ShrinkWrapped

Grand Rounds

Grand Rounds is up, hosted by Dr. Sanity.  It is a collection of medically oriented blogs and worth a look.   Dr. Sanity does a particularly elegant job introducing the individual posts and is worth reading just for her commentary alone.

Whose Side Are They On?

A few items, chosen out of a multitude of possibilities, which raise my concern:

Last week Thomas Friedman wrote an Op-Ed, Just Shut It Down, in which he suggested that since Gitmo is such a source of poor public relations for the United States that we would be better off shutting it and, essentially, releasing the prisoners back to their home countries.    Paul Mirengoff, of Powerline, does a great job fisking this bit of idiocy today in The world may be flat, but it's not one-dimensional so I do not need to. 

Yesterday, the Times had an article, In Rising Numbers, Lawyers Head for Guantánamo Bay, which concerned itself with the large number of lawyers involved in efforts to free various inhabitants of Gitmo, presumably so they could go home and continue their peaceful lives that we so rudely interrupted; or, I suppose, they could return to Jihad as some already have. 

The Times today has a front page article,  C.I.A. Expanding Terror Battle Under Guise of Charter Flights, which essentially breaks the cover of a CIA charter airline involved in the War on Terror. One could be surprised that the newspaper that lead the call to charge someone in the Bush Administration with a felony for supposedly outing a CIA undercover operative (the Valerie Plame non-affair) would turn around and do just what they accused others of doing but the days of surprise at the Times are long past.

This morning on The Leonard Lopate Show on WNYC, public radio, I heard an interview with  Yaroslav Trofimov, in which the WSJ reporter and author of  Faith at War: A Journey on the Frontlines of Islam, From Baghdad to Timbuktu suggested that many Arabs were either supportive, neutral, or mildly opposed to the American invasion of Iraq and the attempts to bring democracy to the Middle East, but since Gitmo and Abu Graib have come to doubt our motives and believe the United States is waging a war of civilizations against Islam.  Neither Lopate nor Trofimov saw fit to mention that Gitmo and Abu Graib both are minor stories that have been blown well out of proportion by our MSM, of which they are a part, and the repetitive showing of the pictures and harping on our supposed mistreatment of detainees (all of whom are trying to kill us, by the way) has done more than anything our military or CIA have done to inflame Arab and Muslim opinion.

All of these things should alarm most Americans, and indeed, most supporters of Western Civilization.  Unfortunately, the liberal and left side of the political sphere is exhibiting an insouciance which borders on enabling, shading into depraved indifference and perhaps reaching all the way to, dare we say, treasonous anti-Americanism.

Democracy in Iran

On Memorial Day, I have set up a link to Regime Change Iran, a blog dedicated to bringing news to, and about, the oppressed people in Iran. 

Iran has one of the most cosmopolitan, educated, urbane populations in the Middle East.  For those who were not yet born or are too young to remember, in reaction to the oppression of the Shah and his dreaded secret police, the Iranian people rose up in a revolution in the 1970's.  Their leader was Ayatollah Khomeini, an elderly Islamist whose stern visage contained the seeds of Iranian religious fascism.  Despite his residency for many years as a guest of the French, he hated the West as decadent and depraved.  When he took the reins in Iran, as with so many other revolutionaries throughout history, he slowly took more and more power to himself and his cronies; the Mullahs now have absolute power, and are absolutely corrupt and evil.  Anytime men seize on absolute power, no matter how noble their cause, corruption and depravity follow.  It only underlines how fortunate the American people were that our earliest revolutionary leaders were men who not only believed in freedom for themselves, but trusted their fellow citizens with freedom; they were not perfect, but they were great men.  Our democracy continues to work because, until recently, the winners and losers played by the rules and accepted the outcome; I do not need to point out how this is endangered by our current state of affairs.

Iran did not have the good fortune to have a Jefferson, or a Hamilton, or a Washington; they had the Mullahs.  Revolutionary regimes need to have enemies to justify their repression in the name of freedom and liberty.  They will often manufacture enemies if none are conveniently available.  The Iranian Mullahs have declared that the United States, the "Great Satan" and Israel, the "Little Satan", are the enemies of Islam and need to be destroyed.  The Iranians have been and continue to be one of the three linchpins of world wide Islamic terror; the Saudi Wahhabi thugs, Princes and others, form the second leg of the triad.  Saddam Hussein and the Baathists of Iraq were the third leg; while not quite off the field of battle, they are no longer a threat to us directly at home, thanks to our brave men and women who continue in harm's way in Iraq today.

We will never be free of the threat of terror until the Iranian people are free.  For their benefit and for ours, I am supporting the efforts of the blogosphere, in my own humble way, to help the Iranian democratic dissidents in their battle against the thuggocracy that afflicts them.   

Islamic Protests American Koran Desecration

I am out of town for the weekend (which is why I couldn't blog yesterday) and I have noticed ongoing reports of all the protests throughout the Islamic world against the vile American Desecration of the Koran (which never happened, but was a good excuse in any event).  While I have not read the reports with much attention to detail, one thing that jumped out at me was the size of the protests.  I can believe that much of the Islamic world doesn't like us very much.  I can believe that much of the Islamic world is predisposed to believe our own media when they accuse our military and our government of desecrating the Koran, but since there are ~1.3 billion Muslims in the world, what I find most remarkable about the demonstrations is how few people seem to be involved.  If the best the Islamists can do is to mobilize a few thousand protesters to burn American flags and rant and rave about the infidels insulting their most precious holy book, despite the efforts of the world wide media to publicize their protests (I cannot tell you how many times I saw the same small group of veiled women burning the American flag on TV yesterday!) then the well of outrage, hatred, Islamic fundamentalism, and Jihadist violence may be shallower than we think.  Perhaps like other bullies, once the world (ie, the West) confronts them (and kills enough of them) they will slink back under their rocks.  Again, as with most bullies, appeasement and surrender is the only thing that can guarantee their success.

Identification with the Aggressor

Everyday seems to bring yet another report on the evils the United States is perpetrating in our administration of the war on terror. Newsweek reports on guards flushing the Koran down the toilet, then retracts the story, and then says, on al Jazeera TV no less, that they are "neutral" on the story. Today The New York Times had the headline Documents Say Detainees Cited Abuse of Koran by Neil A. Lewis.  The LA Times had the story yesterday, Guantanamo Detainees Had Alleged Koran Desecration, Government documents reveal perceived abuses.  Interestingly, none of the articles mentioned that an intercepted al Qaeda training manual, briefly in the news several months ago and then apparently forgotten by the MSM, included instructions to any captured fighter to make exactly these kinds of charges (desecration of the Koran, torture, sexual humiliation.)  It is probably no surprise that the ACLU believes that the Gitmo detainees are more trustworthy than American military, but how does one explain such poor reporting, which not only supplies our enemies with propaganda ammunition, but also undermines our efforts to protect ourselves (not incidentally, protecting our free press as well.) [LGF has lots of links for these reports.]  Of note, none of these report, based on the claims of the Islamists, have been supported by anything approaching factual confirmation.

At the same time, we also have an Italian judge ordering Oriana Fallaci to stand trial for defaming Islam for writing a critical book about Islam with such passages as:

In "La Forza della Ragione," Fallaci wrote that terrorists had killed 6,000 people over the past 20 years in the name of the Koran and said the Islamic faith "sows hatred in the place of love and slavery in the place of freedom."

Meanwhile in the Kingdom of hate known as Saudi Arabia, converts to Christianity face the death sentence, Christians are in jail for a clandestine prayer meeting, and it is illegal to carry a Bible into the country.   Further, aside from death for homosexuals, they are just now wondering if women should be allowed to drive. 

Since I have raised the question of what would drive someone to support those who would behead them against those who protect them, let me propose a partial answer. 

Drugs R Us & the Doctor's Dilemna: Part II

Some commenters raised interesting questions after my last post so I thought I'd continue the discussion.  Maxedoutmama suggested we should halt all advertising for drugs, in part because early users are close to being research subjects without much in the way of informed consent.   USAF_Linguist wondered about offering testing of new AIDS drugs to people in the third world who have no access to such drugs.  And Dymphna told of her own experience of responding to a medicine that was used off-label (which means her insurance will not pay for it, and she has been using samples and buying drugs in Canada to continue getting access to the medication.)

All raise interesting and valid points. 

Drugs R Us & the Doctor's Dilemna

This morning I opened the door to my waiting room for a scheduled patient and found three people sitting there.  I ushered in my patient and even before she could enter the office one of the two other women jumped up and asked if I had any time to meet with them.

I have made it a point, since I was in Medical School to avoid taking gifts from the Drug company representatives.  I decided that I did not want to be influenced, as far as possible, by marketing campaigns, in my usage of medications.  Although Psychoanalysts tend not to use much medication in their treatment, I also spend about half of my time doing general Psychiatry, much of which involves using medications to help people gain or regain better functioning.  While on rare occasions I have taken some pens, and my first stethoscope was supplied by a Drug company, in general I have managed all these years to avoid meeting the Drug Reps and taking gifts. 

That being said, I have noticed in the last few years the reps have become more aggressive.  They come into my waiting room unannounced and unasked; the companies send me all sorts of gifts (ranging from pens to clocks to note pads) without my requesting or desiring such gifts.  I receive two to four phone calls and several letters  everyday asking me to dinners in fancy restaurants to discuss medications, often with the offer of an honorarium.  The phone calls I do not return, the letters I throw out, but the Drug Rep in the Waiting Room is a different problem. 

My initial reaction was annoyance at the intrusion.  I try very hard to keep up with the Medication literature, and I think I do a pretty good job of it, and I do not want to hear the drug company's description of their newest medication as the greatest advance since the invention of fire.  Yet, even beyond the fact that I do not like to be rude (but was given little choice this morning; my schedule does not have much elasticity in it), it is not such a simple situation.

"Good Muslims" and "Good Germans"

In the fall out of the Newsweek "Flushing Koran" story, a lot of people have begun to take more notice of the primitive and viscious response of the Muslim world to any real and/or perceived insults. Jeff Jacoby of the Boston Globe, wondered Why Islam is disrespected and concluded:

...what disgraces Islam above all is the vast majority of the planet's Muslims saying nothing and doing nothing about the jihadist cancer eating away at their religion. It is Free Muslims Against Terrorism, a pro-democracy organization, calling on Muslims and Middle Easterners to ''converge on our nation's capital for a rally against terrorism" -- and having only 50 people show up.

Yes, Islam is disrespected. That will only change when throngs of passionate Muslims show up for rallies against terrorism, and when rabble-rousers trying to gin up a riot over a defiled Koran can't get the time of day.

Yesterday, Bloggledygook wrote an impassioned piece, Taking Islam Seriously.

We may be winning or losing this war; it's getting harder each day to tell. But if we lose, it will not be because the enemy is superior in strength, morality or guile. It will be because we have failed to take the threat with the seriousness and dead calm that an existential crisis demands. We have failed to identify the enemy and in doing so have turned the fight in on ourselves. The current spat between the government and the media would make for lively entertainment in another time. As we grow towards what is likely to be a showdown with thousands, maybe millions, of radicalized religious fanatics it might be a good idea for us to come to some agreement on whom we fight before it is too late.

The majority of tolerant, moderate Muslims must do the same. It is incumbent on both the media and government that they explain that the enemy we face is their enemy also. And it is of the greatest import that Muslims finally decide that they will indeed take their religion, and the internal threat to its very survival, seriously. An army of free Muslims mobilized alongside that of the West would be an overwhelming force in the fight against Islamofascism. It has yet to be enlisted or even contemplated. We must demonstrate to our Muslim allies that we take the threat to their religion and culture as serious as we take the same threat to ours, and that we expect them to do the same. Until Muslims show respect for their own ways, the West will be impotent to force a surrender."

Many, many others are awake to the dangers of radical Islam and the, to them, curious silence by the vast, moderate majority of Islam. I wish the situation were as simple as mobilizing the moderates to repudiate the radicals.

I liken the Islamic world to the state of the German nation in the 1930's. The Nazis were a minority party with a small following at first, in the early years of the decade. The percentage of people willing and eager to join in the party's thuggery was quite small.  A far larger number sympathized with the Nazi program of externalizing all blame for Germany's straits with special emphasis on anti-Semitism, an even larger number were quietly alarmed or indifferent but the number willing to stand against the Nazis was minuscule, and hampered by the fact that they were typically not thugs themselves. By the late thirties, Hitler had been legally elected by a minority of voters and once in power he unleashed a growing band of bullies and thugs who were the spiritual ancestors to Zarqawi and his ilk. By the time the danger of Nazism was noticed by the population, opposition became deadly dangerous. It is one thing to risk your life to protect yourself and your family, it is something else altogether to risk your life to defend an outsider, like the Jew. As it was by the late 1930's and increasingly into the 1940's, to be an anti-Nazi German was to risk a horrible, lonely death; today, in "1930's Islam", to be a moderate Muslim is to risk death.

We cannot expect any help from Moderate Muslims in saving their own hides. Their governments cynically use the radical Islamists to keep pressure on their enemies and to keep their own populations under control. There will be minimal help from that direction. Further, every poll taken of an Islamic country shows a sizable population supporting the most rigorous and most intolerant, often Wahhabi or Wahhabi influenced (thanks to Saudi oil money), brands of Islam. These populations are still minorities in many places, but they are sizable, passionate, and ruthless. In general, the more provincial and unsophisticated a society, the more conservative they tend to be. While we can't expect much help from Saudi Arabia, still playing their double game, protected by their oil for the time being, it should surprise no one that Egypt, Pakistan, the Sudan, parts of Indonesia, and other areas, are extremely fundamentalist, extremely anti-American, and extremely unlikely to ever utter a word of complaint about the desecration and persecution of Christians, Jews and others unfortunate enough to live within their midst.

It is also worth wondering if there even exists a sizable population of moderate Muslims. The MSM, our government, most civilized people seem to believe that if they insist there exists a moderate Islam, then it must be so. While I have no doubt there are moderate Muslims, their lack of visibility is troubling. When even in this country, where dissenters are safer than most anywhere else, a rally for Muslims against terror draws minimal numbers, it is troubling.  Whenever there is an article written, or a public stance taken, opposing the Islamic fascists, the brave individual Muslim puts their life at risk, receives condemnation from official organs of Islam, and often receives death threat fatwas. They receive nothing but calumny from the governments which are supposed to be our allies in this war. The official Egyptian press and the state sponsored Imams in state supported mosques, regularly spew out the worst hatred of infidels (that is Americans and Israelis, especially, but with special vitriol for those Europeans who have the temerity to object to their increasing dhimmitude) and apostates. Most Islamic states have death penalties for apostasy, for desecration of the Koran, and for any of a number of offenses against Islam; at the same time, Shariah law openly, arrogantly, discriminates against those who are not sufficiently Islamic, and grants almost no rights to non Muslims.

Thus, sadly, we can expect minimal help from any Moderate Muslims who might exist, and only the minimal levels of assistance that they can get away with from the so-called Moderate Islamic states in the world. If our MSM and their allies in the Academic, Left wing, and European elites, succeed at disarming us, and the Islamofascists husband their resources, the fight in which we are in the early stages may yet feature all of Islam against the civilized world. The fall out (literal and figurative) will touch everyone on the planet before it is over.

The APA & Homosexual Marriage

The caricature of Psychiatrists is that they offer their patients too little feedback and are too often silent.  Here is one occasion when some silence would have been helpful.  There is really no need for the American Psychiatric Association to take a stand on gay marriage, civil unions, or many other social issue.  While one could make a peripheral argument about the merits of a child growing up in a household with two committed men or two committed women, versus a married, heterosexual couple, that is an opinion with very little data to support it one way or the other.  If we made the choice between a healthy gay relationship and the foster care system in crisis, as in New York or Florida, there would be no discussion; most Psychiatrists would agree that the children would be much better off with the loving gay parents, while recognizing it is easier to grow up in this culture with married, heterosexual parents. 

Any other discussion is about the political and social significance of gay marriage, civil unions, etc, and Psychiatrists are no more learned in the realm of politics and culture than anyone else.  I would not ask a Physicist, even a very talented one, how to diagnose a Schizophrenic, and I would not volunteer how he should go about measuring quantum effects.  Let's restrict our "official" imprimatur for things we are trained for.

Terry Schiavo Revisited

From the May 2005, Psychiatry edition of CNS News: Researchers at Weill College of Medicine-Cornell University, Columbia University, Georgetown University and the JFK Johnson Rehabilitation Institute report on a small study, "Research Shows That Minimally Conscious Patients Respond to Language-but How?" (not available on line), involving 2 patients and 7 healthy volunteers investigating functional magnetic resonance imaging (fMRI) to investigate the responses of patients with severe brain damage in a minimally conscious state (MCS). When the researchers played audiotapes of a familiar relative to the patients in MCS, parts of the brain that are activated in speech recognition in healthy people were activated in the patients. Since the MCS patients are typically treated as if they are unconscious and completely unaware, these findings are significant. 

The study authors differentiate MCS from Persistent Vegetative States (PVS); in MCS there is an ability to react to the environment on occasion, while such an ability appears to be absent in PVS.

When I wrote about Terry Schiavo in Narcissism and Empathy, I made the point that in all the discussion of her condition, no one could possibly know with any certainty what she was or was not experiencing in her state.  No one knows where consciousness resides within the brain and no one really knows where the "I" that experiences the world resides in the brain. 

More recently I wrote about the growing recognition of how much of our mental activity is taking place out of our awareness.  In Science and the Unconscious, I pointed to an MIT study which supported the existence of a complex unconscious mind which could determine overt behavior.

As our knowledge of the mind and brain and their interactions increases, we should remain quite humble about our ability to make definitive statements about other people's minds.  Terry Schiavo's situation was a terrible tragedy but to imagine the situation was an easy to understand binary system (all or none in terms of her consciousness and experience) does an injustice to the complexity of the questions that were under examination.  Definitive statements were made that she had no awareness or experience of her dehydration and starvation, I would suggest a little more caution in the future in making such comments would be welcome.