Big Aeroplanes

There were dreams

that all had wings

I flew them like a kite

They came to me

in the evening

and left before daylight

the rest is complicated

so foggy and so dense

There is no house

no dog, no swing

No white picket fence

Between the sheets

 the darkness

is everything I own

a tire lump of flesh

so naked and alone. 

The dreams have turned

to memories

its there that we still dance

I drink some wine 

and smile....

fixed, as if in a trance

Yes, I do still think of you

every time it rains

every time I hear that song

or see big aeroplanes.

Re: The Illusion of Psychiatry

These comments first appeared on TED.com as part of a question I posed to the TED community.
The Ted Community did contribute to the discussion and there comments can be found at:
http://www.ted.com/conversations/13829/does_psychiatry_have_a_financi.html

Does psychiatry have a financial interest in expanding the definition of mental illness?

Does both the pharmaceutical industry and the psychiatry profession have strong financial interests in convincing the public that drug treatment is safe and the most effective treatment for mental illness, 

The National Institute of Mental Illness reports that currently only 36 percent of those who suffer from mental illness actually seek and receive treatment but they would still like to expand the definitions. What and why should be a concern to everyone. 
There is no question that among the medical profession, psychiatry is the most scientifically primitive. The latest revision to the America Psychiastric Association's Diagnostic and Statistical Manuel of Mental Disorders (DSM-V) has drawn strong criticism. "Owing to criticism over the perceived proliferation of diagnoses in the current edition of the DSM, David Kupfer, M.D., who is the DSM-5 Task Force chair and is shepherding the DSM's revision, said in an interview: "One of the raps against psychiatry is that you and I are the only two people in the U.S. without a psychiatric diagnosis." 

Dr. Daniel Carlet, an Associate Clinical Professor of Psychiatry at Tufts University admits, "We are no more than the most rudimentary understanding of the pathophysiology of mental illness and we have resorted to tenuous and ever-shifting theories of how ..treatments work." 


 "Psychiatry had a powerful weapon that its competitors lacked. Since psychiatrists must qualify as MDs, they have the legal authority to write prescriptions. By fully embracing the biological model of mental illness and the use of psychoactive drugs to treat it, psychiatry was able to relegate other mental health care providers to ancillary positions and also to identify itself as a scientific discipline along with the rest of the medical profession. Most important, by emphasizing drug treatment, psychiatry became the darling of the pharmaceutical industry, which soon made its gratitude tangible." Dr. Marcia Angell

http://www.nybooks.com/articles/archives/2011/jul/14/illusions-of-psychiatry/?pagination=false

"The Diagnostic and Statistical Manual of Mental Disorders (DSM) published by the American Psychiatric Association provides a common language and standard criteria for the classification of mental disorders"
http://en.wikipedia.org/wiki/Diagnostic_and_Statistical_Manual_of_Mental_Disorders

To use the medical model, I think that we are asking, "What is wellness?" We are all in a degenerative physical state, but we all learn to cope with our developed conditions. Wellness is therefore relative.
Health is very personal, and we usually get to make the choices regarding our quality of life, and this means that we get to make bad choices as well This is not true of mental health which is more socially driven, where one can be medicated against one's own will. 

I state that psychiatry is "scientifically primitive," but medicine has an obligation to "do no harm." Can psychiatry's answer to the question of whether its practices meet this obligation pass the straight face test?

So if we were to look at this in a non-linear manner, what's actually broken: What are we not adjusting to that we need to medicate? Big Pharma is merely the commercial side of the equation. The War on Drugs is really a war against people who feel the need to self medicate, and if this does multiple the problem somewhat because the problem of addiction, from both drugs and alcohol, is probably hidden mental health issues as well.

My suggestion to the question, "What is broken?" is that we are social animals and yet we have allow he bonds of social institutions to break down. We put our children into Day Care and our elderly into nursing homes, we feel no real sense of belonging, we fear what will become of us 
As Sherry Turkle notes in her TED Talk that we would rather text than talk. She says, "I believe it's because technology appeals to us most where we are most vulnerable. And we are vulnerable. We're lonely, but we're afraid of intimacy. And so from social networks to sociable robots, we're designing technologies that will give us the illusion of companionship without the demands of friendship. We turn to technology to help us feel connected in ways we can comfortably control. But we're not so comfortable. We are not so much in control.

Is this the roots of some of our mental illness, I believe it is, and medicating will not make things better for us. Real human interactions will. but there is no societal pill for us to swallow that will make it all better. We'll need to learn to be more authentic, more caring, more nurturing and more compassionate toward one another. Big Brother is not the government, it is your neighbors.

"Disability," as it applies to mental health, is a term that can define both cognitive disability, and emotional and behavioral disability. So let's ask, "How did depression, which was once viewed as an episodic illness become a chronic and disabling condition?" 
The issue that I am raising here is that psychiatry has moved away from analysis and talk therapy, and one of the main motivations for this is that it is that it is just to easy to prescribe drugs. I think we have all seen the advertisement there suggest taking an additional medication,"ABILIFY," if our depression medication isn't doing enough for us. Does this make any sense? Should it even be allow to be advertised to us in all its cartoon wonderfulness? "I'll take the pills that surround me with sunshine and butterflies please"
http://www.abilify.com/pdf/treating-depression-hcp.pdf 

Additionally, there is a general divide between the psychiatrist and the neuroscientist and we would do well to ask who is building the between the two. Your comments raises an important issue, that we should make the distinction between neurological disorders and psychological disorders, and that the two sometime overlap. The mind and brain can both be described as being based in the physical world, but explaining the mind, or mental illness, purely in physical terms, may not always be appropriate or useful. Do if we cannot identify medical causations for psychological condition that others views as a disorder, are we not just substituting being medicated and all its side effects with actual wellness?

There are several different points here to address: 
a) the DSM is currently being revised, DSM-5, see the following for some explanation of the controversies surrounding the revisions:
"Bereavement, which has always been excluded from the mood disorders, will become a mental disorder. Mild forgetfulness will become a mental disorder ("mild neurocognitive disorder"). Your child's temper tantrums will become a mental disorder ("disruptive mood dysregulation disorder"). "
http://www.psychologytoday.com/blog/rethinking-depression/201110/the-dsm-5-controversy

2)Prozac should have taught us something. Placebo works. But in America, unlike Europe, it cannot be prescribe.

3) regarding criminally and mental illness, I can recommend the book by David Eagleman, "Incognito." There is also an recent this article by Eagleman from, "The Atlantic." 
http://www.theatlantic.com/magazine/archive/2011/07/the-brain-on-trial/308520/

Butter On My Roll, Before You Go

 

 ...lying on clean sheets 

I wrestling with fat pillows

That will not hold me back

The water's drip &drip, wet outside the window

 drips that count a time

the wind blows in the ruffled curtains

   in and out

 

I am lying to a woman

and she wants to wrestle on clean sheets

with big pllows. and have curtains like these.

Curtains that fly

   in and out..to the breeze of the moon.

 I am lying with the woman

    and she is wrestling with choices 

    she has clean sheets and the freshest breezes

    that blow in off the ocean 

tonight

take off your shoe and dance

pick a song we all know, sing along

 

 she orders chocolates and green tea

 the birds will sing if we are quiet.

    and the branches will sway  

smoke spins around in my head

Turn the stars on. the sky is charcole.

Drink more wine

 

I will draw you

100,000 die....

David Goldhill wrote, "My dad became a statistic—merely one of the roughly 100,000 Americans whose deaths are caused or influenced by infections picked up in hospitals. One hundred thousand deaths: more than double the number of people killed in car crashes, five times the number killed in homicides, 20 times the total number of our armed forces killed in Iraq and Afghanistan. Another victim in a building American tragedy."
He wrote this in 2009.  Why do we not hear more about this since then?
In 2008, there were 37,261 traffic fatalities, of which 11,773 were due to a BAC of .08, roughly 12% of the number that dies due to infections in hospital.  But organizations like Mother Against Drunk-driving are willing to throw $26 million annually, to fight for harsher sentencing laws and stricter enforcement.  This stricter enforcement resulted in the arrest of almost 1.5 million people in the U.S. in 2008 which add to these costs.
The deaths that occur thorough the spread of infection in hospitals may be just as criminal, since they are preventable as drunk-driving, but they do not result in any arrests, and there is no enforcement efforts because that are no laws, and no organizations with big budgets to lobby for new legislation.  In fact, in is often the taxpayers that get stuck with the cost of treatment in cases where the patient is elderly and on Medicare.
Perhaps the big question becomes: Why do we pay hospitals for treating the people they make sick, why are the hospitals not liable? Where is the incentive for them to change practices, to self regulate, if we to not demand action?

http://www.theatlantic.com/magazine/archive/2009/09/how-american-health-care-killed-my-father/7617/

There is at least some hope that this will change at somepoint.
"There’s a new tool for tracking the spread of infections and diseases in hospitals. Developed by the Canadian company Infonaut, this tool tracks the movements of health care workers in hospitals, including if they’ve washed their hands or not! Toronto General will be the first hospital in the world to use this technology. Dr. Michael Gardam is Director of Infection Prevention and Control at the University Health Network in Toronto, and he explains why the data collected will be invaluable, and how they’re ensuring this won’t be a “big brother” type surveillance situation."

http://www.cbc.ca/spark/2012/03/spark-176-march-18-21-2012/

The World is Crazy.....

There are a series of excellent discussions at "To The Best of Our Knowledge" titled "Stories of You."  They explore the notion that "If we are only a collection of stories about ourselves... what's the truth of who "we" are? "  The discussions are both surprising and enlightening.

http://ttbook.org/book/story-you

The interview with neuroscientist and researcher Julian Keenan,  "You & Your Brain"  raises two interesting points for me.

1.  @ 9:12   "We use to think that people with clinical depression didn't see the world realistically they saw it in an overly negative light. Well, it turns out that they're seeing it quite realistically" and it is others that are seeing it in an overly rosy light.  Others are the ones not in reality

2.  @ 9:33  "So the purpose of therapy is to learn to be better at lying" (to ones self, for the purpose of fitting in)? The response by Keenan is " Absolutely!"

Before this point in the interview Keenan says we are always "molding reality not so that it is real, but it is palatable".  This is what everyone does in a self deceptive way.
Jonathan Alder, in his part of the discussion says, this is changing the narrative about the way we view the events.
Keenan then adds a twist, this is not just about how we see the story, but it is also about how we think others think about our story.  By adding the Theory of Mind to the mix we end up thinking about what your thinking about my thinking about your thinking. (@ 6:11)  And we somehow do all of this thinking while avoiding knowing that others are seeing events in a less than realistic way.
The implication is that social psychology, and the influence of a social network, has a larger influence on our individual psychology than our therapist would have us believe. But then the therapist is not devoid of  this rosier than reality thinking either.

It is as if we are being told,  "The world is crazy-deal with it"
Now that's depressing.

Enough Love

Here's an original poem for Valentine's Day:


Enough Love

I'd like to have enough love
To save some for a rainy day
I'd have some to share in this moment
And still have some to give away

But I'm a fool who suffers
Where wiseman fear to tread
Rushing in with heart in hand
instead of using both heart and head

So is there any love in knowing
Ourselves in such a way?
Can we be in need of love
And still have some to give away?

How I Write: “I Still Do Not Write”

This is a comment I wrote as part of an online college course on "Connectivism."  (#CCK11 #ELTchat)
I originally  posted it at the blog: "profesorbaker.wordpress.com"   But I also ran across it again at a web page called, "The Yoon Soo Lin Daily." 


 Theodore A, Hoppe says:
February 4, 2011 at 8:42 pm

I have to admit that I still do not write.

If it were not for the computer, I would not create written text. I compose in words, a challenging concept to describe: type sentences, shift them around, reread, cut and paste, re-read, add sentences, spelling check, dictionary lookup, and so forth. Typos are always there, still. So I'm constantly re-reading to re-edit is needed, always. And still they slip in, cemented forever on the wed (haha-”web”)

Many, millions, perhaps even most, are not oriented to the written word. Even though we read, it is not the same as the challenge of writing.

This is the source of much shame, when it is actually a process deficiency of an intelligence type. Learning assumes a singularity of process, when language is but one of many processes.

Here I will reference Howard Gardner: Linguistic intelligence involves sensitivity to spoken and written language, the ability to learn languages, and the capacity to use language to accomplish certain goals.

This intelligence includes the ability to effectively use language to express oneself rhetorically or poetically; and language as a means to remember information. Writers, poets, lawyers and speakers are among those that Howard Gardner sees as having high linguistic intelligence.

Regarding the reply:  Professor Baker aka "Thomas" was very very kind in his comments, and it is with this encouragement that I continue in my attempts to combined words in a way the create meaning.

profesorbaker says:
February 5, 2011 at 5:21 am

Hi Theodore,

Thank you for this incredible story that you share with me here. You began, in medias res, with a powerful, attention grabbing statement: (quote) “I have to admit that I still do not write”. (end of quote)

I read this, started to answer, and then left it, wanting to reflect, deeply, before answering. I will quote a second statement, if you will be patient with me: (quote) “This is the source of much shame.”

And now I quote myself: (quote) “Writing is a skill that requires a lot of practice to do well. It’s not easy.”

Here is a final quote from you: “If it were not for the computer, I would not create written text. I compose in words, a challenging concept to describe: type sentences, shift them around, re-read, cut and paste, re-read, add sentences spelling check, dictionary lookup, and so forth. Typos are always there, still, so constant re-reading to re-edit is needed, always. And still they slip in, cemented forever…”

Theodore, to sum up, you have my deepest admiration for your writing ability. You admit it’s difficult for you, painstaking, time-consuming. This causes you personal discomfort. For others, blessed with the linguistic intelligence described by Gardner, it is a matter of applying their linguistic gift to the writing task.

I would like to point out that you describe perfectly, in a comprehensive manner, the writing process. If my students would apply themselves to their writing, as diligently, and as purposefully as you do when you write, I would be a highly contented teacher of English.

Finally, I’d like to leave you with the words of Dr. Peter Elbow, regarding spelling and grammar: (quote) “Many, many good writers are not good with spelling, not good with grammar, but they know how to get the help they need.”

My friend, as defined by Dr. Peter Elbow, you are a good writer. Your words impacted me today, and will influence the way I go about teaching writing to my students, who have the disadvantage of writing in English as a foreign language.

The writing process, as you describe it here, going forward, then backward, editing, re-editing, re-ordering, cut and paste, and finally, when all is said and done in this process, the final product is ready.

In my book, that’s good writing, any day, rain or shine. That’s all it is, good writing…

Thank you for your valuable interaction here with me. I owe you a debt of gratitude for what I learned today.

Best regards,
Thomas

Theodore A, Hoppe says:

February 5, 2011 at 7:01 am

Encouragement!
Thank you Thomas. It is always welcomed. In the need to express ourselves, we overcome much.
Here is a link to some of my well edited written thoughts.
http://www.ted.com/profiles/comments/id/242907

But I will also share with you this.

We live in turblent times-
How well do you tread water in an ocean of negative emotion
Shame is a storm, welling up and approaching
Backstroke kick kick, look up at the clouds,
the elephants with angel wings and the funny faces smiling back
Up and down the waves churning with no shore in sight.
No compassion in sight….
No one to toss us a peppermint lifesaver.

Best,

Theodore

profesorbaker says:

February 6, 2011 at 4:59 pm

Hi Theodore,

I found this to be powerful, which you have written on your “TED, Ideas Worth Spreading”, main page:

Here I quote you: (Quote) “The future of education has been the focus of the discussions I have been having with others. I love this quote and it seems to capture the essence of what TED is about: “Continual learning is the only skill that enables people to meet the challenge of expanding complexity wrought by expanding technology. Learning is a mental process that integrates intelligence and communication in the architecture of human thought . As the 21st century unfolds, technology must aim to avoid continual bumbling by strengthening literacy through continual learning using a process of intelligence that enables proactive concurrent discovery, rather than allow the future to merely arrive with increasingly disastrous consequences. ” Rod Welch. I am also very interested in the concept of eGovernance and how social networking analysis might lead to public-networking.” (end of quote)
…

It is a pleasure to make your acquaintance, Theodore.

Kind regards,
Thomas

Reply

Be Suspicious of Stories~ Our own

Tyler Cowan is a professor of economics at George Mason University.  He recently gave a talk at TED .com advising us to be suspicious of stories, specifically, stories that tell us the same things over and over again.  He says we screw up by telling ourselves too many stories, we are easily seduced by stories.  But if we are susceptible to stories perhaps it is because the stories we are attracted to the most are the ones too much like our own.


http://www.ted.com/talks/tyler_cowen_be_suspicious_of_stories.html?c=389069


Cowen is an economist, and so we can excuse the fact that he may know very little about the brain. He is after all telling a story as well. Daniel Kahneman knows a great deal about the brain, and the mind. In his TED talk "The Riddle of the Experience v. Memory" he explains this:

"Now, the remembering self is a storyteller. And that really starts with a basic response of our memories -- it starts immediately. We don't only tell stories when we set out to tell stories. Our memory tells us stories, that is, what we get to keep from our experiences is a story."

This is why we are so invested in our story, in our narrative. But we are not such good storytellers. This is true from a therapist point of view. We spend so much of the hour explaining the narrative, the "he did this, so I did that", that there is very little progress made in an hour long therapy session. We focus on telling our story and not looking at how we might develop the story, and perhaps in doing so rewrite the ending.
In this regard there is a lot we could learn from reading more science paper, where the abstract tells you every thing we need to know right in the beginning. Then, if we need more details we can wade through the pages to evidence.
Shakespeare was like this as well. If we recall a play like Romeo & Juliet it tells you everything you need to know right at the very beginning:

"Two households, both alike in dignity,
In fair Verona, where we lay our scene,
From ancient grudge break to new mutiny,
Where civil blood makes civil hands unclean.
From forth the fatal loins of these two foes
A pair of star-cross'd lovers take their life;

It would seem that stories have value, to us or we would not be so good at them.
Do see the Daniel Kahneman talk to learn more about why