The Last Psychiatrist

Gossip Girl Is Going To Corrupt Someone

2009-11-05T14:25:38Z

please let it be me, please let it be me

]]> Gossip Girl:

Will you now be complicit in establishing a precedent and expectation that teenagers should engage in behaviors heretofore associated primarily with adult films?

Wow. Do you really think that this is the best choice of words to sway the makers of a show called Gossip Girl?

II.

I can understand worrying that menages are being mainstreamed-- "Parents worst nightmare!" But there's a bit of ignorance here: teens don't watch Gossip Girl, they watch The Hills. The median age of the CW network is 34. Gossip Girl draws 2-3M viewers, 84% are women over 18-54, average age 27. Believe me, they already know about threesomes, and at least eleven have been in one (p<.00001)

III.

That said, the PTC does have a valid point, made terribly. Barely five percent of the TVs that are on at that time are tuned to the show; in other words, very few people watch it. Yet there isn't anyone who doesn't know about it, even if it's imagined based on magazine covers. So the airing of a menage episode mainstreams it for people who don't watch the show, and that's actually more powerful a cultural influence. i.e. If you're a fan of the show, the threesome is specific: those three people are doing it. For everyone else not watching, it becomes background noise: "oh, people are having threesomes now..."

This is why it is true that even if you are not interested in pop culture, pop culture is interested in you.

IV.

Look back at the PTC's quote at the top: the overly formal syntax is a set up, it's an organizational chart. They're the parents, reprimanding the adolescent network "who should know better" than to do that to their little sister audience. Obviously the CW isn't going to buy it, so in order for this to have any power, it has to be made public.

Hence, this comes from a press release.

The PTC asks, I assume without intending any irony:

Finally, you must ask yourself, how does airing this program serve your obligation to serve the public interest?

If the PTC's obligation is to try and get sex off TV, how does releasing a press release angry about "promiscuous and consequence-free sexual behavior", days before the episode airs, serve the public interest? Doesn't it just make you program your DVR? The press release got picked up by the news agencies and now it's everywhere-- the only reason I know there is a menage episode coming up is because of this letter.

The network's own promotions talk about the program as a 'parent's worst nightmare.' How many 30-year olds care what their parents think? Zero. Only a teenager would be responsive to a parental 'forbidden fruit' marketing ploy like that, and CW knows it."

Do they not understand, or do they understand perfectly well, that their press release far more contributes to the mainstreaming of "risky behavior" than the show itself? It's a question of branding: since the PTC is out of touch, anything they hate must be good. Once a brand is established, anyone can use it any way they want:

The PTC needs to read its own mission statement. They're upset not simply that there's sex on TV, but that the TV makes that sex more acceptable to society. Ok, fine, but then they should not be in the business of censoring TV, but in influencing cultural norms to not want sex on TV.

In other words, they should be doing it quietly, applying direct pressure on networks so that if they obtain the desired outcome, it appears that it came naturally. Otherwise, it looks like you are suppressing something-- and people will look for it; or it appears self-aggrandizing.

I have no personal beef with the PTC, but I am observing that the PTC, like so many other groups pressing for change, deliberately take approaches that fail (and have repeatedly failed--"mind blowingly inappropriate" is from 2007) and thus ensure their own existence. Worse, not only are they not effective, but their self-referential publicity makes it difficult for another group to gather members in order to legitimately try to effect change. If the PTC really cared about stopping sex on TV, then, oddly, the best way for them to do it is to disband.

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http://twitter.com/thelastpsych

50% of American Kids Receive Food Stamps

2009-11-03T15:03:46Z

Marx was right. America is finished.
]]> the study in the Archives of Pediatric and Adolescent Medicine, and was blown away. The data were solid: simple enough, just ask people if they'd ever been on food stamps, and count them.

30 years of household interviews, 1968-1997.

By age 20, 50% of all kids will have used food stamps at one time.

For black kids, the figure is 90%.

40% of kids in married households will have touched food stamps; it's 91% of kids in unmarried households.

The good news is that only 19% will use them for more than 3 consecutive years, which, of course, is also the bad news.

I was all set to be terrified about America's future, until I read the accompanying editorial, which reminded me of something someone said:

The bottom line is that the current recession is likely to generatefor children in the United States the greatest level of materialdeprivation that we will see in our professional lifetimes.The recession is harming children by both reducing the earningpower of their parents and the capacity of the safety net torespond. However, it is also essential to recognize that childrenhave been made extremely vulnerable to this recession by a decades-longdeterioration in their social position.

That something was: what does the author want to be true?

II.

In this case, while the results are technically accurate, they don't mean what it looks like they mean, i.e. that we should dust off Oliver Twist for a glimpse into our future.

Although the Food Stamp Program described in the paper is separate from the Women-Infant-Children (WIC) program, it appears that the study conflates the two. It's not relevant to the outcome of the study, so I'll simply focus on the WIC to show you why the headline is alarmist and misleading.

First, in determining household income, only the legal family is counted. The income of unmarried couples, grandparents, etc is not counted. This is true, e.g., even if the boyfriend is the biological father and he lives there or gives money.

Second, even though cutoffs for income are written as annual figures (e.g. $22,050 for a family of 4 or "185% of federal income guidelines"), they don't look at the past year's income, they look at how much the household is making right now, and then extrapolated.

Don't be fooled by "rate" of income. If you just lost your job, your rate is zero; you are eligible. And the next "mandatory" review is every 6 months. See you then.

Third: No proof? No problem.

Fourth: and more relevant to food stamps, a person can receive income from exempted sources (there are many);

Fifth: unlike unemployment, in which you have to "show" you are looking for work, food stamps aren't tied to need, only to nominal income. If you choose not to work (or choose to do volunteer work) and thus have no income, you're eligible. I'm not accusing people of abusing the system, but it is evident that some people would make adjustments in their behavior if food stamps didn't exist, rather than be committed to growth retardation and scurvy.

III.

There's also a bit of crazy, crazy math in play.

Nevertheless, only approximately 60%of those who are eligible for the program actually participatein and receive food stamp benefits. Consequently, it couldbe argued that the number of food stamp recipients representsan undercount of the total number of households in need of foodassistance.

So... 90% of America is in need of food stamps?

IV.

You will notice that I haven't used this study to make any judgment on whether food stamps is a "good" or "bad" program, not because I don't have a... nuanced... opinion, but because the study can't be used that way. However, it will be/is used precisely in that way.

It's troubling that, as scientists, it never occurs to the authors to objectively speculate why these figures might be erroneously high; in fact, they assume that they are too small.

Studies like this one are op-eds with numbers. They promote the particular bias of the doctors (read: social policy analysts) writing it. If 50% of kids get food stamps, then food stamps are necessary, end of story-- that's the point of the study. No politician in his right mind would dare question the implementation of such a program, let alone the need. In other words, it's not the the actual data that compels social policy, but rather the ability to say, "doctors have determined that..."

The press report interviews the author, the author of the editorial, and James Weill, "president of Food Research and Action Center, a Washington-based advocacy group." Gee, I wonder what they're all going to say.

I've many times remarked that doctors spin data to subtly impart their particular bias. Sometimes, however, they just yell it at you. Here is the first sentence of the each paragraph of the editorial:

Clinicians always inherit the results of bad social policy.
Children are poor because their parents are poor, a fact thatties the well-being of children to the employment status ofyoung adults.
Children are particularly vulnerable to the current recessionowing to the longer-term crisis in the American family's abilityto provide for its children.
In meeting the basic needs of children, the only real alternativeto the family is the state, an alternative that is increasinglyincapable of meeting the growing need.

And goes on like this, until the last paragraph:

Children depend upon political proxies to advance their societalclaims.

Note that he sets up the government not outside a family helping it, but inside the family, as a proxy parent, able to pick up the slack. Since the government has money, it looks like this works, and it seems crazy to say you want them out ("are you saying you want the government to stop handing out food stamps?"

But the populace is being trained to see themselves not as solely responsible for their children, but as part of a larger network of interested parties. That may sound comforting, but it radically alters behavior. It reinforces your connection to the state, as opposed to fostering your independence from it; and you become willing/obligated to sacrifice more and more in defense of the bureaucracy.

You Want To Be Don Draper? You Already Are

2009-10-29T20:13:36Z

One of these is Dorian Gray, the other is the picture

]]>
(Part 1 here.)

I.

Some say that the desire to be Don Draper is really the desire to live in a simpler time with established gender roles, a romanticizing the past. That's a girl talking. When a guy fantasizes about living in the Middle Ages or a different planet of Don Draper's America, they're not wishing for a different environment, they're wishing for a different movie. It's not the setting, it's the plot. No one wants to live in 500 AD; they want to be in King Arthur's court, with a certain kind of adventure, or relationship, or... they want to be somewhere where most of the plot is already known: I want that to happen to me.

Even when it's a real historical time, even one as well detailed as the one in Mad Men, what you want isn't to be alive then, but to be in that show. They want a movie in which the main character (you) already possesses a character that everyone accepts (you don't have to be like Don Draper, you are Don Draper, and everyone knows you as that kind of person), act in any way you want; and though there will always be consequences and miseries and laughter and whatever, no matter what happens it always happens about you.

II.

A key plot point in Mad Men is that Draper's coolness and masculinity is artificial, it is an act. That's fine, everyone has an act of some kind, why not be cool? But when you choose your own act, be careful you do not choose to act like someone else who is themselves acting.

This is why, whenever someone tries to affect the style and mannerisms of a character in a movie that other people have seen, it makes the other people cringe; it always looks horrifically fake. We already know what the original looks like. If you're get on a bus to go to a sci-fi convention and are dressed like some kind of alien, you're judged by the, well, coolness of your costume. But if you dressed like an existing alien-- like a Dalek-- people on the bus will think you're an idiot. The better your costume, the more people will hate you.

It's even more difficult to emulate Don Draper, because Don Draper is already emulating something else (forget about Jon Hamm for the moment.) Draper (on the show) can get away with it because no one is familiar with what he's pretending to be (some construct in his head) so they can believe it's really him. You can't be Draper because we already know Draper.

Being someone else is very hard. Sometimes, even if you are actually who you say you are, it can still be fake. When an aging rocker tries to dress all cool and rock starry, it's creepy, because even though he is authentically a rock star authentically himself, he is still faking it: he's pretending to be who he was 30 years ago. We already know who he was 30 years ago, and that's not him now, so this impersonation is obviously, pathetically fake. Stop it.

The only time we tolerate this is if we are at an aging rock star's concert: because we're all aged by that point, and we'd all like to pretend, if only for a little while.

It goes both ways. Don Draper is 36. If you are 26, is there any way you could be Don Draper and make it legitimate? It only works if you're in your late 30s, because the game he is playing is "I've seen it all." You haven't. You can't fake it, any more than you can fake playing the guitar. It's fake. She can tell. She may not tell you, but she can tell.

III.

"Can't I just borrow some of his characteristics?"

I know, it helps your social anxiety; I'm pretty sure no one wants to be Don Draper because they think it will help them pass a midterm. Ok, so what will being Don Draper get you?

Suave? Cool? Sophisticated? Because I've written those three words, it appears that those are three things you could copy. But Draper doesn't actually possess those three things, he is conveying those three things. He has branded himself as a guy with those three things; just as Nike has branded itself as a certain kind of shoe that isn't made of inferior leather in a sweatshop. Draper the brand is a guy with a nice suit, but that suit is a brand, too (Hickey Freeman?)

Note how uncanny it is to see him in bed in the morning, without a suit.

If you want to emulate Don Draper, you will get the same exact outcome a) if copy his persona but wear your clothes, and b) if you wear his clothes while keeping your own persona. They're all brands, they're all equivalent, and no matter what you choose the girl will figure it out the moment she purchases you.

"No, you're wrong, you've misunderstood me, I feel like you're almost giving me an answer, but you're missing something, you're not getting what I'm asking. He is cool and sophisticated. That's why he can pick up girls so easily. I want to do that, I want that secret."

You can't emulate Don Draper, and you think the problem is that I've misunderstood?

I understand you very well, I've seen you in action. When I'm in a bar-- and I have been in a great many bars-- I watch the show. Life has become so much a copy of TV that I sometimes forget to pee because a commercial hasn't come on. In one show I watched you were standing with a beer, staring but not staring, talking with your friends about things that interest you, but trying to figure out the right conversation to have with the girl across the way who probably would not be interested in those things. I saw you. I saw that there were the female equivalents of you in that bar, too, but you didn't see them.

In every case the problem is the same: you don't want what you think you want. And the type of girl you think you want sensed this the moment she saw you. That's why she was pretending she didn't see you. Or did you think hot girls have no peripheral vision?

IV.

So you want to be Don Draper? You are. No, that's not a motivational speaker's empowerment mantra, it's a sad, unfortunate truth. Or a warning, if you choose to listen.

Look at your suave, sophiticated, masculine Don Draper. He married a beautiful woman; you will, too; and like him, when you get her you won't be happy.

But forget about marriage, who has this well hung lothario seduced? Has he had affairs with sexy secretaries, bedded underwear models?

No, he's had none of that; the three affairs he's had in two seasons are a hippie artist with numerous other men in her life that she likes more than him; a beautiful owner of a department store-- hardly one night stand material-- who actually hopes it is going to turn into a marriage; and a woman as marginal as she looks. These are the conquests of the great Don Draper. Real women, to be sure, but none of them are who you'd want, right?

And in every case, these women dump him the moment he reveals to them the black, infinite, starving neediness inside him. "I need you now!" he says to his mistress. She does not mace him because it had not yet been invented.

Don Draper is that worst of all possible men. Cosmo warns its future starlets to beware the heartbreaker, but what girl doesn't want her heart to get broken by a great guy? None of Draper's conquests have their hearts broken; they have their spirits broken. He's not a cocksman, he's not a player, he's not a ladies man. He is a serial monogamist, incapable of committing entirely to one person, but similarly incapable of at least committing to the playful lightness of physical intimacy and then just taking a nap. At least she'd know where you stand. They destroy the lives of everyone around them not limber enough to leap out of the moving car. Tuck and roll, that's the secret Cosmo never tells you. Tuck and roll; but at least get out; he is driving you nowhere with a full tank of gas.

These men stay with the girl-- sometimes for years, without cheating-- but their inner eye is always on something else. No matter how desperately they think they love, they also know, simultaneously and without contradiction, that they're not really in love, and that this, too, will pass. They are immortal; there is always a future, because... because this can't be it. But they fear the future, so instead of pursuing it, they wait for it, along with the girl they've handcuffed with inertia.

These men are already Don Draper, they think because they lack his facility with gab they aren't-- but in every way that counts, at a genetic level, they are the same. If you want to see how it all turns out, watch the show.

Now maybe you understand: when a guy with moussed hair and a seashell necklace starts staring at the girl's chest and rubbing his own, it must feel to her like some kind of immense relief.

The New York Yankees: Mission Accomplished

2009-10-26T14:04:09Z

The House that George built.

]]>
I hate to say this, but we simply don't deserve to win.

The Yankees have made some serious mistakes in the League, and they've never taken any responsibility for them. Yankees fans ignore the mistakes, forgive the missteps, and turn a blind eye to everything, simply because it's their team. They conveniently forget the 80s, the steroids, the domestic violence, the racism. They're nothing but fans.

The reporters are equally to blame, they have completely given up on objectivity. Ever since they were allowed to travel with the players and enter their lockerrooms, they've become extensions of the teams. They seem objective, but all they care about is maintaining their privileged access to the players, and if that means doing a fluff piece on A-Rod boning Kate Hudson instead of looking into Congressional perjury charges, well... It's sickening, we should be ashamed, but we're not. And they call Erin Andrews a reporter? She gives new meaning to the word embedded. They use her breasts to hide the fact that she's just a cheerleader which I realize doesn't make any sense, but that's what's stuck in my head. You know?

No one seems at all concerned that the guys who call the games are all former players and coaches. No one calls them out on the obvious conflict of interests. You read about a game or listen to it on the radio, you think you're getting objective information, but how do you know? "Strike 3!" Really?

No one seems surprised that the national newspaper of record is called the New York Times. Hello? Is anybody getting this? I'm sure the Houston Chronicle has a different perspective, but we deliberately suppress other viewpoints. I challenge you to even find a copy of the Houston Chronicle anywhere in the city. Try and write a story about how power is being transferred from Steinbrenner to his sons, and see if you're ever allowed in a ballpark again. So much for discourse. So much for dissent.

Most Yankees fans are completely blind to the fact that the rest of the world hates us.

If nothing else, the Yankees have been guilty of arrogance. What makes us so great? That we have more money to spend on their team? We may have a superior record, but that has to be looked at in the context of our ability to spend more money. The Yankees can just buy whatever talent they need. And Yankees aren't smarter or more sophisticated than other players, they just have better equipment, better facilities. How the hell are the Mariners going to compete? It rains there constantly. The Yankees are just steroid fueled schoolyard bullies. The Yankees are the United States of baseball.

Funny how while we're busy destroying every other team, we ignore the fact that our players all come from those other teams. It's not like we have any native talent, we're a ballclub of immigrants. But you won't hear that on ESPN.

Let's not forget a fundamental truth: yes, we're New Yorkers and we love the Yankees, but that's an accident of history. If we had been born elsewhere-- if we were born in Houston, we'd be Astros fans, and every time a Yankee got pulled over for a DUI or got their head taken off by an errant fastball we'd ejaculate in our pants.

If we want to be respected throughout the world, not just feared, we have to come together, come to understand that we're not just Yankees, but baseball fans, and we have to respect that unity above all.

Look, what happened in 2001 obviously was a tragedy. Of course I'm not saying I'm happy Arizona decimated us 4 games to 3, I'm not saying I want it to happen again, I'm not saying we deserved it, but... I understand.

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http://twitter.com/thelastpsych

Shouting vs. Spanking

2009-10-23T10:59:51Z

Fake, fake, fake, fake...

]]> NYT:

"I've worked with thousands of parents and I can tell you, without question, that screaming is the new spanking... As parents understand that it's not socially acceptable to spank children, they are at a loss for what they can do. They resort to reminding, nagging, timeout, counting 1-2-3 and quickly realize that those strategies don't work... they feel frustrated and angry and raise their voice. They feel guilty afterward, and the whole cycle begins again."

The article describes parents who (of course) wouldn't spank their kids, who thus end up yelling.

Psychologists and psychiatrists generally say yelling should be avoided. It's at best ineffective (the more you do it the more the child tunes it out) and at worse damaging to a child's sense of well-being and self-esteem.

This is absolutely TERRIBLE advice.

II.

The problem is neither the yelling nor the spanking, the problem is when. When these parents yell or spank, it isn't in response to intrinsically bad behavior, it is in response to behavior that burdens the parent.

Note what it is that causes them to yell:

She can emulate one of those pitch-perfect calm maternal tones to warn, "You're making bad choices" ... That is 90 percent of the time. Then there is the other 10 percent, when, she admits, "I have become totally frustrated and lost control of myself."
It can happen... at the end of a long day at home -- just as adult peace is within her grasp -- when the 7- or 9-year-old won't go to sleep.

"I'd like to think that most of the time we have a good interaction based on reason," Lena Merrill said of her 4-year-old daughter, whom she has never spanked. But then there are the times when "she's done something like poured milk on the floor or ripped a page out of a book," Ms. Merrill said. "I just lose it."

The yelling isn't just disproportionate to the behavior, it has nothing to do with the behavior. She's angry about other things, but she's yelling about the milk.

The kid has learned nothing about good and bad behavior. In fact, they've learned that "bad behaviors" merit only calm discussion, while things that annoy Mom or Dad are met with wrath.

Watch your kid: are they more terrified of your reaction when they are caught in a lie, or when they accidentally knock over a glass?

The natural thing to do would be to yell about bad behavior ("did you push that boy on the playground?!?!") and be calmly annoyed when they spill milk. But.

III.

But that doesn't happen, because the parent isn't being honest.

I recognize it's done with good intentions, but pretending to be calm and reasonable "as much as possible" is neither honest to yourself, nor helpful to them: no one else on the planet is going to treat your kid that way.

Two-thirds of respondents named yelling -- not working or spanking or missing a school event -- as their biggest guilt inducer.

Read the article: the parents' reactions are all of guilt. But it isn't guilt, exactly--

"Admitting I'm a mom that screams, shouts and loses it in front her kids feels like I'm revealing a dark family secret."

--it's shame. Their yelling reveals them. Their carefully maintained identity (of sensible uber- parent) is revealed as a facade. And the facade isn't in service of the kid

...as parents understand that it's not socially acceptable to spank children, they are at a loss for what they can do.

but in service of their identity of "good parent." But they get exposed, turns out they aren't as rational as they thought-- they yell over spilled milk.

IV.

Consider a mom and a kid in a toy store. The kids starts whining about buying something. He gets loud. The mom hisses through clenched teeth, "wait till I get you home."

I understand she's frustrated. But why is she whispering it? At home she would have yelled, why not just yell now? She's willing to carry the anger by car to another location-- is the behavior that serious?

She's whispering because she's embarrassed, not at the kid's behavior but about what it says about her as a parent to onlookers. And she's even more embarrassed by her reaction. She can't let other people see her rage when it appears to other people that it is only about a kid wanting a toy.

But if she catches the kid stealing, then she'll let him have it, right there in public, because then there's no shame in her yelling-- it reflects well on her.

The yelling isn't the problem, the problem is that yelling is used for the wrong things.

V.

The single problem of modern parents, mothers and fathers alike, is that they are trying to be something-- "good parents" (an identity construct) and not doing what is good for the kid only for the sake of the kid. (I look forward to your emails.) They may be doing good for the kid, but they are also trying to reflect themselves as good parents, they are also considering their shame. That cannot work, ever. The kid will sense this, and the lesson they will learn is that there is no absolute right and wrong, only pleasing the boss.

I'm not judging you, untoggle the caps lock, I am trying to help you understand where it all goes wrong.

If the parents had simply been real-- angry when something angers them, more angry when it is worse and less angry when it is not as bad--they'd feel better, and their kids would learn much better life lessons. If they showed frustration when they were frustrated (and labeled it: "this is frustrating me!") and disappointment other times and rage for the big things-- instead of holding it in and then unloading-- they'd be much less stressed and the kid could learn to mirror a range of emotions, instead of acting out. "He bites for no reason!" There's a reason.

But I have asked a generation of parents raised by amazingly bad parents in 30+ years of a preposterously self-absorbed media environment to forget everything life taught them and be real.

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http://twitter.com/thelastpsych

How Am I Going To Get Paid If It Isn't Autism?

2009-10-21T07:43:27Z

But many children whose symptoms significantly differ from classic autism--who belong only on the milder end of the autism spectrum, if they belong anywhere on the spectrum at all--are inaccurately ending up with serious autism diagnoses.

Wait: it isn't what you think.
]]> The Atlantic, Behind The Autism Statistics:

So parents whose kids' challenges are less severe are often urged to accept a full-fledged autism diagnosis, as otherwise they would lose access to state-funded treatment, and might, down the line, end up ineligible for support services in public school. The result is that the autism statistics grow and grow.

In diagnoses without obvious physical pathology (i.e. anything in the DSM), doctors often give a diagnosis to a person with the express purpose of getting them benefits, e.g. Medicaid, school supports, etc.

The Atlantic hints at one side effect of this: the national statistics for psychiatric diagnoses may be inflated. I'll editorialize: not maybe, but absolutely are; we can't get paid un;ess we bill a diagnosis. In the chart we may write, "rule out MDD" and in the note indicate they were normal, but epidemiological studies don't read notes; they take billing diagnoses or look at the listed Axes.

This is compounded by "awareness"-- as more people hear about a diagnosis is, and they come in for an eval, their very presence contributes its prevalence even if they are told they don't have it.

II.

The Atlantic spends the bulk of the space lamenting the inappropriateness of the diagnosis:

[Dr.] Greenspan told me on the phone, (and later on camera), "Basically we have to misdiagnose these kids to get them help." It's the wrong help sometimes, but it's the only way to get state funding.

The concern isn't the state funding, but the odd way the government, e.g. Medicaid, covers treatments. There are "approved treatments" for autism; any other treatments are out of pocket. However, if you're not sure of the epidemiology, then you're not sure of anything else like treatment or sequelae. If the autism stats are skewed by the presence of kids with something else other than autism, then how can anyone say with any usefulness that "studies have shown that treatment X is effective"? How can any government tell you what the best practices" are?

The article talks about Sensory Processing Disorder-- if the kid has it, he has to get an autism diagnosis to be eligible for services, except

...while [the child] was making some progress, the therapy didn't seem to be addressing his biggest problems, which involved motor challenges and sensory issues, rather than the kinds of social impairments typical of autism.

I know very little about this diagnosis or its treatment. However, it's logical and obvious that its inclusion in autism will make a) autism treatment seem less effective; b) SPD treatments untestable.

III.

The article, and the supporters of "autistic-like" disorders, take (IMHO) the wrong tack: they want "Sensory Processing Disorder" to be included in the DSM, "which would turn it into an official diagnosis that would come with much-needed help."

That's the wrong approach, because it legitimizes the government's use of the DSM, and so every new treatment will have to wait for their blessing. The better approach would be to provide coverage for treatments based on the recommendation of a treatment team, within the limit of a budget. Instead of saying, "we'll cover this treatment at $120 a session but not this other", simply provide $120/session for any kind of treatment suggested by the team.

IV.

Here's the most important secret about Medicaid and Medicare: it isn't about improving health, it is about paying people off.

While the kid described above can only get the "approved" treatments for autism, he can get the approved treatments for every other condition as well: surgery, eye evals, antibiotics for infections. In other words, his "autism" got him full health insurance.

Medicaid requires a "disability" and a very low income. The income of the child's parents is irrelevant. All kids with a "disability" (e.g. ADHD, depression, etc) are eligible for Medicaid and its services. A child can get physical therapy, occupational therapy, speech therapy, not to mention a prescription plan, doctor visits, etc -- all for free; never mind that the "child" goes to Eaton. Certainly the parents' private insurance might cover these things but it might not. Maybe the Dad owns a restaurant and doesn't want to pay for insurance.

If you have a 25 year old unemployed actor for a son who lives rent-free in your house and spends your money on chest waxing and self-tanning cream, and he can get a doctor to believe this depresses him, he can get Medicaid.

Because a disability has to be verified by a doctor and updated over time, the patient's only way of maintaining the coverage is to use it. This happens all the time. Patients will come once a month for visits, fill the Zyprexa prescription and then throw them out-- all to maintain their benefits.

Before you get angry, understand that this isn't a loophole, it is the point of Medicaid. For a myriad of reasons we do not have universal (not single payer, but universal) coverage, which would have the (seemingly) paradoxical result of reducing healthcare costs. But, surprisingly, we have a lot of poor people in the country. The government has found a way to transfer to them just enough money and services to keep them from rioting, without calling it a transfer, without calling it socialism. Simultaneously, it manages to pay doctors, hospitals, employers (through tax breaks), etc. Where is all the money coming from?

Debt.

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A Boy With SPD?

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http://twitter/com/thelastpsych

Wolf Blitzer Is Not An Idiot

2009-10-19T06:23:59Z

It's much worse than that.

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Then it is learned that the family are "storm chasers," they had previously been on a reality show called Wife Swap, the boy's name is Falcon and the dad looks like he's trying to look like another storm chaser:

But the jig is up. In an interview with Wolf Blitzer, who asks the child why he didn't come out of hiding when he knew people were looking for him, he looks at his mom and dad and says, hesitatingly, "you guys said... we were doing this for the show."

But Wolf doesn't pick up on it. The father ("oh, man") muddles through the interview-- he's waiting for Wolf to start yelling at him. But it never comes, 900 monitors in The Situation Room's and Wolf Blitzer misses the obvious. The interview finally ends.

There was a flood of emails, apparently, and Wolf gets the family back for a follow up interview, "can you explain what the boy meant?" but by that point the father has had a chance to straighten the kid out.

The conclusion is: The whole thing is a hoax, and Wolf is an idiot.

II.

The other conclusion, if it hasn't already occurred to you it will before you finish reading this sentence, is that Wolf did pick up on it, but let it go anyway.

Here's an analogy, which may seem imperfect, but follow it through. The analogy is when a coworker walks in on two people who are calling him a jerk. Rather than confront the coworker, he pretends he didn't hear it. So now everyone knows he heard it, but everyone is pretending it didn't happen. It's not fear of the other guy, it's a fear of changing the delicate balance of the work environment. All he wants is to get through each day, he didn't ask for drama, he didn't ask to get involved in office politics. None of that stuff matters; the goal is to hold your breath, get paid, go home.

So whenever they pass each other in the hall, they're not just civil, they overcompensate. "What did you do this weekend, anything?" "Oh, I went down to the bay, my father in law's got a boat." "Yeah? Do you do any fishing?" etc.

They both know it's fake; they both know they hate each other. But if they want to keep working there, if they want the job to get done, then they're both going to have to pretend the thing didn't happen, to play their respective parts. The show must go on.

III.

While people are saying Wolf missed the obvious, in fact it is evident he did not. Here's exactly what was said:

Boy: You guys said that we did this for the show.
Wolf: I- I- I heard what he said-- but I'm not-- it wasn't really clear what was his reasoning why he... he heard you screaming Falcon, Falcon, and I'm sure he heard his mom screaming Falcon, Falcon, but why didn't he come out of the garage at that point?

What happened is that Wolf was in the middle of a story some people suspected was a hoax, but was still being reported as a "thank god he was hiding in the garage" drama. So he tried to protect the story. He tried to pretend he missed the comment so that everyone could go on with the story as it was being told.

If you agree with this, then you have to also face the fact that Wolf didn't consciously plan, "no matter what happens in this interview, I'm going to cover it up"-- it was a reflex, an instinct. Get a drink, think about this: a reporter's instinct wasn't to go for the truth, but to go with the scripted story.

You may think that I'm too much with the rum or too hard on Wolf-- "he seems like such a nice man" but it's not Wolf's fault. He's a cog in the Matrix. The next day Meredith Vieira interviews the family live on the Today show. While the father is denying to her it was a hoax, the boy suddenly says, "mom, I need a cup" and vomits. Vierra's response to this is nothing. Forget about the implications of the boy's vomiting, she does not even acknowledge that he vomited. Is she heartless? No. She's flustered: her instinct is to preserve the show, like a stage actress, keep the scene going no matter what else happens.

Now take your favorite political issue of the past, oh, I don't know, 25 years, think about all you think you know about it, think about where you truly learned it-- don't lie to yourself, go ahead and google the phrases you use in your arguments and see where they came from-- and despair.

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http://twitter.com/thelastpsych

The Neurobiology of Wisdom

2009-10-16T14:55:59Z

It's always in the last place you look. Does psychiatric practice make us wise?

We also integrate our complex observations and findings with the rich collage of each patient's unique cultural, religious, and educational background. We strive to find hidden or higher meaning in patients' symptoms... We assess their potential lethality toward themselves or others and examine the often tortuous course of their existence. And, unlike other physicians, we observe their transference toward us and simultaneously examine our own countertransference

etc. What can be said? The article is self-aggrandizing wishful thinking, the kind of thing you expect from a bass player when he tries to convince a girl that his instrument is the most important one in the band.

The article could be ignored, if it didn't take a tragic turn off a cliff in the final third.

The wonder of psychiatric practice is that we somehow navigate each patient's unique jungle of thoughts, emotions, behaviors... By doing so, we develop different regions or circuits in our brains than surgeons, radiologists, or internists do. Meeks and Jeste's wonderful article about the neurobiology of wisdom suggests that psychiatrists' brains probably develop "wisdom circuitry" via advanced neuroplastic connectivity in the:
prefrontal cortex (for emotional regulation, decision-making, and value relativism)
lateral prefrontal cortex (to facilitate calculated reason-based decision-making)
medial prefrontal cortex (for emotional valence and prosocial attitudes and behavior)

I hope that readers of this blog can now see through this inanity. This is no longer just wishful thinking; it's an outright lie. I don't need to read Meeks and Jeste's "wonderful" article to know that there is absolutely no way they suggest that psychiatrists develop wisdom circuitry of any kind, let alone through the three made up pathways (aren't they all just the prefrontal cortex?) he lists in bullet points ("I've summarized the points you need to know for the test with bullets.")

Nevertheless, there's Nasrallah's article. You don't realize how significant it is: it becomes another article listed in the superscript of references no one looks up, supporting statements like "there is considerable evidence that..."

II.

It's not all Nasrallah's fault: he saw porn and couldn't look away. The Meeks and Jeste article he references has a catchy title-- The Neurobiology of Wisdom-- and it's in the Archives of General Psychiatry. But Meeks and Jeste's article isn't just bad, it is horrendous. It's the research equivalent of a sarin gas attack. Everybody dies, nobody can tell why.

It would be impossible to list all of the specific problems with the paper. As proxy, here's the quote at the beginning of the article:

Of all the pursuits open to men, the search for wisdom is most perfect, more sublime, more profitable, and more full of joy.--Thomas Aquinas

That the six letters w,i,s,d,o, and m appear in that order is the only similarity between the "wisdom" sought by Aquinas and the one pursued in this article. While this might seem like an academic or minor quibble, it's not: the purpose of the paper is to conflate "wisdom" with a set of characteristics that have nothing to do with wisdom at all, and claim a biological link. The article studies the color red and finds there "the essence of NASCAR."

The pursuit of wisdom for Aquinas was the pursuit of ultimate truth or cause; the article uses the term as a relativistic judgment on behavior. Here are the six components:

(1) prosocial attitudes/behaviors,
(2) social decision making/pragmatic knowledge of life
(3) emotional homeostasis
(4) reflection/self-understanding
(5) value relativism/tolerance
(6) acknowledgment of and dealing effectively with uncertainty/ambiguity.

Don't fall into the trap: though these may be positive attributes, only (4) has anything to do with wisdom as defined by Aquinas, or even as described by one of the references they use, e.g:

reasoning ability
sagacity
learning from ideas/environment
judgment
good use of information
insight

Spend a moment and think about the difference between the two "wisdoms." But don't spend too long: the article takes the first group, finds a poor proxy for each, muddled by fashion and politics, and reviews the neurobiological data for those.

III.

Here's the first one:

One of the most consistent subcomponents of wisdom, from both ancient and modern literature, is the promotion of common good and rising above self-interests, ie, exhibiting prosocial attitudes and behaviors...

"Common good rising above self-interests" would make Ayn Rand stab a harp seal; but regardless of what you think of Rand, it's at least evident that this isn't at all "consistent" in the definition of wisdom. Or are there no wise capitalists? But accept it and follow the logic to your doom:

...such as empathy, social cooperation, and altruism.6 Thus, sociopaths, who may exhibit exquisite social cognition and emotional regulation that actually facilitate their selfish motives, would not be considered wise.

So selfish is not wise. Ok, I get it.

Altruism: Altruism overlaps with cooperation, although altruism is notable for the potential harm or "decreased fitness" the altruistic person risks to help others.55 Harbaugh and colleagues56 demonstrated that the idea of voluntarily giving money compared with that of paying taxes... caused increased activation in reward circuitry... Similarly, Moll et al57 reported that both receiving monetary rewards and deciding to donate money activated ventral and dorsal striatum. This somewhat paradoxically suggests that the neural substrate of altruism may be akin to that of more instinctual self-pleasures.

I defy anyone to tell me how that paragraph describes altruism as putting the common good above self interest. If altruism makes you feel good, then it doesn't rise above self-interest. I'm not saying altruism isn't valuable, only that if it is valuable because it rises above "selfish motives" selfless, then the research suggests it isn't valuable (modus tollens).

IV.

In order to illustrate what this paper did, I'll explain it backwards: regions in the brain typically thought of as "reward centers" were seen activated in studies of donating money; the giving of money is thus labeled altruism, which, being a selfless activity, is "prosocial," which, of course, is a component of wisdom.

Hence, one can write the following sentence: "There is evidence showing a neurobiological basis of wisdom."

V.

The entire article is like this. One more example:

Value Relativism/Tolerance: Tolerance of other persons' or cultures' value systems is often considered an important subcomponent of wisdom.

Oh my God I need a nap. Is this really true? I'm not asking if desirable, I'm saying is Julius Ceasar not wise? Odysseus? Any of the Indian killing Founding Fathers? Or are they wise except for their wanting to take things over?

Brain Localization via Neuroimaging. Neuroimaging studies of tolerance have frequently focused on prominent societal prejudices, especially those related to race/ethnicity. Some investigations have demonstrated that the regulation of "automatic" prejudicial responses follows a neurobiological pattern similar to that described for impulse control: dorsal ACC detects an undesirable attitude surfacing, prompting lateral PFC inhibition of undesirable attitudes, and leading to downstream amygdala deactivation.122-123

First of all, the paragraph tells you these studies are about automatic race bias, e.g. does the picture of a black face make you think of the gun or the hammer? But what does that have to do with "tolerance of value systems?" Nothing, as they admit in the next paragraph:

While sharing rudimentary neurobiology with impulse control, value relativism is conceptually more complex and its study would benefit from the development of novel measures/tasks.

Here's the point: since you admit that paragraph doesn't support your argument, why do you even write it down? Because then you can say:

Summary. Dorsal ACC and lateral PFC play important roles in tolerance of varied value systems by detecting and inhibiting, respectively, expressions of prejudicial responses.

VI.

One might now ask, "why was this paper even written, let alone accepted for publication?" Go back to the quote:

Of all the pursuits open to men, the search for wisdom is most perfect, more sublime, more profitable, and more full of joy.--Thomas Aquinas

Note that they dropped the "Saint." Meanwhile, there's no problem referring, a few sentences later, to Ghandi as "Mahatma." That's okay, because no educated person actually thinks Ghandi is a saint, but there are still plenty of numbskulls who think Aquinas is.

Cultural narcissism; the prevalence in science of "end of history" guys who think this time is different than all others, everyone who came before was stupid, naive, myopic, or less ethical. The authors may even be good Catholics, who knows, but they know philosophy was just marking time until the invention of the MRI. Summa Contra Gentiles becomes, well, a footnote.

They don't realize that their belief in the "neurobiology of wisdom" is nothing more than faith, structurally no different from Catholicism: a hierarchy of beliefs with no foundation in physical reality, and an endless stream of words.

But Catholicism doesn't call itself a science; and Aquinas at least had logic on his side.

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Previous post on the overreach of neuroradiology

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Summa contra gentiles, from where the quote was taken, was Aquinas's discussing "wisdom" using arguments of reason, not religion:

Some of the Gentiles, such as the Mohammedans and the pagans, do not agree with us on the authority of any Scripture by means of which they could be won over--in the way that we can argue with Jews by appealing to the Old Testament and with heretics by appealing to the New Testament. But they accept neither the Old nor the New Testament. Therefore, it is necessary to revert to natural reason, to which all are compelled to assent

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http://twitter.com/thelastpsych
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Don Draper Voted "Most Influential Man"

2009-10-15T20:21:34Z

The most important thing to understand is this: Don Draper does not exist.

]]>

On just about every level, the show's protagonist is a jaw-dropping example of what so many men try -- and often fail -- to be.

That would be a man, a real man; not a man-boy

...[who are] are much more boy than they are man, obsessed as they are with fast food, video games and bodily functions. If the mainstream media is awash with representations of perpetually pubescent males, then Don Draper's masterful manhood stands in stark contrast.

II.

One might think it ironic that this brand of retro-masculinity is being honored by a site that that itself caters specifically to "perpetually pubescent males." It's no accident, it's website bait, like putting pictures of girls in bikinis. The type of person who wants to be Don Draper is squarely in AskMen's target demo. If you're watching it, it's for you.

I understand the appeal, why someone would want to be Don Draper. But I'm going to try and explain why you shouldn't. This post isn't for everyone: you know who you are.

III.

Don Draper is a narcissist. That's not an assessment, it's the premise of the show. The definition of a narcissist is one who creates an identity and prizes it above all other things, every moment of existence is spent perpetuating that identity, trying to get everyone to believe it. That's Don Draper. The show gives him an interesting back story, but the key element is that the man at the ad agency called Don Draper is a constructed fake identity, one which he protects zealously. Nothing else carries that much importance.
And like all narcissists, Draper isn't pretending; he's convinced himself that's who he is. He often sabotages his job, health, and his relationships with only transient anxiety; but when his real/original identity is threatened to be exposed, he almost goes bananas.

The ultimate goal of narcissism is not just to get everyone to accept the identity, but to get everyone to perpetuate it. He wants to be a brand. He wins when people confirm the brand even when he's not around, like when someone on a train says to another, "Dell makes the clearest flat panel monitors around." That guy's reinforcing the Dell brand. Never mind they are all made by Samsung.

Neither does narcissism care about being liked, only about being branded. You can hate the taste of Fiji water, as long as you concede that that horrible taste is the result of the water being too pure and from Fiji. The fact that you hate it is an advertisement itself; it supports the brand as something that the kind of person you are wouldn't like.

On the show, the office staff regularly discuss Draper's exploits and characteristics, always in the same way. People may like or hate those characteristics, but no one disputes the characteristics. Campbell, indeed, hates him for these characteristics.

IV.

Don Draper (the character) wants everyone to believe his persona. Well, it worked; not only do the readers of AskMen believe it, they want to emulate it.

You think it's passive on his part; he's hyper cool, and you want to be like him. Wrong. He's trying to con you into thinking that. He's voted Most Influential not because he has enduring qualities worth being influenced by, but because he is trying to influence you.

"You're getting way too abstract. I just like how cool he is, that's all." This is what I'm trying to tell you. He's not cool, he's pretending to be cool.

V.

"I don't want to be Don Draper, just the old time masculinity he represents." Don Draper doesn't represent that, he's faking it. Look at the show: how come in a show set in those "old times," there aren't any other "real men?"

"Ok, fine, but he is masculine, strong, suave..." You're saying something you don't even believe. If you met Don Draper at the company picnic, would you think he was a real man? Would you want to emulate him? Would you want to take over his body and life?

"Well, certain characteristics..." Now you're almost there. You want to be an a la carte version of Don Draper. You want to pick and choose the good parts. When he's voted Most Influential, they mean only the iceman, suave, sly, creative, "masculine" Don Draper. That's not a person, that's a brand image. If you hired an engineer from Dell because you like how they built the monitors, you hired the wrong guy.

VI.

"But I want to be a ladies man like Don Draper. Back then it was easier, because affairs were more acceptable."

No they weren't. Leaving aside morality, cheating on your wife means that you haven't fully connected to her, or have lost some of that connection. You don't have to be Don Draper to pull that off. "Well, I want to be as suave as he is, I want to pick up girls like he can." It's the same disconnectedness. You could do it, too, then you'll lose the ability to be deeply connected to someone. You can't do both simultaneously.

Consider a guy in 2009 who says he can't meet women in bars. The biggest mistake guys make when trying to meet women is being overzealous, overinvested. They are unable to differentiate a one-night-stand from a full relationship. They approach both in the same way. When you're trying to get laid, you can't be trying to show her your soul, and you can't be trying to see hers. It has to be light, fun. The "pick-up tricks" work because they delay the guy from doing what comes naturally, which is being stupid, dropping all 52 of his cards in her lap and saying, "see?! I'm worth it, I think!"

This is why many men who actually get what they think they wanted are still unsatisfied. They meet a hot girl and it turns into a relationship, and they're upset they can't get one night stands. But if they got a one night stand, they'd be upset they couldn't convert it to a relationship (and of course it would be her fault for being a slut, not knowing what she wants, etc.) You can't have it both ways.

Here's how the logic disintegrates: if you're at a bar and see a woman with a tattoo on her tailbone and big hoop earrings, we can all agree, given the right circumstances, she'd probably be up for a one night stand. "Yeah, but she only wants a guy who X---" Maybe, but she'd probably settle for you. "I don't want her to settle for me, I want her to want me." Then you don't really want a one night stand, do you?

She already knows all of this. Just as you think you can tell those are implants, she's has you sized up from 100 paces.

Here's how you succeed: you have to have confidence in yourself, while simultaneously accepting that it could just as easily have been some other guy. If you're not comfortable with that, get out of the bar.

VII.

"But it's the whole idea of Don Draper-- that kind of man, living in that kind of time, where men were men... it was more acceptable to have affairs, drink all day... The old days, men could act like men, even if they were flawed."

Draper can seduce women easily because he has both confidence and also lives, perpetually, in that state of emotional disconnectedness that let a girl know you're not going to get all mushy on her. But that means he also doesn't connect with his wife, nor she with him; that's why the affairs "aren't a big deal." It has nothing to do with the year being 1960. It's just a bad marriage.

You should note that his disconnectedness doesn't make his wife less connected to him (though it doesn't help.) His disconnectedness lead him to marry a woman who was not likely to be able to fully connect to him. Many times, you get only the relationship you're ready for.

This isn't unique to Draper. Look at Campbell. He can cheat on his wife with almost no guilt because he's disconnected from her; but of course she is just as disconnected from him. She doesn't love him, she needs him as a supporting cast in her "perfect wife and mother" movie.

The show doesn't depict a "different time;" it depicts a (somewhat improbable) scenario where everyone in a 200 mile radius is a narcissist.

VIII.

Shakespeare created a lifelike, realistic character named Hamlet. Every actor who plays him, from Richard Burton to Mel Gibson, reinterprets Hamlet differently.

What no one does is try to emulate Richard Burton playing Hamlet. You're not playing a character, you're pretending to be someone else.

In the 2009 movie Star Trek, Captain Kirk was played by Chris Pine. But Pine wasn't playing only Captain Kirk, he was playing William Shatner playing Captain Kirk, i.e. using Shatner's same staccato delivery and other mannerisms. Any accolades Chris Pine gets-- "he was great in Star Trek!" refer to his ability to imitate William Shatner, not be Captain Kirk.

When you say you want to be like Draper what you are saying is you want to be the person Draper is pretending to be in a specific context. That's not real. Given that Don Draper is a character acted by Jon Hamm, then you're saying you want to be what an actor is pretending to be pretending to be. If you even try this for Halloween, they're going to lock you up in a lunatic asylum.

IX.

What you want, really, isn't to be Don Draper. What you want is to live in Draper's world: where it is almost acceptable to have affairs; where you can drink all day and not get drunk; where you can say whatever is on your mind and not have it offend people; where creative men have some outlet for their ideas, and at least get paid really well instead. Where you can eat any kind of food you want and not get fat. Where you can act like you want to act, act like what you think a man acts like, and people will admire you.

In other words, what you want is to be the main character in your own movie.

part 2 soon

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http://twitter.com/thelastpsych

In Honor Of Columbus Day: Christopher Columbus Was Wrong

2009-10-12T14:55:15Z

Repost.

More On Amygdala, Anxiety, and MRIs

2009-10-08T14:04:11Z

After the last post, I thought, "perhaps I was too broad. Maybe too political, maybe I didn't have enough concrete examples."

Then I opened my mail.
]]> Primary Psychiatry, in which appears Imaging and Genetics: Future Applications in the Emergency Room.

It reviews the literature on the neurobiology of aggression in precisely the way I was railing against in the earlier post: sufficiently vague that it makes people think this is alerady established, common knowledge.

The amygdala, located in the temporal lobe, has been shown to be associated with aggression and violence. Studies(29) have found a high rate of atrophy, as much as 20%, of the amygdala in aggressive and violent patients.

Note: studies (plural) but one reference. Note: you can't tell if 20% is a high rate of atrophy, or if it means "high rate of people who have 20% atrophy." And you're not supposed to know, because the point is simply to make you feel secure that his overall thesis is well supported.

But, according to reference 29, in a study of aggressive patients, only 20% of them had any amygdala atrophy (e.g. the other 80% didn't.) The amount of atrophy was fairly small.

Furthermore, that reference was a study of aggressive vs. non-aggressive epileptics. In addition to differences in aggression, the subjects also differed in IQ (lower IQ in aggressive group) and a history of encephalitis (associated with smaller amygdalas.) The study could well have been resubmitted: "A Couple Of People With Low IQs And A History Of Encephalitis Have Kind Of Smaller Amygdalas. We Think."

Here is the next sentence:

Imaging studies9,10 have also shown abnormalities in amygdala functioning, including decreased activation of the amygdala during affective stimuli in psychopaths

I'm sure whatever imaging studies they were doing 12 years ago were crackerjack, and based on two of these (which are the same data), the reviewer concludes psychopaths have decreased activation in the amygdala.

Which isn't what the studies found anyway.

First, the study didn't measure just psychopaths (e.g. antisocial PD), but psychopathic murderers who were incarcerated and legally insane. Note how the author extends these findings to psychopaths in general.

Second, it didn't find decreased activation in the amygdala, it found the opposite: higher activation on the right, and no difference on the left. Do you know the relevance of it being right vs. left? Of course not.

So the studies say: "psychopathic murderers have increased activation on the right." The reviewer summarizes: "psychopaths in general have decreased activation overall."

You would think that difference matters, but it doesn't, because the point of the review article isn't to teach you information, e.g. what happens to the amygdala, it is to convince you that aggression is biologically mediated. These articles succeed because it is established that no one will check whether it is actually increased or decreased (note that three reviewers did not check), because no one cares whether it is increased or decreased, because we all know those are just silly details.

I may as well point out that the studies referenced here didn't even measure the amygdala, they measured the subcortex (amygdala, hippocampus, midbrain, thalamus, together). Take that, precision instruments.

II.

In fairness to the psychiatry review author, the authors of the above references jumped to an even worse set of conclusions based on their own data

Raine et al. speculate that excessive subcortical activity contributes to an aggressive temperament in both types of murderers, but that "while predatory violent offenders have sufficient left prefrontal functioning to modulate such aggressive behavior in a way to bully and manipulate others to achieve desired goals, affectively violent offenders lack this prefrontal modulatory control over their impulses, resulting in more unbridled, dysregulated, aggressive outbursts." (bold mine, emphasis theirs)

and then published this in a forensic journal. Do you see?

The entire article is filler. All he wants to say is this single sentence:

In effect, research is supporting the notion that repetitive acts of aggression are grounded in a neurobiologic susceptibility.

This is simply not true. There may be aliens in the universe, but it is false to say, today, "in effect, evidence is supporting the notion that aliens can and do live in the universe." All we know is that there are studies that show a relationship between specific behaviors and specific anatomical areas. However, we do not know the nature of that relationship.

We cannot accurately quantify the behaviors and distinguish them from similar behaviors (is it aggression out of fear, anger, horniness, temporary insanity, or a combo?), and we can't adequately control for billions of confounders (3 red wines/d vs. 3 beers/d, bad parents, too many horror movies, frequency of one night stands, etc). How then can we relate them to inadequately characterized anatomical regions using machinery with the precision of an icepick, and then conclude "predatory violent offenders have sufficient left prefrontal functioning to modulate such aggressive behavior in a way to bully and manipulate others?"

We tend to focus only on one error, e.g. MRI false positive rate. But these studies don't take into account all of the other errors. It is the problem of significant digits: 3.225 x 5.23441 x 7 does not equal 118.16680575. It equals 100.

III.

You all think I'm exaggerating. That I am punching windmills.

In keeping with this development, sometime in the future cord bloods will be taken routinely from birth and used to delineate the individual's DNA so that genetic information will be readily available under emergency conditions to assure proper assessment of violent people. Hence, a patient presenting with an episode of violence and a history to support that will have their DNA contrasted with norms to determine if they have a predisposition to aggression and violence...

I have enough rum to get through the rest of my life, but the rest of you would do well to heed my warning: if you do not rein in your social scientists, your civilization is doomed.

The Problem With Science Is Scientists

2009-10-06T19:38:55Z

one of these is a false positive, the other is false

]]> the story:

In a recent fMRI study, a salmon was shown a series of pictures of human faces showing various emotions: can a salmon distinguish them? and what brain regions are involved. 15 pictures, ten seconds each.

I won't bore you with the anatomy. Because of the small size of the brain, exact brain structures could not be distinguished, but something in the brain did light up. A statistically significant number of voxels, comprising an area of 81mm3 in the midline of the brain, were active (p<.0001).

So can fish interpret human emotions from a picture? I have no idea. I do know, however, that that fish can't do it: it was dead.

II.

Others have discussed the hows/whys of such false positives and what can be done about them. But there are two other problems not discussed:

These researchers chose a dead fish specifically so they could discuss the issue of false positives and why multiple comparisons correction in MRI studies is important. Thus, we know these results are false positives because we know that the fish is dead. Note carefully, however, that both of the things you know are told to you by the researcher; yet you are valuing one as "truth" and the other as "artifact" based on nothing but his word.

The researchers might have been mistaken about the deadness of the fish-- thus nullifying a potentially interesting finding. Or, they could have lied.

There is no way to check. You're rolling your eyes, "why would they lie about that?" or "how would they possibly make a mistake about it being dead?" and you're right, about this they wouldn't.

But what about the old studies?

If they do a study in which an anxious person shows weak activity in the amygdala-- how do you know he was anxious? How wrong about the anxiety do you have to be to invalidate the weakness of the MRI findings? Not much.

III.

The danger of the "false positive" discussion is that it is forward looking: from now on, why should tighten our significance thresholds, change the confidence intervals, controls, etc. But what about all the prior data that finds only "moderate positive correlations" using more liberal significance thresholds, that may be infected by invalid behavioral assessments--

--that because of the passage of time alone-- not better data, but time-- are now knowledge?

IV.

The biggest problem with MRI studies is that they're hard for the layman to understand. Complexity in science protects prejudice.

Understanding the Anxious Mind, in the NYT Magazine, discusses the science of temperament. Jerome Kagan studied babies, then followed them over the years. Predictably (i.e. what you'd expect the NYT to say), temperament as a baby predicted temperament as an adult, especially in the extreme cases.

They explore the case of the highly anxious "Baby 19" (defined as being distressed by novelty) who, when she was 15, was a plain looking teenager who liked writing, playing the violin, worrying and fidgeting. See? Genetics.

...[Scientists] have put the assumptions about innate temperament on firmer footing, and they have also demonstrated that some of us, like Baby 19, are... born predisposed to be anxious...

...[other scientists] all have reached similar conclusions: that babies differ according to inborn temperament...

You'll observe that those two quotes are about babies-- babies are born a certain way. No argument from me. What they do not say is that the inborn temperament is the reason they are also anxious as adults, but that's the conclusion they make every single time.

"Temperament, it turned out, tended to be stable over those five years, at least in children who started out at the extremes." Its stability is the evidence that the temperament is biological. If his haircuts are stable over the years, is that biological?

But more importantly, the kids were raised by parents. Parents don't parent in an ideal dispassionate manner, they parent in reaction to the kid in front of them. In other words, kids' temperaments alter the manner in which they are parented, and it's a good bet that the parenting fosters that same temperament. Not a word on that; it's as if it that couldn't possibly be relevant.

And why is testing a four month old's behavior evidence of an innate quality? The first four months of parenting don't count? "Kagan restricted his sample to children who were white, middle class and healthy." Oh. So now all white people are the same?

V.

But that's not real science, real science uses MRIs. If they studied it in an MRI, it must be true.

Teenagers who were in the group at low risk for anxiety showed no increase in activity in the amygdala when they looked at the face, even if they had been told to focus on their own fear. ...In the high-risk kids, even those who were apparently calm in most settings, their amygdalas lighted up more than the others' did.

"Overreactivity in the amygdala" = anxiety. But we don't really know what the amygdala does, nor how it does it, all we know is where it is. Saying something occurred in the amygdala is like saying something occurred in Ohio. "Yes, but we have some sense of what the amygdala does." And I have a sense of what Ohio does, too, it causes trouble in elections and gets its teens to kill themselves.

But at least whether or anxiety is mediated by the amygdala is worth discussing. What you can't do is take a structure that may be involved and therefore conclude that anxiety is an innate trait that is generally stable. Every time I punch someone my shoulder is overactive. Is my genetically mediated shoulder the cause of my alcoholic rages?

And overactive as compared to what? What could possible serve as a control? Seriously, think about this. Point to a guy you believe could be a control in a study measuring what are here defined as subclinical levels of anxiety.

Not every brain state sparks the same subjective experience; one person might describe a hyperaroused brain in a negative way, as feeling anxious or tense, while another might enjoy the sensation and instead uses a positive word like "alert."

None of those words mean anything. Brain state? Hyperaroused? Alert? How can anyone know that the "brain state" that two people are describing differently is the same? These words concepts are so vague that the researcher has to resort to Jungian terms in his descriptions:

The persona can be controlled, but the anima often cannot... Nathan Fox of the University of Maryland says that when the anima erupts in high-risk children, it often takes the form of excessive vigilance and misdirected attention. In the first of his two longitudinal studies...

If you don't even have precise words to describe what you're seeing, how in God's name can you measure it, let alone blame it on the amygdala?

VI.

But research has to start somewhere, and my problem isn't with the researchers or their study, nor do I doubt the relevance of genetics. My problem is that when theory is written up in the NYT, it becomes FACT, it becomes the default understanding. This understanding becomes part of our cultural filter. In the same way porn and Cougar Town has assured us that women over 40 can have satisfying extra marital sex with 20 year old bicycle messengers, we know that behavior is, in large part, genetically determined.

This is how the article ends:

The predictive power of an anxiety-prone temperament, such as it is, essentially works in just one direction: not by predicting what these children will become but by predicting what they will not. In the longitudinal studies of anxiety, all you can say with confidence is that the high-reactive infants will not grow up to be exuberant, outgoing, bubbly or bold.

Think about this. Think about what the average person now understands to be true.

Still, while a Sylvia Plath almost certainly won't grow up to be a Bill Clinton, she can either grow up to be anxious and suicidal, or simply a poet.

VII.

Back to the salmon. The results were statistically significant, but the fish was dead. So we laugh. In 1620, that would have been evidence for the soul, and no one would have laughed.

The problem is the same in both cases. They are questioning the nature of the data. They should be questioning the nature of the fish.

part 2 here.

Part 2: Why Can't Kids Walk Alone To School

2009-10-02T20:32:49Z

]]> From part 1, here.

VI.

Narcissists don't feel guilt, only shame. Since we are a generation of narcissists, we can't see other people's perspectives, so we extrapolate: we assume that no one else feels guilt either. (And that's probably accurate.)

If guilt is gone, then there are no internal controls to a person's behavior, only external ones. Follow along:

You may have even been to a psychiatrist a few times-- god knows millions of other people have-- and you're actually normal... imagine how messed up other people are!

And be honest, look into your heart: you're a pretty twisted person. You saw Halloween in the theatre on a weekday at 10pm. At points, the audience was laughing. You know they're not all serial killers, but... isn't that weird? Well, you laughed at one point, too, but you have control. How much can you trust them, in certain circumstances...?

And I know you and your wife would never try to get your 16 yo cheerleader/babysitter drunk and seduce her, duh, obviously. But that concept is arousing, right? Nothing to feel guilty about, of course, you're not actually doing it...

Here's the problem. Sometime around KROC Howard Stern, admitting such thoughts went from being acceptable ("as long as you don't do it") to commonplace. So there's no associated guilt with the thought, at all. I'm not judging whether there should be guilt, only observing that there definitely isn't any anymore. Include here masturbation, pornography, etc.

So the issue isn't whether there are pervs who might try to seduce your daughter on a babysitting gig after cheerleading practice; you already assume everyone is thinking it, because if you don't feel any guilt, why would they? What you're left wondering is to what degree external controls-- shame-- are a strong enough disincentive-- word chosen very carefully-- for the other guy. And the answer you're going to come up with is: if there's a way they can get away with it, not very strong.

Societal narcissism has put us in a bit of a bind.

We don't believe that guilt will will control a person's behavior, because we don't feel any guilt in ourselves.
We are very aware of the gigantic numbers of people that have easy access to us, but they are mostly supporting cast in our movie that we know nothing about because we do not really want to know anything about them, so we assume they're like us-- unable to feel guilt.
if you consider yourself ethically/morally above average-- despite the porn, cheating, self-serving lying, then it is entirely logical to assume most people you see in the street are cannibals.
And the external controls you place on your kids and on strangers as protection end up being reminders that you haven't done an adequate job of preparing your child for life.

This is the result: you hover more, trust less, live with an unrelenting low level anxiety, and masturbate a lot.

VII.

And back in the day-- sorry, back in a time you assume existed based on what little you know of it from watching Mad Men or Family Ties-- you could at least trust that women were more moral and upstanding, they kept the men in check. So the fact that a guy was married was one point in his favor. But nine seconds of any modern TV drama-- Private Practice, Brothers and Sisters, whatever-- let you know that a perfectly normal, mannered, intelligent woman will sleep with a guy they don't even like not just for lust or money or revenge-- but for absolutely no reason at all. They're not just immoral, which is fun; they're amoral, which is terrifying.

"Are you saying women are amoral?" --- No, I'm saying the message men (and women) constantly get is that women are amoral. You did nod three sentences ago, right? Since you are too much of a narcissist to know what women think-- I don't mean you aren't interested, I mean you are unable-- how would you know if TV is wrong?

What happens to society when the kids are taught not to feel safe with women? Guess we'll find out.

VII.

"Are you talking about me?"-- of course not you, you're different.

IX.

This is a good time to point out that when we were kids, we were allowed to walk alone to school, to ride bikes without helmets, got spankings, took our chances down at the creek. Now we're adults. Look around at the results. Perhaps walking to school alone wasn't such a good idea after all.

Why Can't Kids Walk Alone To School? Part 1

2009-10-02T04:33:42Z

136 comments on Metafilter about an article on the NYT, and none of them suggest that the problem is that adults are untrustworthy and dangerous.
]]> New York Times is compelled to write an article about it.

" 'She's just so pretty. She's just so ... blond.' A friend said, 'I heard that Jaycee Dugard story and I thought of your daughter.' And they say, 'I'd never do that with my kid: I wouldn't trust my kid with the street,' " said Katie, a stay-at-home mother, who asked that her full identity be withheld to protect her children.

Katie, too, is tormented by the abduction monsters embedded in modern parenting. Yet she wants to encourage her daughter's independence. "Somehow, walking to school has become a political act when it's this uncommon," she said. "Somebody has to be first."

Any parent can sympathize: what if?

But what if... what? Be specific, put some thought into this: are you worried your daughter will cross paths with a Bad Man, or are you worried that your daughter is walking into a world where everyone is an opportunist?

II.

One problem is that we aren't trusting of ourselves as parents. Perhaps the older generations didn't know or care about their shortcomings, but we do, for sure. Have we really done our jobs? Did we teach them enough about the complexities of human nature?   It's easy to say "don't talk to strangers," but how do you tell your kid to watch out for his otherwise good teacher? How do you tell them not to let a cop drive him home? ("Why would you ever tell him that?" A: Why would they ever drive him home?)

It's easier to hover.   Not a judgment, just an observation.

We probably all imagined that when we had kids of our own, we'd teach them how to beat down a bully. Well? I know we dreamed about how we'd teach our kids to escape from bad guys. Did you? Did you teach them how to manipulate their attacker? Or did you leave them to the Wii?   "Well there are just too many other important things--" Oh, you taught him French? Started him on push-ups early? Game theory?

Kids don't ask to be chaperoned; they don't ask to be forbidden from going "down the creek" and they sure as hell don't ask for bike helmets. That's all chosen by the parents. So the question really is, why do parents choose to do this?

Don't misunderstand me: I'm not saying we are failures as parents; I'm saying we are afraid we are. We are insecure that we have adequately prepared kids for life. This insecurity prevents us from letting them experience life. And thus they are actually unprepared, and thus we were right.

III.

"All this helicopter parenting is going to make kids grow up to be wusses."

Maybe, but it's interesting that most people who say this don't have any kids of their own. Parents might agree with the sentiment, but they're still going to buy bike helmets. Geezers may like telling stories of how they had to walk five miles to school in the snow, but I don't know any geezers who would let their grandkids do that today.

Do you see that Katie, quoted above, is hiding her identity "to protect her children?" The world is much smaller. Just like it's easy to imagine calling a guy across the country on a whim, it's not so crazy to imagine a guy buying a $100 LAX to NYC plane ticket for the possibility of free 9 year olds.

IV.

Question: have we squandered the nanoseconds we do spend with our kids by using it to teach them not to judge people by how they look?

Xanax yourself, Caps Lock. We adults do frequently judge people based on how they look, right or wrong. So on the one hand we think we can identify the Bad Men, on the other hand we are aware that we have not taught our kids to do it. So we have to do it for them.

Have we crippled kids, in the name of equanimity? That we don't believe anyway?

Maybe such politically incorrect heuristics are precisely what we should be teaching them, precisely because they have nothing else to go by? I know that not every 50 year old white man with a mustache is a pedophile. You know what else I know? Run.

Heuristics are short cuts that save you from overthinking. Sometimes you need handy, explicit rules so that thinking, education, logic, experience, and civilization don't make you do the wrong thing. A joke by Dave Attell:

If you walk outside and see a naked man running down the street, cock flapping in the wind, you run with that man. Because there's some scary shit coming the other way.

"But not all bad men look like bad men!" I know, but maybe at least steel the kid against some identifiable Bad Men? "But not everyone who looks bad is Bad!" So maybe the kid misses out on the gentle friendship of a mustached IT guy. Oh well. He can have a snow cone instead.

V.

Our insecurity is not unfounded. We barely spend real time with them at all, we get through the time until they go to bed or college, whichever comes first. And we're certainly not anticipating the issues they'll face in their future. What did you tell them about the ethics of killing robot hookers?

Narcissism. We don't see our kids as total human beings, they are still mostly extensions of ourselves. Since we're not sure how well we've prepared them, AND we fail to see their unique strengths because they didn't come from us, we just don't know how they'd react.

Will the kid really not be enticed by a guy with some candy/Playboys/pot? If he tries to grab a six year old and she runs, will she know how to get home?

Or, and I can't believe I'm writing this, if she's 15, will she remember to run?

We're not confident in how we've trained our kids and so we don't train them, reinforcing our insecurity. Meanwhile, we don't see that they're growing up anyway.

Kids are the best, Apu. You can teach them to hate the things you hate. And they practically raise themselves, what with the Internet and all.

Good point. We'd better monitor their internet use, then.

Part 2 here.

Is More Regulation Needed?

2009-09-29T15:34:19Z

I know disagreeing with Daniel Carlat is like disagreeing with Obama-- how can you?-- but someone has to. Has the regulation of physician-industry relationships gone too far?"

Dr. Daniel Carlat starts with a rhetorical trick, conceding ground at the outset thus establishing himself as a practical centrist and not an ideologue, and then stealing the ground back. Remind you of anyone?

I disagreed with many of the presenters but was in absolute agreement on one point: interaction between industry and physicians is a good thing. It is crucial to scientific progress.

It's an election year trick. Carlat followers already know exactly where he is coming from; so conceding this much isn't going to turn them off. "It's politics. He has to say that." Those who don't know him can be soothed by what sounds like a reasonable voice.

But suppose I want to find out whether Drug A is better than Drug B. Would I go to Company A for this find of advice? Of course not-- this is the last place I would go.

I realize this seems unassailable, but it's not only theoretically wrong, it's actually false.

First, Company A can't actually say it has a better drug than Company B. It's illegal. They can't even tell you about a published study, even one they didn't do. (Don't worry, I'm sure doctors will come across it on their own.)

Second, if it was allowed, why wouldn't you want Company A's answer? It may be biased, but you already know the bias, and they're not allowed to lie. Does Company A have nothing useful to say? Then you can ask Company B what they think. Isn't that how people pick their President?

But here's why it's actually false:

Likewise, I would not go to a physician paid to promote Drug A for this advice. I would go to a source without that conflict.

He means a unicorn. It does not exist.

In fact, he does go to Company A for the info, he just blinds himself to it. The studies, academics, Departments, journals, reviewers-- all are eye deep in Pharma money. "It's not Company A money." Oh. So when a Republican senator who does not get oil money votes for an oil project, you figure he conducted a dispassionate analysis of immediate energy needs vs. environmental/climate impact?

II.

... I know about human nature. When you have a financial incentive... you will respond to that incentive.

I know something about human nature, too: more powerful than money is the desire to maintain identity. Narcissism. When a politician "gives the money back" in order to keep his job, he's not doing it because the job will get him more money, he's doing it because the job is more important than the money-- it's his identity.

Your identity is so powerful that it actually biases other people more than money. Look back at my Republican/oil example. It fit perfectly, it made sense to you. But if I had made a Democrat/labor union analogy, it would have rubbed you the wrong way, even though they are equivalent. You're biased, and for cheap.

That's why a man free of financial bias may be trustworthy, but he is not trustable. Where's he coming from? Is he pushing Depakote because he "believes" it? Because his son, N=1, responded to it? Because he works at a university where antiepileptics are the cause du jour? Because his Depakote rep is hot?

I don't particularly want financial bias in my academics, but to single that out as the main source of trouble in our field is like singling out the elbow as the pivotal component of matricide.

III.

This is the same error people make about the need for government intervention, e.g. that the "free markets" have failed and more regulation is obviously needed. Even if one were to agree on principle that people can't be trusted, the mistake is in forgetting that government is people. These people are subject to the same biases, cognitive errors and general prejudices as the guys at Goldman Sachs, albeit currently it in the opposite direction. We can argue that we prefer the government's biases, but one cannot argue that the government is less biased, self serving, or corruptible.

This may originally have been a country of laws, not men, but that's not the country most modern people want; they want to be able to alter the laws to suit the times. Fine, it's your country. But understand that if the laws are subordinate to men, then the enforcers of those laws will always have more power than you. Has anyone tried to get an anti-Depakote study published in J Clin Psych in the past decade?

It's excellent that Daniel Carlat thinks doctors like himself cannot be trusted to read and interpret their own studies, and that some other group of-- doctors? lawyers? what?-- with special bias-immunity rings need to be assembled to protect us. But those people are still people. This is why the NIH, with their incestuous grant reviewers, crazy politics and flavors of the decade philosophies is so dangerous-- they're just as biased as Pfizer except you think they are objective.

In other words, before I agree to being regulated, I want the names of the people regulating me, so that I can at least laugh at the irony.

I am asked all the time, "where can I go for unbiased information on medicine?" My God-- if the physicists don't have such a place, do you really think that medicine does? And why does no one ever ask where they can go for unbiased political information?

People would do well to remember that at one point in our nation's history, "government" was George Bush. When you argue that government needs to be more involved, you are arguing that George Bush needs to be more involved. I do not trivialize this discussion by offering Barack Obama as an equivalent example of the government you want so desperately to supervise your lives.

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also: The future of bias

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http://twitter.com/thelastpsych
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