>> It is now illegal in the state of Washington for pregnant women and children under the age of three to receive vaccinations that contain mercury products. This includes vaccinations (and flu shots) that contain thimerosal. The legal code of the state does comment
Regardless of the absence of thimerosal in childhood vaccines in Washington, scientifically reputable organizations such as the Centers for Disease Control and Prevention, the National Institute of Medicine, the American Academy of Pediatrics, the Food and Drug Administration, and the World Health Organization have all determined that there is no credible evidence that the use of thimerosal in vaccines poses a threat to the health and safety of children.
There are plenty of sites, however, that argue that thimerosal causes autism in children.
It sounds like the bulk of vaccinations in Washington state are free of thimerosal, though I do wonder how (some) parents negotiate the risk-benefit ratio of their kid(s) potentially contracting a preventable disease without vaccinations and “potentially” (…?) developing autism with vaccinations.
>> I now have a Twitter account. I blame Joshua, the kidney guy. If you choose to follow me (yeah, I’m not sure why you would want to, either), you can learn about what I read for work. I’m not sure if posting phrases from the literature will be sufficiently reinforcing for me, but it could be. It’s an experiment. With only one observer at this point (the kidney guy). Consider joining him—two kidneys are better than one.
22 Oct 2007 | 5 comments.
Help Me Choose a Dessert.
With autumn comes rain, wind, and fleece—
—well, in Seattle, anyway.
In addition to fashion (how we love long, tailored, black wool coats!) and football (go Bruins!), there is great food. Particularly baked foods. Baked dessert foods.
The time is rapidly approaching when I shall be baking large quantities of something for friends and family (”beware of geeks bearing gifts”) and, as of now, I do not know what that “something” is. I’ve already received requests for my famous chocolate chip cookies, though they’re not exactly festive. Two years ago, I sent out chocolate chip cookies and pumpkin loaves. Last year, I sent out pumpkin loaves and ginger cookies.
What should I send out this year?
Though my love for cookies is known far and wide, I must comment that they are a bit labor-intensive for me: In addition to the time it takes to roll chilled dough into balls (to achieve that cute, miniature shape), there is the lack of efficiency associated with small ovens. If I want to bake a standard batch of cookies, I must do it in three cycles, as my small oven accommodates only one cookie sheet on the top rack.
Maybe I should send out muffins this year. My pumpkin loaf recipe can be easily used for muffins—perhaps I can throw in some chocolate chips?
Or maybe zucchini bread (or muffins). I’ve never baked a zucchini loaf, though I enjoy eating them. (Apparently, I’m a fan of squash.)
I’ve also never tried to make fudge.
Maybe I can make bricks of rice crispy treats (is that a trademarked name?) and coat them with melted marshmallows in autumn hues?
Dear internet: Any tasty, relatively low-effort suggestions? (coughTheBlogThatAteManhattancough)
(Not much can beat a cookie, though.)
21 Oct 2007 | 8 comments.
Context Matters!
It all started with a talk on malingering.
Malingering is defined as the conscious fabrication or exaggeration of physical or psychological symptoms for secondary gain. Examples are useful here:
- Ferris Bueller. (”Anyone? Anyone?”) He feigns a feverish cold (symptoms) so he can enjoy the day (secondary gain) with Cameron (hot!) and Sloane.
- A soldier reports significant abdominal pain (though he had none) and other related symptoms to decrease the likelihood that he will deployed to fight in a war.
- A man without any psychological problems who murdered a family reports to his lawyer that tormenting hallucinations and delusions coerced him to complete this deed—that he is not responsible for his actions.
How skilled are psychiatrists at detecting psychological malingering?
Not very. There aren’t a lot of studies on this topic, though the reports that are available suggest that psychiatrists, at best, miss malingering in over 10% of people who present with feigned symptoms. (The usual statistic hangs out closer to 50%. I don’t remember the citation and I currently can’t find it on Pubmed.)
Certainly context matters. The psychiatrists who work in emergency rooms have many more tales of people who malinger than private practice psychoanalysts in hoity-toity parts of town. Most agree, however, that while we should remain vigilant for malingering, it doesn’t happen that often. (Still, no one is entirely sure what that means.)
One paper that is frequently cited in the malingering literature is this fantastic article, which actually isn’t really about malingering:
On being sane in insane places. (Very long, unformatted paragraph follows.)
It is clear that we cannot distinguish the sane from the insane in psychiatric hospitals. The hospital itself imposes a special environment in which the meanings of behavior can easily be misunderstood. The consequences to patients hospitalized in such an environment-the powerlessness, depersonalization, segregation, mortification, and self-labeling-seem undoubtedly countertherapeutic. I do not, even now, understand this problem well enough to perceive solutions. But two matters seem to have some promise. The first concerns the proliferation of community mental health facilities, of crisis intervention centers, of the human potential movement, and of behavior therapies that, for all of their own problems, tend to avoid psychiatric labels, to focus on specific problems and behaviors, and to retain the individual in a relatively non-pejorative environment. Clearly, to the extent that we refrain from sending the distressed to insane places, our impressions of them are less likely to be distorted. (The risk of distorted perceptions, it seems to me, is always present, since we are much more sensitive to an individual’s behaviors and verbalizations than we are to the subtle contextual stimuli that often promote them. At issue here is a matter of magnitude. And, as I have shown, the magnitude of distortion is exceedingly high in the extreme context that is a psychiatric hospital.) The second matter that might prove promising speaks to the need to increase the sensitivity of mental health workers and researchers to the Catch 22 position of psychiatric patients. Simply reading materials in this area will be of help to some such workers and researchers. For others, directly experiencing the impact of psychiatric hospitalization will be of enormous use. Clearly, further research into the social psychology of such total institutions will both facilitate treatment and deepen understanding. I and the other pseudopatients in the psychiatric setting had distinctly negative reactions. We do not pretend to describe the subjective experiences of true patients. Theirs may be different from ours, particularly with the passage of time and the necessary process of adaptation to one’s environment. But we can and do speak to the relatively more objective indices of treatment within the hospital. It could be a mistake, and a very unfortunate one, to consider that what happened to us derived from malice or stupidity on the part of the staff. Quite the contrary, our overwhelming impression of them was of people who really cared, who were committed and who were uncommonly intelligent. Where they failed, as they sometimes did painfully, it would be more accurate to attribute those failures to the environment in which they, too, found themselves than to personal callousness. Their perceptions and behavior were controlled by the situation, rather than being motivated by a malicious disposition. In a more benign environment, one that was less attached to global diagnosis, their behaviors and judgments might have been more benign and effective.
It’s not a hard-hitting scientific paper in that it does not have robust study methods, etc. Though published in 1973 (prior to two revisions of the DSM), it still has relevance today and, at eight pages long, it is an easy, thoughtful, and humbling read. (For those of you with institutional access, you can find it within the online Science archives; for those of you who do not, simply consult the oracle—the full text is out there. Alternatively, you can read the summary on Wikipedia, though it does not do the original article justice.)
Much of the paper deals with the issue of context: What are the consequences of labels? environments? How do interpretations of behaviors change as a result of the current circumstances? At the time the paper was published, cognitive-behavioral psychological theory was experiencing greater dissemination, but psychodynamic/psychoanalytic psychiatry was still the primary mode of diagnosis and treatment. Psychodynamic theory does not emphasize environmental context (i.e. thoughts and behaviors are attributed chiefly to intrapsychic phenomena). This paper clearly criticizes this perspective (amongst other things). (Compare this with Gladwell’s The Tipping Point. Gladwell spends much of the book discussing “The Power of Context”—he argues that the crime rate in New York City declined in the 1990s because the environment—graffiti-free subway cars, the absence of broken windows, etc.—did not encourage misdemeanors. No one is going to tag a building if it is well-lit, clean, and sparkly.)
We interact with each other and the environment in a dynamic way. Does our individualist culture facilitate beliefs that we are more independent than we really are?
While on the subject of psychiatric misdiagnosis, I looked further into the “Martha Mitchell Effect“. (Hi Brock!) There is only one article in the literature that discusses this phenomena:
Robitscher, Jonas. “Stigmatization and stonewalling: The ordeal of Martha Mitchell.” Journal of Psychohistory. 1979. Vol. 6, Iss. 3; p. 393-408.
In a 1977 TV interview with David Frost, former President Richard Nixon suggested that Martha Mitchell’s mental and emotional problems had so upset her husband John, then the attorney general, that he was unable “to mind the store” and thus allowed Watergate to occur. The present paper finds that the facts were quite different, that there is no evidence that Martha Mitchell was mentally ill, and that there is evidence that she was labeled by those involved in the Watergate conspiracy so that her suspicions would be discounted. The story of Martha Mitchell’s mistreatment is described in detail as an example of political stigmatizing. It is suggested that Nixon’s confusion was based on projection: Martha, rather than John or Richard, was responsible for Watergate.
It’s a slippery slope, yeah? I’m hoping to get my hands on a copy of the article; it sounds fascinating. In fact, the Journal of Psychohistory sounds intriguing—though potentially too psychoanalytic for my tastes. (Just to be clear: I am not totally anti-psychoanalytic psychiatry; I just can’t grasp the concepts with the same ease that I comprehend cognitive-behavioral theory. I’m concrete that way.)
And notice where the Journal of Psychohistory is published? That’s right, New York City. Wouldn’t it be awesome if I lived in New York City next year? Wouldn’t it? WOULDN’T IT?
20 Oct 2007 | 4 comments.
Shoes.
“Would you like to purchase these with a credit card, miss?” the man asked. Like every other man working in the Nordstrom’s shoe department, he was tall, attractive, and exceptionally well-groomed.
Without looking away from the box cradling the $425 Isabella Fiore embroidered pumps, she replied, “I’ve got cash.”
She pushed her thin, blonde hair over her shoulder and, redirecting her attention, began to dig through her $295 Juicy Couture velour shoulder bag. After pulling out two tubes of lipstick, a brush, three gum wrappers, and a handful of crinkled papers, she pulled out a roll of bills. She laid out 23 twenty dollar bills.
“Thank you,” the man answered, smiling at her rouged face. She was probably in her early thirties. Her eyes were ringed with thick, black eyeliner, from which arched long, black eyelashes. Her eyelids were shaded a faint shade of purple and her lips glistened cranberry red. Large hoops of gold dangled from her ears.
She didn’t bother to dress up; she felt self-conscious about the bites on her shoulders and chest. A red, form-fitting cotton hoodie hugged her Rubenesque frame and loose black pants swished around her legs. Flip-flops—she got those from the hospital—adorned her feet.
Her disability check had arrived three days prior, though she did not have the opportunity to cash the $690 until now. Excited with the prospect of darling shoes, she proceeded immediately to Nordstrom’s from the bank. (Macy’s simply didn’t have the shoes she liked.) This became the usual chronology of events after her seven-month hospitalization at the state psychiatric hospital: Get check, spend over half of it on a pair of shoes (or a handbag, depending on the month), use the rest on cigarettes, make-up, and food.
She returned to the homeless shelter, swinging the Nordstrom’s bag from her right hand. The gaggle of men in the lobby murmured slick phrases about her body shape; she purposely ignored them.
“You’ve been wearing that sweater for almost two straight weeks now,” someone remarked as she walked past, clutching her Juicy Couture bag close to her body. “Don’t you want to wash it?”
“No,” she answered. “It won’t help. The bugs won’t get washed out.”
“We can wash your clothes completely—we can wash your blankets, too. You can take a shower at the same time; that way, everything will be clean at the same time,” the same someone coaxed.
“No,” she answered again. “The bugs live inside the cotton. If you wash the cotton, the bugs will float in the water and when it drains away, the bugs will go back into the cotton. They will never go away. They will bite me forever. I just hide the itching and scratching now.”
The same someone—one of the shelter staff—quietly sighed. There were no bug bites. There were no bugs living in the cotton. Her skin was unblemished, except when she scratched her skin raw with her pink-painted fingernails.
“Okay,” the shelter staff said. “I’ll ask you again tomorrow, but if you change your mind before then and want to wash your clothes and blankets, let me know.”
“No,” she answered again. She found her usual chair, sat down, and put the box of shoes in her lap. She removed the lid and smiled. Her fingers quickly folded open the thin paper and then ran over the stacked heel and satin cloth overlying the shoe.
They were lovely shoes.
She replaced the lid and placed her Juicy Couture bag on top of it. She then put headphones over her ears and a scarf over her head and around her neck. She folded her legs onto the chair and then tightly wrapped a blanket around her, the shoe box, and her bag.
This was the only way to kill the bugs. They would suffocate to death.
18 Oct 2007 | 2 comments.
“I’m not gonna be ignored!”
There is a point in the movie Fatal Attraction where Glenn Close utters the line, “I’m not gonna be ignored!” (The link is the movie trailer and she says the line around 0:54.)
That’s not what she actually means. Instead, she may mean
I shall put forth my greatest efforts to increase the likelihood that you will attend to me.
Or perhaps she means
I interpret your behavior to mean that you are not attracted to me the way I am attracted to you and this causes me great frustration.
Or maybe she means
If I need to escalate my behavior so that your behaviors will become congruent with what I want your behaviors to be, then I shall do so.
Or
I perceive that you do not value me.
The unfortunate truth is that while we can influence the behavior of others, we cannot control it. The sad irony, therefore, is that while she adamantly states that she is “not gonna be ignored”, she is. True, her increasingly volatile and frightening behaviors ultimately induce a response from Michael Douglas’s character, though it is not the response that Close’s character necessarily wants.
Pithiness is sexy. Which is why I, too, shall hit my fist on the table and emphatically say, “I’m not gonna be ignored!” while I continue to be ignored.
UPDATE: I apparently wasn’t hitting the table hard enough. I am no longer being ignored! Oh, the excitement!
16 Oct 2007 | 4 comments.