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Monday, February 22, 2010

I do not always agree with Rush Limbaugh on matters of political strategy, but this morning he has been asking if anyone knows any reason why the Republicans should go to the upcoming health care reform summit at Blair House. I've been asking that for weeks. So far neither of us has received a coherent answer. The Republicans are going to be excoriated as "no sayers" and for causing stalemate in Washington whether they go or not; what's the upside?

=============

If you have not seen yesterday's View, there is an item of interest regarding Windows Sentinel Software and Devil Mountain Software that is worth your attention. There is also a short note on assassination in modern warfare.

==========

I can recommend the Wall Street Journal op-ed piece "No (Tenured) Teacher Left Behind" although it doesn't say much that we haven't been saying here for a long time. Lifetime tenure makes sense for higher education professors in research universities, and a case can be made on the grounds of intellectual freedom for teachers in some primary teaching universities; but it makes no sense whatever for public school teachers. In my judgment there should be no tenure whatever in community colleges and the state teaching colleges and certainly none in the grade and high schools. The purpose of public education is investment in the future: the notion is that the schools will teach good citizenship and the primary skills needed to be useful citizens. While tenure is a good idea to preserve some opposition, for the most part the investors ought to be in control of the institutions they have invested in.

Does this mean "indoctrination"? Well, of course it does: that is, there is no moral argument for taking money away from a community in order to have its children taught principles antithetical to its way of life and beliefs. As soon as the schools and teachers are controlled by people who don't pay the taxes that support the schools and teachers, the danger that the schools will be instruments for indoctrinating the students against their parents gets very high. Some of us can remember governments that encouraged students to denounce their parents, with teachers as the transmission belt for the denunciations.

Now it is certainly true that local control of schools produced situations in which teachers were fired for teaching their political beliefs and lived in some fear of the local school board and its narrow minded morals. That's the price of public education: if it's an investment in the future, then the investors ought to get a say. If it's not, then what's the moral justification for paying for them with tax money? What do the taxpayers get out of this?  The answer appears to be the usual answer of the intellectual elite: "It's a good investment and it's not our fault that you don't understand that. We know what's best. You don't. Live with it."

Note that private schools don't operate that way. They can't.

Teacher tenure and the seniority principle make no sense at all in a liberal democracy. Yes, it's unfair -- perhaps -- to teachers who become genuinely convinced in the truth of a cause and believe they have a moral obligation to teach it without regard to the wishes of the parents and taxpayers. Sometimes they may even be right. Sometimes they are not. (Few in America would defend the right of a convinced Zoroastrian Fire Worshipper to proselytize in a sixth grade class.) Right or wrong, tenure is not morally justified: culture wars should not be decided in the public schools, and public school teachers are not the final arbiters of cultural issues to begin with.

And of course it is on this high moral plane that tenure is always justified: when it fact it is seldom the actual situation in which it is invoked. In Los Angeles I don't think of any cases where teachers were challenged for their beliefs, some of which can be bizarre. The problem here, and so far as I can tell just about everywhere, is sheer incompetence. Teachers once given tenure can retire on salary, and while not very many do, the number isn't insignificant. The number of clearly incompetent teachers moved in slow circles through the system is fairly high. The "intellectual freedom" arguments are always invoked when tenure is challenged, but the real issue is that tenure preserves incompetence, and puts seniority above competence at layoff time.

The Gates foundation has discovered what many of us always knew, that the secret of good education is good teachers, and weeding out the worst while promoting the best is still the most effective way of improving a school system. Tenure stands that principle on its head and makes education reform from difficult to impossible.

With education as with many governmental operations, the principles of transparency and subsidiarity are the best guideposts. Tenure stands in direct opposite to both.

And see below

==================

 

 

 

 

 

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Tuesday, February 23, 2010   

Hollywood Economics

Today's Wall Street Journal has a a book review by Sonny Bunch of Edward Jay Epstein's "The Hollywood Economist". The book review itself is a brief summary of the arcana of Hollywood's peculiar economics. The Hollywood entertainment industry is in fact a financial industry, and its purpose is investment; art and entertainment are the outcome but they're not the reason the industry exists. Hollywood has invented some of the most creative bookkeeping and financial products imaginable, more so that anything Lehman Brothers ever came up with.

Epstein has written about all this in a previous work. From the review:

"Parts of "The Hollywood Economist," it should be said, may seem familiar to some readers, since its arguments and even some of its details appeared in Mr. Epstein's previous work on the subject, "The Big Picture: Money and Power in Hollywood" (2005). Entire passages are transferred almost word-for-word from one book to the next, such as Mr. Epstein's explanation for why film productions purchase insurance for their stars and why, for a time, Nicole Kidman was deemed so injury-prone that she became almost uninsurable. Mr. Epstein's in-depth examination of Arnold Schwarzenegger's lucrative contract for "Terminator 3" (2003) is also explored at length in both books. Other portions have been interestingly updated, such as Mr. Epstein's take on the state of home video."

The most interesting lesson I got from Epstein is that the weekly shout about the box office revenue from the top movies is part of marketing:

"In 2007, the studios earned only $400 million from digital downloads, compared with $17.9 billion from DVDs, $16.2 billion from pay and free television, and $8.8 billion from theaters.

Note the imbalance in those numbers: a combined $34.1 billion in revenues from home-theater products compared with a mere quarter of that amount in box-office booty. Mr. Epstein wants us to see that this is the true economy of Hollywood. The gaudy box-office receipts dutifully reported every Monday morning have little to do with the fiscal reality of the world's entertainment capital. "

All of which explains the current interest in digital streaming, which will very much impact the DVD part of Hollywood's revenue. Since Hollywood is one of the reasonably healthy industries in the US, this is a matter of importance.

===================

Cell Phone Radiation, redux

"Lab Rat with Cell Phones" by Christopher Ketcham in today's LA Times raises once again the question of the effect of cell phone radiation on the users. When I first heard about this I thought it silly, but one study Ketcham cites makes me wonder.

"For example, in 2008, neuroscientists at Swinburne University of Technology in Australia strapped Nokia phones to subjects' heads, then turned the phones on and off. On -- the brain's alpha waves spiked. Off -- the brain settled. The researchers speculated that the effect was the result of the brain "concentrating to overcome the electrical interference in brain circuits caused by the pulsed microwave radiation."

"Swedish neuro-oncologist Leif Salford, chairman of the department of neurosurgery at Lund University, has found that cellphone radiation kills brain cells in rats, especially those cells associated with memory and learning. The damage occurred after an exposure of just two hours. In duplicating earlier research, Salford also found that cellphone microwaves produce holes in the barrier between the circulatory system and the brain in rats. One potential outcome, according to Salford, is dementia. "

I have not seen the primary studies. The experimental design would be important: for instance, how does one get a reliable EEG while turning a cell phone on and off? When my iPhone gets within a few feet of a normal telephone, we immediately hear the gallop sound. When I use SKYPE I often have to put my iPhone on another table; clearly it radiates even when turned off, putting out enough energy to affect non-sensitive electronics. It has been years since I had to design electronics to measure EEG (electroencephalograph), EKG (electrocardiograph), and EMG (electronic muscle activity; I forget what the EMG stands for example) but in those days we had to use analog computers (huge banks of them) to filter out extraneous noise. Getting medical quality data from a non-restrained subject was very difficult in the early days of space human factors. I expect it is easier with today's technology, but it would still be a difficult experimental design. Given that it is properly designed, I'd think the results a matter for concern. I'd have about the same comments about the other data given here.

The piece concludes:

"Salford, the neuro-oncologist, has called the unregulated use of cellphones by 4.5 billion people worldwide "the largest human biological experiment ever." It's only common sense to do what you can to take yourself out of the guinea pig pool."

I've been a "cell phone radiation" Denier in the past; but I think I'll try looking up the primary data. In my case I don't use a cell phone much, so I doubt it has much effect on me, and in any event I don't intend to change my procedures; but it's one more thing to worry about I suppose.


============

In the past ten years, LAUSD has tried to fire seven teachers for incompetence; they have succeeded in four cases. Each firing cost half a million dollars. There are over 30,000 teachers in LAUSD. Meanwhile ABC News has laid off 300 people. I don't think any of them will be able to fight their dismissal.

One might think there is something wrong here.

I have mail regarding yesterday's notes on tenure:

One issue that hasn't been mentioned often in the tenure debate is one which I remember being stressed when I was entering education many years ago. It was represented by union officials that the tenure law was enacted at least in part to prevent school districts from arbitrarily firing teachers who had worked enough years and taken enough extra schooling to raise themselves to the top of the pay scale and replacing them with beginning teachers often earning a third as much.  In Michigan, at least, it took about 13 years, a master's degree and 30 additional semester hours to "top out", at which point a teacher could make a reasonable, but certainly not extravagant living. At that point, the teacher had little chance of changing school districts, voluntarily or not; since few districts would hire a top pay teacher unless they had some special skill to offer - most notably successful athletic coaching.

 Jim Bunnell

Such things happen; but the answer remains, in my judgment, local control, not some attempt to impose a "fair" system. Note that LAUSD in effect cannot fire an incompetent teacher no matter how ineffective. I cannot believe that in all of LAUSD there have not been more than seven incompetent teachers in the past ten years.

Which is the worst threat here?

 

 

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Wednesday,  February 24, 2010

The February Chaos Manor Reviews mailbag has been posted.

The bloom is coming off the rose: independents elected as Republicans are acting independent, not adhering to the strict conservative principles enunciated by political purists.

Hardly astonishing. The people of these United States are center-right, not paleo conservative and not libertarian. They mostly want government to work properly, and they don't want to become experts on government. They want to get on with their lives. They owe more on their houses than the houses are worth in today's market, many have lost their jobs, the Depression is getting worse and they can see that. Unemployment is much higher than the Administration promised it could get. They want jobs, they want an economy, and they have been taught by all the intellectuals that only government can fix this.

None of this is astonishing. In November 2008 the people turned the rascals out: they rejected the failed Republicans. The Democrats had promised to make things all better. The Democrats had economic policies that would fix things, stop unemployment below 9%, buy up toxic paper and get the economy moving again, and in addition we'd get a black president and show the world that the people of the United States adore diversity and aren't racists, and we all think right.

That didn't work, so the anti-government sentiments are rising. A few understand that there are no instant fixes. There is no way to jump out of our economic doldrums. There are principles that will work:

transparency and subsidiarity. Put more power back in the hands of the locals. Let us compete on regulation and compassion and taxation. But none of that will be an instant fix.

People will continue to try instant fixes. They won't work, but many will continue to try. The intellectual climate is there: surely something will work! Government can do something! Surely!

No: all that government can do is get out of the way, and that's not going to happen very quickly. The Iron Law has had far too long to operate.

Possony and I long ago concluded that the inevitable course of history is to convert more and more of the output of civilization into structure, until it becomes so congested that supporting that structure becomes the only thing it can do. How long it will take the voting public to understand this I don't know: it's hardly being taught in the schools and universities, which continue to tell people that government can fix things, and never say "The remedy is to do less and get out of the way."

It is unfortunate that our newest Senator thinks that cooperation with the Democrats in passing a "jobs bill" is a good idea, but he's hardly alone in that. There were tax incentives for hiring toward the end of the Carter stagflation, and some remember them as contributing to the Reagan recovery. A lot of people think this bill won't hurt and might help, and it's pretty small potatoes. It's also got a popular title. It's for jobs! At least that's addressing the right problem. It's not health care or carbon taxes. It's not a good bill, but I can't imagine that the junior Senator from Massachusetts has committed the unforgivable sin by voting for it.

We are in a hole, and we should stop digging, but the intellectuals at Harvard and the other major Universities don't say that; and people continue to listen to them. I'd sure rather have the present junior Senator from Massachusetts in that seat than its previous occupant.

People are scared, and our politicians aren't smarter than economic professors, and they're scared too. The smartest guys in the world got us into this, and don't know the way out; and burning the junior Senator from Massachusetts at the stake won't get us out either.

The Country Club Republicans lost in 2008. The left wing Democrats lost in 2009. The people want the Creeps and the Nuts out. They know that much. It remains to get it across that government can't just fix things with yet another law, jobs bill, spending bill, or regulation; and those of us who understand that have got to understand that "pragmatic America" will continue to thrash about trying this and that in the notion that something has to work.

I've been recommending Amity Schlaes' history of the Roosevelt era "The Forgotten Man"  (paper) (kindle) for a year or more now. I continue to recommend it: it shows just what kind of thrashing around was tried back then, and why the legend that Roosevelt got us out of the Depression is just that, legend.

==============

The healthcare summit is tomorrow and some Republicans are foolish enough to be going. I don't quite understand: while I can understand why the junior Senator from Massachusetts might be reluctant to vote against a "jobs bill", I can't imagine anyone being unable to understand that the American people want no part of this blighted bill the liberals are desperate to ram done our throats whether we like it or not. I see no upside to attending the summit, which is really intended to see if the Democrats can get enough votes to proceed with the ramming.

============

The Weekly Standard observes that only two states have funding for their pension and retirement programs. The heading of the Standard piece is "Fifty Bernie Madoffs". Good title. Just about all the states are in Ponzi schemes, hoping that the Federal government, which is trillions in debt, will bail them out; so we have that to look forward to if we recover from the current Depression. And that doesn't count the carbon taxes and the health care taxes they're hoping to ram through while the Democrat majorities endure.

The voters turned out the Creeps in November 2008. They showed they aren't thrilled with the Nuts in November 2009. The Nuts are now desperate to put their monuments in place before the next election. The will of the people is pretty clear, but that's not what the Nuts want. We live in interesting times.

==========

<http://www.americanthinker.com/c_edmund_wright/> shows why this Depression is worse than anything since Carter's stagflation; and why it's going to be harder to get out of it.

Oops. Thanks to those who asked. The referenced article is

http://www.americanthinker.com/
2010/02/dear_mr_president_why
_we_are_n.html

 

 

 

 

 

 

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Thursday,  February 25, 2010

Writer Bill McKibben says Climate Change Deniers are like the OJ Simpson defense team.

The O.J. tactic Climate change skeptics sound like Simpson's lawyers: If the winter glove won't fit, you must acquit. Opinion February 24, 2010|By Bill McKibben

In recent years, every major scientific body in the world has produced reports confirming the peril of climate change. All 15 of the warmest years on record have come in the last two decades. And Earth's major natural systems are all showing undeniable signs of rapid flux: melting Arctic and glacial ice, rapidly acidifying seawater and so on.

Yet because of a recent onslaught of attacks on the science of climate change, fewer Americans now believe humans are warming the planet than did just a few years ago.

His argument isn't particularly new, but my question is his data: is it true that "all fifteen of the warmest years on record have come in the last two decades"? My memory isn't what it used to be, but I thought I heard that 1938 was the :"warmest year on record"? Given that the warming from 1885 to 2005 has been from -0.2 to + 0.6 degrees -- see the NASA chart -- and the error bar for measurement for much of that time can't possibly be less than .2 degrees to begin with, is anyone justified in making that statement? The chart shows a steady rise, and the highest peak in the pre-1950 era is about 1942; but I am not entirely certain that chart is the last word on the subject.

Accepting that chart -- I grabbed it off Wikipedia as convenient, but I'm never comportable with using that as a data source on anything important about a controversial subject -- the real question is how much of this steady warming trend is due to CO2 and how much would have happened anyway. The more I look at that chart the more I see a steady linear rise of about a degree a century with a ripple, and given the accuracy of the data, I'm not sure you can put much confidence in any other inferences -- and that's assuming that the manipulations to computer the world averages were applied fairly to all parts of the graph.  Clearly our data generation techniques have improved enormously since 1885. I'm not sure I trust the 1990 to present data to generate a "world temperature" to better than a .5 degree accuracy; I'd like to hear a defense of the techniques used to generate that world average; certainly I want to hear how it's generated now, and how it was generated for 1938, before I accept the "all fifteen of the warmest years on record" assertion.

If you assume that the "natural" trend since the end of the Little Ice Age has been a linear rise of about one degree per century with a ripple of about .4 degree, then I suspect that will be about as good a "model" as all the supercomputer models have come up with. What I find interesting is that I don't see much effect from war or peace or industrialization or the green revolution or the great rise in population or the rises in average prosperity in that chart. I admit I haven't looked very hard.

=====================

The reason I don't have ready access to the charts I've been using is that I foolishly trusted Firefox again, and I got what I deserved. I tend to use Firefox when I ought to the using OneNote, as a sort of data collector: I have 8 gigabytes of memory on this 64-bit Windows 7 system, and I just leave a lot of Firefox tabs open. Periodically I save the lot as bookmarks, but I haven't done that since last November or so -- my fault -- and the other day Firefox insisted on updating itself. As part of the update it seems to have thrown away its record of open tabs, of which there were, I fear, about 70, far too many. I'm having to rebuild that list again, and it's my fault. In future I'll do a better job.

I need to build a data organizing system: what I want is a way to be reminded of a lot of things I ought to look at so I can deal with them. Many are things I use these daily exercises. Others go in specific projects.

=================

Rush Limbaugh is saying that he was wrong in advising the Republicans not to go to the Health Care Summit. It's half time and the Republicans seem to have come out ahead, showing among other things that they know far more about the details of the health care bills than the President. According to Limbaugh they have "slapped the President around the room." They have read the bills. Biden, Reid, Pelosi have come off badly as has the President.

I haven't watched the proceedings, but the reports I hear seem to bear this out. Apparently I was wrong (I reached the "don't go" conclusion quite independent of Limbaugh).

The Democrats are now denouncing "process" which Limbaugh interprets as a signal that they will now use "reconciliation" as a means to ram the health care bill through without regard to the polling data. Is this a Constitutional Crisis? Note that when the Republicans said they would use a simple majority to confirm judicial appointments, it was called "the nuclear option". We can discuss the wisdom of Senate unlimited debate rules another time; it may be moot because the Democrats may no longer have a House majority on the health care bill.

Meanwhile the "Jobs Bill" that did pass the Senate with support of 15 Republicans may be in trouble in the House. It's a pork pie bill, and at $15 Billion it's small potatoes; it has a number of provisions that may do some good and won't do more harm than a lot of other stuff the intellectuals are throwing up in their frantic attempt to "do something" about the economy. You'll see a lot more of this. I refer you to yesterday's recommended reading. For that matter, if you missed it, yesterday's view is worth your attention when we consider tactics.

= = =

What we may be sure of is that we will hear more and more sob stories about how badly we need comprehensive reform and we need it now. Whether this trap will catch anyone is not clear.

=====================

Something else to worry about:

YouTube users are having their accounts hijacked and used to post porn.

<http://www.youtube.com/watch?v=9W9b15XiF1s

-- Robert Bruce Thompson

==

Yet another reason for users who put their credentials into a page they arrive at from a random link to alt.die.or.think.twice.

Short URLs have their place. It's the same thing, really, as a link where the text says "funny video", and the underlying URL is someplace evil in .cn.

.b

I try to limit the number of short URL's I give here. It makes the place look messier but it's one fewer thing to worry about.

=============

Apparently the health care summit hasn't been all that favorable for the President's team; they're now running out the clock with long speeches. We'll know more later, although I suspect Katie Couric will have a different view from Fox news on just what happened.

 

 

 

 

 

 

 

 

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Friday,  February 26, 2010

Summit Ends

The health care summit came and went, full of sound but not a lot of fury, and signifying what we knew before it began. The Republicans said they didn't want any of the current bills because it all costs too much, and the President said "Guess what? I won. Get used to it."**

The kabuki is over, and both sides have repaired to their lairs to marshal their forces. In theory the Democrats have the votes to ram this through whether you like it or not, but in the real political world that's not assured. Pelosi may not be able to get the Senate version passed in the House. It's not only a bad bill, but it includes the Louisiana Purchase and the Cornhusker Kickback as well as the Union Grab.

It also includes the tax on medical equipment, the logic of which escapes me; I can only conclude that the makers of wheel chairs and crutches and by-pass stents and x-ray machines and diabetes meters and stethoscopes and orthotics and hospital beds and urine bags didn't understand that they were targets until it was too late, and thus never formed medical device lobbies and PACs. (At least one did exist but finding it's not easy; apparently they weren't very effective.) Why medical device makers are targets is not known to me: is it merely because they are profitable? Did they do something to offend the Democrats? I don't understand that one.

In any event the Republicans seem to have come out way ahead among those who actually watched the show, but not many watched it: the media hasn't shown much from the summit conference, and if you get your opinions from the headlines you'd think the President won a grand slam.

The Wall Street Journal editorial this morning was "Defining ObamaCare Down". It quoted Obama saying "We want competition, we just want minimum standards." He didn't mention that the minimum standards are set by lobbyists who tell what must be included in coverage. Minimum standards sound great, but they really conform to pressure groups.

Perhaps it would have been worse if the Republicans had not shown up. At least the Republicans won the game, and the decks are cleared. "I won. Get used to it."** The two-step is over, and it's now down to procedures and the Party Whips.

The Los Angeles Times supports the "reform"; the Times concluded that the summit wasn't terribly relevant. The headline was "Democrats' Next Option: Go It Alone." The question becomes whether the Democrats can go it alone: do they still have a majority on this issue, now that Ted Kennedy's seat is now in Republican hands.?

==

** This is my translation of the President's closing remarks, not an actual quote. See Mail for more details.

===================

Italian Madness

This morning's Wall Street Journal had another editorial worth thinking about. Italy's Google Miscarriage tells the story of how a group of thugs beat up a disabled person.

In the annals of judicial folly, a place of honor ought to be reserved for this week's conviction of three Google executives by an Italian court. Their crimes, apparently, included a failure of clairvoyance and an inability to time-travel.

The case involved a video clip shot by some depraved Italian teens who beat up a Down syndrome child, recorded the deed and uploaded it to the Web. When the video, which was posted on Google's now-defunct Google Video service, was reported, Google promptly took it down and assisted the Italian police in apprehending the thugs.

For their trouble, four Google executives—none of whom were even aware of the video's existence until it was taken down—were charged with violating the privacy of the beaten-up boy and with "criminal defamation," a considerably more serious charge. All four were acquitted on the defamation charge, but three were convicted of the privacy violation and given six-month suspended sentences.

This isn't likely to withstand appeal even in Italy, but it's very strange that things could get this far. The intersection of reason and the technological revolution produces odd things, but this is one of the oddest.

=================

The health care summit drew attention away from the Toyota fiasco. I'm still not convinced that there are fundamental flaws in the Toyota; of the incidents described so far, some appear to be floor mats improperly installed, a couple may be due to bad assembly, and the rest don't seem to have any systematic cause. What is clear is that Toyota is rich, and there are a lot of tort lawyers circling like sharks; and like global warming and the 'health care crisis' there's a lot of benefit to building a consensus.

One sign of the times: Toyota has tens of billions. That's a lot of money, but in these times of multi-trillion dollar budgets it doesn't sound like so much at all.

================

 

 

 

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Saturday,  February 27, 2010

I had noted this in my breakfast log, but it seems Monty beat me to it:

Subj: Why Psychiatry Needs Therapy + Cognitive-Behavioral Therapy + Comfortably Numb

http://online.wsj.com/article/SB1000142
4052748704188104575083700227601116.html 

Interesting history about the struggle within the American Psychiatric Association between the psychoanalysts and the psychometricians. The DSM-III and its successors apparently embody a both-and political resolution of that struggle.

>>Where is psychiatry headed? What the discipline badly needs is close attention to patients and their individual symptoms, in order to carve out the real diseases from the vast pool of symptoms that DSM keeps reshuffling into different "disorders." This kind of careful attention to what patients actually have is called "psychopathology," and its absence distinguishes American psychiatry from the European tradition. With DSM-V, American psychiatry is headed in exactly the opposite direction: defining ever-widening circles of the population as mentally ill with vague and undifferentiated diagnoses and treating them with powerful drugs.<<

I wonder why Dr. Shorter did not mention Cognitive-Behavioral Therapy, which stands in contrast to both the psychoanalytic and the psychopharmaceutical enthusiasms?

See, for example,

http://www.nacbt.org/whatiscbt.htm 

and particularly

http://nacbt.org/evidenced-based-therapy.htm 

For another perspective on how mushy diagnoses and psychopharmaceutical enthusiasm distract attention and divert resources from the treatment of serious disease, try

http://charlesbarberwriting.com/ 

http://www.c-spanvideo.org/program/199864-1 

Rod Montgomery==monty@starfief.com

The DSM did not exist when I was in graduate school in psychology, and I have never studied it, so my views are not based on experience or primary observations. Clearly my conclusions based on other reviews and quotations from the DSM have not been sufficiently favorable to goad me to becoming more familiar with it. When the first DSM came out it seemed to me far too eager to label odd but not really abnormal behavior as a "disorder" warranting treatment. In particular there were a list of "disorders" attached to what seemed to me fairly common teen age funk. I never thought talking back to Mother was something to be treated with a pill.

DSM has, in my judgment, far too often been influenced by the pharmaceutical industry, and used to justify payments from insurance; it is, in my judgment, one of the many reasons for the high costs of health care, since "mental health" coverage is now generally required in state mandated healthcare insurance policies as one of the "minimum" requirements. As to the conflicts between the Freudian analyst based theories of mental disorder and the behavior-based medical theories that generally prescribed chemical treatment, that was just beginning when I left psychology graduate school. Of course my emphasis in psychology was in engineering and human factors on the one hand, and mathematical and statistical analysis using tests and measurements on the other, so I am hardly an expert on abnormal psychology.

I did note that many years ago my friend Poul Anderson became so depressed that he asked me to take him on a two week sail through Channel Islands and down to Catalina (I owned a 20 foot midget ocean racing sailboat in those days; Alan Susia built it for me in Seattle). The sailing trip was a success in that he wasn't depressed while we were on the voyage, but it wasn't a cure either: but not long after he was pretty permanently 'cured' by lithium treatments. It was a bit of a revelation to me, because in my graduate studies in psychology there was no simple treatment of depression. (Miltown existed, and was controversial; lithium was a treatment for mania, but seemed to help some cases of depression.)  Serious depression was a candidate for shock treatment, particularly if there were a pattern of manic then depressive episodes, and any danger of suicide. Depression could be sorted into various categories, including manic-depressive psychosis (with or without flight of ideas, etc.) and involutional melancholia. The latter was what we now tend to call acute depression, and often ended in suicide.

A few years after I left psychology graduate school the various chemical treatments for depression became more widely used, and while they certainly caused a lot of problems with side effects, they were also highly effective. Poul was effectively 'cured' by lithium, and while he had some episodes of depression for another 30 years, they weren't life threatening. Poul died in 2001 of prostate cancer. He had told me thirty years before that "that's what gets us all in the end." Whether that was prophetic or he was making a clever pun I am not sure.  Anyway, my point is that acute depression and involutional melancholia were pretty well considered incurable in the pre-chemical days of psychiatry, and the Freudian treatment had no specifics. My textbook of psychiatry from the 1950's essentially says take steps to prevent suicide, and try anything that seems to work. Occupational therapy is good, including getting the patient interested in a hobby. Opiates sometimes help, but often do no good.

In those times some psychiatrists thought convulsive therapy a good idea; Freudians and non-medical (psychologist) therapists generally opposed it. Hydraulic treatments (pack and bath) were found to be seen "as methods of coercion rather than cure." The most important thing was to prevent suicide. The only sure way to do that was institutionalization.

I ramble. In any event, the article is worth your time. And perhaps the DSM has done more good than harm; certainly the development of chemical treatments for depression seems to have done some good; those who blame the anti-depressants for patient suicides seem to forget that prior to the discovery of chemical treatments, suicide was a very common end to many forms of depression.

Incidentally, my own experience has been that fish oils including salmon oils can have a positive effect on mild depression. So does St. John's Wort. I get both of those from Trader Joe's.

The following extract is given to show some of the flavor of the article. Think of it as a pull quote to get your attention:

Major depression became the big new diagnosis in the 1980s and after, replacing "neurotic depression" and "melancholia," even though it combined melancholic illness and non-melancholic illness. This would be like incorporating tuberculosis and mumps into the same diagnosis, simply because they are both infectious diseases. As well, "bipolar disorder" began its relentless on-march, supposedly separate from plain old depression.

New drugs appeared to match the new diseases. In the late 1980s, the Prozac-type agents began to hit the market, the "SSRIs," or selective serotonin reuptake inhibitors, such as Zoloft, Paxil, Celexa and Lexapro. They were supposedly effective by increasing the amount of serotonin available to the brain.

The SSRIs are effective for certain indications, such as obsessive-compulsive disorder and for some patients with anxiety. But many people believe they're not often effective for serious depression, even though they fit wonderfully with the heterogeneous concept of "major depression." So, hand in hand, these antidepressants and major depression marched off together into the sunset. These were drugs that don't work for diseases that don't exist, as it were.

The latest draft of the DSM fixes none of the problems with the previous DSM series, and even creates some new ones.

I don't claim ever to have been much of a clinical theorist. I've always been more a psychometrician, and I have never been fond of any of the Freudian-based personality theories. (Note that L. Ron Hubbard's Dianetics was a synthesis of the Jungian offshoot from Freud and Korzybski's General Semantics, both quite respectable disciplines in 1950) because I have never seen any physical analogs of the various hypothetical structures they mandate. I do wonder if the DSM has done more harm than good.

Another pull quote:

A new problem is the extension of "schizophrenia" to a larger population, with "psychosis risk syndrome." Even if you aren't floridly psychotic with hallucinations and delusions, eccentric behavior can nonetheless awaken the suspicion that you might someday become psychotic. Let's say you have "disorganized speech." This would apply to about half of my students. Pour on the Seroquel for "psychosis risk syndrome"!

DSM-V accelerates the trend of making variants on the spectrum of everyday behavior into diseases: turning grief into depression, apprehension into anxiety, and boyishness into hyperactivity.

If there were specific treatments for these various niches, you could argue this is good diagnostics. But, as with other forms of anxiety-depression, the SSRIs are thought good for everything. Yet to market a given indication, such as social-anxiety disorder, it's necessary to spend hundreds of millions of dollars on registration trials to convince the FDA that your agent works for this disease that previously nobody had ever heard of.

I am very glad that the DSM did not exist when I was growing up. I would almost certainly have been diagnosed with a disorder that could only be cured by drugs. As it happens, I was "cured" by being forced to learn a modicum of self-discipline.

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Sunday,  February 28, 2010

I read in the last couple of days an argument from one of the health care reform bill proponents that went like this: Yes, the bill probably will raise your insurance premiums, but that's because you will get more and better coverage.

I wish I could find that one again.

I am sure the argument is true: that is, the reform bills raise the minimum levels of coverage. What's not being discussed is what do "more and better" mean. Likely among other things there will be a mental health mandate that will turn out to be keyed to the new psychiatric Diagnostic and Statistical Manual (DSM) that's coming out. I'm only guessing on that but it's a likely guess. There are likely other mandated coverages, but since I don't follow the lobbyists any longer I can't tell you which. How strong is the chiropractic lobby? We know that anything having to do with tort lawyers will be protected. Doubtless there are others who get their services mandated in the 'reform' bills.

The question is whether the Democratic whips can marshal their votes. No one seems to know. We live in interesting times.

 

 

 

 

 

 

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