richard Nixon, who first made that promise in his 1968 campaign. Yet Republican presidents have largely failed in their efforts.

In the last 36 years, four Republican presidents have appointed all but two of the current nine justices.

But on the most contested social issues – abortion, affirmative action, school prayer and gay rights – the court has sided with liberals, while only modestly advancing the deregulatory agenda of the Republicans.” (New York Times)

And:

An Interview with Tony Campolo: “Speaking out on gays, women and more, a progressive evangelical says ‘We ought to get out of the judging business.’ Interview by Laura Sheahen (Beliefnet)

The coming war against sex: “You just know high-ranking members of the Bush administration stay awake at night thinking that somewhere out there people are masturbating, and they have to do something to stop it…” (Wired)

Most of the attention this has gotten on the internet stops right there, with the headline. The impression is justifiably chilling, horrible. But if you read on you find that the boy was “wielding a piece of glass and threatening to hurt himself, officials said Thursday.” As a physician, I am not familiar with the potential lethality of this ‘sub-lethal’ weapon when used on a child of 6. A quick medline search has nothing to say. And I am sure that the policemen wielding the weapon had no idea how ‘sub-lethal’ it might be in a 6-year old, never anticipated using it on a child that small. Insofar as the electric shock did not stop the child’s heart, did they ‘dodge a bullet’?

But assuming for a moment that it was not merely sheer luck that the shock did not kill him, he was efficiently disabled at a time he was potentially quite lethal to himself, having already cut himself on the face, hands and leg. The article takes pains to note that, while one officer shocked him, another grabbed him to prevent a violent fall to the ground. Perhaps this was, thus, lifesaving heroism in a desperate situation. I cannot underestimate the value of a minimally injurious way of disabling someone who might be on the verge of, for example, opening up an artery and bleeding out. It is pretty likely that a six-year old cannot appreciate the finality of death and the concept of the potential lethality a chosen behavior; some thinkers deny that there can be true suicidality in someone so young. Regardless of whether you believe that certain adults can make a rational decision to end their lives and that preventing them from having the discretion to do so is immoral, the same cannot be said in children; I believe that all self-destructiveness in children requires and justifies preventive action.

But unlike the usual authoritative posts on psychiatric topics to which FmH readers are accustomed, in which I lead with my confidence and opinionation in my chosen field, here I remain bewildered and befuddled. This turns out to be a deceptively complex and difficult situation for me to make sense of as a psychiatrist, someone who treats deliberately and inadvertently self-destructive people day in and day out. I cannot actually metabolize that this was a 6-year old who was so disturbed. Both as a psychiatrist who cares for adults and has seen most of the things adult psychopathology can throw at me (and has no training or experience in child psychiatry) and as a father, whenever I hear about such derangement in a 4-, a 6-, a 7-year old, I can only reel with incredulity. My hospital has a child unit, but I stare at the daily census in blank incomprehension when I read the ages of the kids hospitalized there. Does such a young child even have the capacity to be so disturbed on their own, or is it only in the eyes of the (adult) beholder? And, once conceived of as so disordered, does it have a self-fulfilling prophetic influence on their behavior? What must some adult have done to them for them to present in such a deranged fashion? And what would it take to ever conclude that your child’s care, no matter how out of control in acute crisis, needs to be abandoned to the hospital instead of your dropping everything to care for him at home (with professional assistance in the community)? Despite utterly believing in the premises of the psychiatric hospitalization of adults, something in me balks at extending those rationales to child psychiatric admissions, especially realizing that they are subject to the same managed care pressures and bastardization of psychiatric training that mitigate for cost-cutting measures, an inability to deliver nurturance and individual attention, and an obscene rush to overmedicate. (No, medication practices with children are not likely to change appreciably even with the new ‘black box warning’ of enhanced suicide risk associated with SSRI antidepressants…)

Grappling with this has me wondering, what if there were no such thing as a child psychiatry ward? Where would these children be? The opportunity exists to look at that issue since, with such a severe shortage of child psychiatry beds throughout the country, many kids in crisis are turned away from being hospitalized if any other setting will do.

(Some might make you sick to your stomach, in which case you might vomit and, if you aspirate some of your vomitus, develop a nasty aspiration pneumonia with possible dire consequences. So, National Review reader, if you were so inclined, you probably ought to forego buying this deck of cards, and leave them for the liberals who might treat them more reverently.)

Chronicler of 1937 ‘Rape of Nanking’ Dies at 36. Chang, who took an unflinching, breathtaking look at one of the worst human wartime atrocities of the modern age, and is the mother of a young child, took her own life by gunshot at 36. (New York Times) This is very very sad. She had struggled with severe depression and some around her have suggested that ending her life in despair was connected to the intimate examination she made of human depravity in her work.