Monthly Archives: February 2017

Rabbi Michael Lerner warns against psychoanalyzing/diagnosing Mr. Trump (or any political leader, for that matter), especially when such psychoanalysis is intended as a tool for opposition. He points out that it’s questionable to diagnose people without working with them for a long time in a therapeutic setting. Rather, he says, one should focus on actions instead of on the internal demons of one’s opponent. (Mr. Lerner lists other reasons as well. Read the whole thing.)

I’m inclined to agree. I get very uneasy when I read of a psychotherapist or other mental health professional diagnose a politician with a disorder.

Occam’s Razor can do some good here. If Mr. Trump is unstable, erratic, or unpredictable, his actions by themselves speak to how much we can trust him or how competent he is. Whether the diagnosis is right or wrong, we don’t need it.

Or mostly we don’t. Mr. Lerner’s warning is an “editorial note” to another piece, “Trump as Narcissist,” by Michael Brenner, also found at the above link.* Brenner makes several arguments that stand or fall on their own. But his key point is that Mr. Trump is a narcissist and we cannot expect the demands and incentives of the presidency to tame his narcissism.

That argument is marginally informed by whether Mr. Trump really and truly suffers from narcissism. If he does, there’s less hope that he’ll mature and grow into the presidency. If he doesn’t, there’s slightly more hope. And if a 25th amendment solution is at all in the offing, then maybe psychological unfitness is a way to invoke that process. (At the same time, I’m not sure we really want to invoke that process, and I am especially wary of admitting to that end testimony from mental health professionals who have not even met with Mr. Trump personally.) So…maybe diagnoses of the sort Mr. Brenner offers do some good after all.

But the argument that Mr. Trump will grow into the presidency doesn’t rely only on the proposition that he’ll become a better person. It also relies on the claim that our system of checks and balances might actually work and that the federal bureaucracy will do what bureaucracies do and somehow condition what Mr. Trump can accomplish. We may of course doubt whether any of this will happen or if it does, whether we’ll welcome what the country would look like afterward. (For example, I’m glad that Michael Flynn has quit the National Security Agency, but I also share Noah Millman’s concerns about the intelligence leaks that seem to have prompted his ouster.)

And for the record, I don’t believe there’s something epistemologically magical about the “months, or sometimes years” of working with a client that Mr. Lerner says is necessary to determine if a person suffers from a disorder. I acknowledge that the the diagnoser probably has to always base his or her decision on incomplete information. So maybe it’s not entirely fair for me to claim the public diagnoses lack sufficient information.

That acknowledgement, however, doesn’t change my mind that such health professionals are acting unprofessionally and to a certain extent dangerously in their public diagnoses. They’re contributing to a discourse in which mental illness is seen as something shameful or to be feared. To my mind they’re weaponizing techniques that originally were meant to help or at least understand people.

Such is not their intention, and it’s not everything that they’re doing. Some mental disorders and perhaps even “personality organizations” ought to disqualify a person from certain positions of responsibility, among them the presidency. When an apt case presents itself, then maybe these mental health professionals are doing a service in highlighting it. And as even Mr. Lerner notes, there is something to be said for noting certain “styles” of politics and cultural expression. He cites Christopher Lasch’s study of the American “culture of narcissism, and I could cite Richard Hofstadter’s essay on the “paranoid style” of American politics.

Maybe there’s no “pure” approach. Maybe some harm has to be done for a greater good. I will probably not convince these mental health professionals otherwise. But I urge them to at least acknowledge and more forthrightly address the dangers of what they’re doing.

*If you read Tikkun Olam a lot, you’ll find that Mr. Lerner often attaches editorial comments to essays he publishes but disagrees with.


Category: Hospital, Statehouse


Category: Espresso

For Linky Friday, I had an item about the c-section rate and whether it may promote evolution towards big heads. In the comments, Kristin Devine linked to this article, about c-section rates:

Experts say that even total C-section rates—which include cesareans for all births, not just the low-risk ones we focused on—should rarely be high. “Once cesarean rates get well above the 20s and into the 30s, there’s probably a lot of non-medically indicated cesareans being done,” says Aaron B. Caughey, M.D., chair of the Department of Obstetrics and Gynecology at Oregon Health & Science University School of Medicine in Portland and a lead author of the new ACOG/SMFM recommendations. “That’s not good medicine,” he says.

When asked to explain their high C-section rates, hospitals offered several responses.

Mark Rabson, corporate director of public affairs at Jersey City Medical Center, described how his hospital, which serves “a diverse metropolitan area with many socio-economic issues,” was working to lower C-section rates by, for example, reviewing the care of all providers whose cesarean rates are above 30 percent and offering them assistance in how they manage patients during labor. In addition, he says the hospital is now using midwives, healthcare professionals trained to avoid intervening in childbirth unless medically necessary, and people fluent in multiple languages to educate patients about cesareans.

Patricia Villa, a spokeswoman for Hialeah Hospital, told us “while there are many factors that impact a woman’s decision to have a cesarean section, we are focused on driving improvement in this area.” She also noted that the hospital had been recognized by the March of Dimes for it’s efforts to prevent elective early deliveries before 39 weeks.

Most people know that hospitals and obstetricians have incentives towards c-sections, but it’s hard to fully appreciate just how many incentives there are unless you see it at work (or, like me, hear regular testimony). The fact that the hospitals get more money is only a part of the equation. The time physicians get back isn’t just for playing golf. When Clancy was in Arapaho, she was regularly faced with one of two options. She could hover over a mother all night, extracting all sorts of costly resources from the hospital along the way. She would be staying there, not seeing her daughter or her husband and not getting much goodsleep. She wouldn’t be generating any other revenue while there because she has to be on stand-by. If she delivered the baby before 6am, she would then finish her paperwork, get maybe an hour of rest, and spend the next day seeing clinic patients. If it is after 6am, then she gets the morning off. Which allows her to get some sleep, but forces patients to reschedule and means less revenue for the hospital/clinic. Alternately, she could reach for the scalpel at 8pm be done with everything before 9, come home, get rest, see all of her patients the next day. And, if she cares, make more money for the hospital and possibly herself (through bonus structures) or at least have better efficiency numbers when it came time for the performance review.

My wife is the type of person to hold the line. I’m frankly not sure that I wouldn’t find some sort of way to rationalize interventions.

But while people know about that aspect of it, and probably know that a lot of women pressure their obstetricians for c-sections, that’s really only a part of the equation. The other part involves decisions that the OB makes well prior to the c-section decision. Intervention begets intervention. If a woman gets an appointment for induced labor, a future c-section becomes more likely. If she gets an epidural, a c-section becomes more likely. If labor is sped along through other interventions, c-sections become more likely. Why? Well, as best as I can figure, the more that a hospital intervenes, the less control the body has over the process. So even if two physicians have the exact same philosophy towards c-sections specifically, their philosophy on earlier interventions may lead to different c-section rates. And a woman’s chances of getting a c-section may depend not just on the obstetrician or the hospital, but the specific anesthesiologist on duty and how aggressive their philosophy is.

In the map on Kristin’s article, you notice that a lot of rural states have lower c-section rates. That’s at least part of why. Clancy’s employer in Arapaho didn’t even offer epidurals. The less resources, the less earlier intervention. The less earlier intervention, the less likely a c-section is to become necessary in the first place. My wife’s c-section rate isn’t just low because she views it as the Option of Last Resort, but because she’s not an interventionist generally (in obstetrics and elsewhere).

So it’s not just a question of whether a c-section is medically necessary, but also whether it becomes medically necessary along the way. Both of these things are going to depend on a lot of things like obstetrician philosophy, hospital policy, resources, other personnel, and (as important as anything else) patient philosophy. Whether they want an epidural has a cultural context, and that’s going to vary from place to place. Whether a woman will be the only person she knows that had a c-section, or whether she’s been told that’s the way to go. Whether she lives in a place where people read Mother Jones, or Newsweek.

Right now we live in a culture where, in addition to all sorts of other incentives, c-sections are normal and giving birth on hands and knees or underwater is considered weird and unnatural. Because intervention begets intervention (both psychologically and medically), and our health care system is an interventionist one from top to bottom, I am skeptical that we’re going to see change any time soon.


Category: Hospital

Daughter Explains Brutal Obituary She Wrote For Her Father | GOOD

At a young age, Leslie quickly became a model example of bad parenting combined with mental illness and a complete commitment to drinking, drugs, womanizing and being generally offensive. Leslie enlisted to serve in the Navy, but not so much in a brave & patriotic way but more as part of a plea deal to escape sentencing on criminal charges. While enlisted, Leslie was the Navy boxing champion and went on to sufficiently embarrass his family and country by spending the remainder of his service in the Balboa Mental Health Hospital receiving much needed mental healthcare services.


Category: Espresso


Category: Espresso

Sir Humphrey: Unfortunately, although the answer was indeed clear, simple, and straightforward, there is some difficulty in justifiably assigning to it the fourth of the epithets you applied to the statement, inasmuch as the precise correlation between the information you communicated and the facts, insofar as they can be determined and demonstrated, is such as to cause epistemological problems, of sufficient magnitude as to lay upon the logical and semantic resources of the English language a heavier burden than they can reasonably be expected to bear.
Hacker: Epistemological — what are you talking about?
Sir Humphrey: You told a lie.
Hacker: A lie?
Sir Humphrey: A lie.
Hacker: What do you mean, a lie?
Sir Humphrey: I mean you… lied. Yes, I know this is a difficult concept to get across to a politician. You… ah yes, you did not tell the truth.
Hacker: You mean we are bugging Hugh Halifax’s telephones?
Sir Humphrey: We were.
Hacker: We were? When did we stop?
Sir Humphrey: [checks his watch] Seventeen minutes ago.


Category: Espresso


Category: Espresso

20161107_091838

Last week I posted an Linkage Over There about a superbowl Audi ad:

Well, if you’ve been reading along, I think you’ve figured out what the real message of this Audi advertisement is, but just in case you’ve been napping I will spell it out for you: Money and breeding always beat poor white trash. Those other kids in the race, from the overweight boys to the hick who actually had an American flag helmet to the stripper-glitter girl? They never had a chance. They’re losers and they always will be, just like their loser parents. Audi is the choice of the winners in today’s economy, the smooth talkers who say all the right things in all the right meetings and are promoted up the chain because they are tall (yes, that makes a difference) and handsome without being overly masculine or threatening-looking.

At the end of this race, it’s left to the Morlocks to clean the place up and pack the derby cars into their trashy pickup trucks, while the beautiful people stride off into the California sun, the natural and carefree winners of life’s lottery. Audi is explicitly suggesting that choosing their product will identify you as one of the chosen few. I find it personally offensive. As an owner of one of the first 2009-model-year Audi S5s to set tire on American soil, yet also as an ugly, ill-favored child who endured a scrappy Midwestern upbringing, I find it much easier to identify with the angry-faced fat kids in their home-built specials or the boy with the Captain America helmet.

While some dismissed this characterization, I thought it was rather spot-on. If this were a Chevy or a Nissan ad, I might think that some of the characterizations are happenstance, but this is an Audi ad. That means class is not incidental, but rather core, to the product. So we can likely assume anything involving class in the ad is likely intentional. And in this case, it did so in a rather politically skewed direction.

This ad was clearly conceived when it looked like Hillary Clinton was going to be the first female president. And in the run-up to the ad, Audi did a publicity blitz about its commitment to gender equality (hehe, hehe). It was aimed squarely at a particular segment of its clientele. But before we get too much into that, let’s talk about wine and cheese. For a few months, my Twitter feed contained this ad:

There is some really intense social and class signaling going on in that ad. I mean, let’s count the ways: Name-checking the most exclusive university in the country, science!, whiteboard with code, Apple computer, elegant geek girl. It really has it all and it just screams New White Collar through and through. Which, if they’re selling a cultural service like wine, is a pretty good pitch! They know their likely audience. Being close to that audience myself, I actually think it’s pretty well done. Maybe a bit overkill, but I only have one foot in that pond.

Now, the Audi ad goes for a slightly different set. Older and wealthier. More likely for their to be a family involved. As the article says, the protagonist isn’t the girl so much as the dad. The dad with the girl to be proud of. The dad who is on the Right Side of History. The dad who doesn’t need an Audi to be good, but is good and Audi is good and let’s get together. The characterization of The Other is probably a necessary component to that because goodness needs something to be compared to. Something a little grubby and unclean. The ad, as a whole, makes its pitch by equating vanity for virtue. It’s not toxic to conservatives, but to the extent that it appeals to conservative it’s going to be the squishes, the #NeverTrump sort, and those whose sensibilities align with left at least in terms of cultural cues.

Now, lest anybody think I am wanting to pick on one side, it’s not hard to come up with an idea of something similar aimed at conservatives would look like. Even if we’re looking an ad seeking to confuse vanity and virtue – or is it vulgarity and virtue – for the well-to-do right. We don’t even need to leave the auto market. Or the luxury auto market. Or the Superbowl.

A visceral yell. A combination of individualism and group (patriotic so it’s okay) achievement. My accomplishments are mine, your accomplishments are ours. It speaks to some less savory impulses in the same way the Audi ad does. Get this because you’ve earned it. Hard work! While the Audi focuses on a degree of innate you-are-evolved goodness, this one focuses on work and achievement. Which sounds good, if you kind of glide past the part where his achievements are his and others’ achievements are ours. But go America! This struck a positive chord with the people it was meant to, and a negative chord for others.

But just as you know the dad in the Audi ad didn’t vote for Trump, you’re pretty sure this guy did. This guy is, more or less, what I think of when I pass by the house of the guy that had the Trump flag in his yard. Really nice house. Obviously, the person was well off. Given that they put a flag in their yard, along with a Gadsden, suggests that he probably supported Trump throughout. That house has (surprise surprise) a full-size pickup in the driveway. Which is kind of on the opposite end of the spectrum as the electric car this guy is pitching.

Which is actually sort of the point. If the Audi ad is telling a well-to-do liberal that it’s okay to have a car that only rich people can afford because you’re good, this ad was telling future Trumpers that it’s okay to have an electric car because it indicates hard work and you work hard because you’re an American.


Category: Market

I’m watching The Man in the High Castle right now, and am mid-way through the second season. (No spoilers offered here.) The really wicked thing about it is not that it’s a What If involving the Axis winning World War II, but that it puts you in a place where you’re sincerely thinking “Man, I hope Hitler doesn’t die. Everybody needs him to stick around for a while.”

Also, I wish writers would never use the name John Smith again. I know they’re doing it for artistic reasons, but it’s dumb.

Not sure how I feel about turning the show’s namesake from a staid suburbanite into a paranoid crank guy, but Stephen Root is pretty awesome in everything he’s been in.

That’s all for now.


Category: Espresso

The courts, in general, want presidents to have the power to restrict refugees and inflow as they see fit.

They do not, however, want Donald Trump to be able to do this.

Therefore, their reasoning in striking down whatever they can of Trump’s executive order will involve things specific to him such as comments made about it being a Muslim Ban.


Category: Espresso