ShrinkWrapped

Angry Boomerangs

A young male patient was referred to me because he was failing in college.  He was terribly frustrated and angry.  In fact, his primary affective state was anger which he tried to deal with by drinking too much and smoking marijuana.  When he drank, he became disinhibited, as people tend to do when suffused with ethanol, and his anger would lead him to find provocations and irritations everywhere around him.  Typically, the greatest irritation would be found emanating form the largest male at the bar.  Often fighting ensued.  Unfortunately for this unhappy young man, he was deficient in physical stature and strength and consistently emerged from the bar at a high rate of speed, liberally spouting blood from his many and varied lacerations.

More unfortunately, this young man not only did not see his anger as a problem but he also did not connect his drinking and smoking to his travails in school.  He had only come in for an evaluation because his parents had forced him and announced that since he had nothing wrong with him, he had no real need of my services.  I told him I didn't know enough about him to speculate on the source of his anger but did think it odd that he was untroubled by the fact that his anger so consistently boomeranged.  While he directed his anger at the world, and it always felt justified, in the end his anger always seemed to end up hurting him more than the person he was ostensibly angry at.  It was a puzzle to me and I wondered if he was puzzled by such a seeming contradiction as well.  He paused and mused that he had never thought about it before but it certainly seemed that I was correct.  At that point, I had a patient.

My patient was enraged with the unfairness of his life and could not contain his anger.  As a result he was also quite self-destructive (both because the anger was projected and re-introjected and because of deeply ambivalent feelings toward his self- and internal-objects.)  As a result, his anger injured him much more than it injured those he felt had hurt him.  He scared friends and potential friends away, could never keep a girlfriend for very long, and as noted, tended to get himself beaten up when disinhibited.  This young man was perfectly capable of destroying himself because he could not let go of his anger.

I often think of this young man when considering the behavior of the easily offended and chronically enraged, especially our Arab and Muslim enemies.  For example, we have already seen that al Qaeda in Iraq has long since run out the patience of the Iraqis who should have been their allies but whom they have thoroughly alienated.  Two new items suggest that angry boomerangs may be the weapons of choice in two other areas of interest.  The first item is from Israel and offers an interesting suggestion:

Liberalism and Economic Illiteracy

I was born and raised in a liberal Democratic household.  My grandparents were socialists and my parents leaned to the left side of the democratic party.  Socialism is the default position for most people growing up, for the best of reasons, which is why young people overwhelmingly support political parties that lean left. 

Historically and phylogenetically, socialism is the more congenial system because, above all else, it lends itself to the illusion that it is more fair.   In capitalist systems, there is enhanced competition and the very nature of the system is to be unfair, as successful people get rewarded and the less successful garner much less material reward.

The last century showed, in rather unmistakable terms, that capitalism is the much superior system in terms of generating wealth, but under capitalism, unfairness is impossible to avoid.

Since we spend a great deal of time and energy trying to ensure that life is fair, a truly noble imperative, capitalism is counter-intuitive.  It requires unlearning much of what we learn in our earliest years and gaining a much deeper and more nuanced view of the economy and fairness.  In the end, those of us who evolve in our economic/political  thinking recognize that capitalism is ultimately more moral and more fair to the greatest number of people.  Unfortunately, far too many Americans are economically illiterate and well into adulthood operate as if the world should be designed the way a typical kindergarten works, where adult authorities make sure everyone plays nice and that all the toys are equally shared. 

Being economically illiterate is apparently one of the prime qualifications for being a New York Tims columnist.  Consider this story from Bob Herbert, who bemoans the state of the job market for young people today:

When the dismal unemployment numbers were released on Friday (at the same time that oil prices were surging to record highs), I thought about the young people at the bottom of the employment ladder.

Energy & Food and the Coming One Term Presidency

Amir Taheri has written an important piece about Barack Obama's Middle East Education which raises important questions:

IN his address to the American Israeli Political Action Committee last week, Sen. Barack Obama discarded some of his most dangerous positions.

Of Iran, for example, he said: "The Iranian regime supports violent extremists and challenges us across the region. It pursues a nuclear capability that could spark a dangerous arms race and raise the prospect of a transfer of nuclear know-how to terrorists. Its president denies the Holocaust and threatens to wipe Israel off the map. The danger from Iran is grave, it is real, and my goal will be to eliminate this threat."

Except for the politically correct phrase "violent extremists" instead of the more accurate "terrorists," those words could have come from President Bush.

All who've supported the Bush Doctrine should welcome this dramatic change. No longer does Obama claim that talk of a threat from Iran is an "obsession instead, he recognizes the danger of nuclear proliferation - and acknowledges the Islamic Republic as something more than a "tiny" challenger.

He has also "evolved" on Iraq. He no longer shares Senate Majority Leader Harry Reid's belief that America has already lost the war. And he's discarded his pledge to pull US troops out in the first year of his presidency. He now talks of "a responsible and phased withdrawal" - exactly what Bush is committed to.

More important: He no longer says "there are no good options in Iraq now, "there are not many good options" - which means there are some.

Taheri hopes that this is a reflection of an open mind:

Slow Blogging

There will be no post today and blogging may be light for the rest of the week; a project on which I am working requires significant time.

The Importance of Knowing What You Don't Know

My daughter has always been an exceptional student.  She is very bright and works very hard.  In college, she would study enough to feel that she had mastered even the most difficult material.  When she arrived at Medical School she discovered that no matter how much she studied, and no matter how bright she is, she could never master the quantity and complexity of all the material she was expected to learn.  This led to several painful conversations where she complained of how difficult Medical School could be and how impossible were the expectations of her and her classmates.  I explained to her that the tests were designed to be so difficult not only because of the sheer quantity of the material but for a more important, more deeply subtle reason.  Impossible tests were part of the creation of a Doctor.  In the real world, Doctors are often faced with having to make life and death decisions and recommendations with insufficient data.  In a great many situations it is impossible to know enough to be able to offer any certainty to our patients (who, under duress, often want and need our certainty to reassure them.)  Medical students who come to their education with a history of academic excellence and the youthful arrogance to believe they can master anything academically, quickly learn humility and come to understand that they not only do not have G-d-like judgment based on their degree but of necessity cannot have G-d like knowledge with which to treat their patients.

This is a round about way of getting at what troubles me so much about our current choices for President.  I worry that both John McCain and Barack Obama evince certainty about issues where there can be no certainty.  There are going to be innumerable times and places where a President must make decisions and must do the best he can under trying circumstances.  Yet, when Barack Obama casually and unknowingly makes diplomatic blunders, and then acts as if his reversal is of no consequence, or John McCain suggests he knows best how to manage complex issues like the role of CO2 in climate, their lack of appreciation of the limits of their knowledge is troubling.

At the same time, we are certainly complicit in this; the public colludes with our politicians when we surrender our judgment to theirs and fail to hold them or ourselves to standards that correspond to reality.  Fro example, Charles Krauthammer makes the eminently sensible point that if we want to decrease our use of fossil fuels, the best way to do it is to keep the price of oil high, rather than create a new bureaucracy to establish a cap and trade system that will offer all the disadvantages of a government bureaucracy (including bureaucratic immortality) and none of the advantages of a free market.  (He would establish a floor price for oil, supported by taxes if necessary, which would leave more of the money here rather than sending our cash overseas to peopel who do not have our best interests in mind.)  He knows that such an idea would be electoral suicide because Americans want to be fooled into believing that the government can reduce our dependence on foreign oil while refusing to drill for oil at home while simultaneously keeping the price down.  This can't work but if a politician points that out, the MSM will savage him or her.

Beyond the foolishness of cap and trade, which might more accurately be referred to as the lifetime lobbyist and lawyer full employment full bill, lies the greater concern over the apparent failure of Obama and McCain to understand, let alone pass, the Rumsfeld test.   They seem to not recognize that there are not only known unknowns but, even more importantly, unknown unknowns, and this is troubling.

Reasons for Concern and Reasons for Optimism

There are too many things to cover these days so I thought I'd simply post a brief sense of what I have been reading and suggest you take a look yourself.

Signs of the looming Singularity

Human stem cells used to cure brain disorder:

The treatment uses human glial progenitor cells — cells that can differentiate into the glial cells that, among other things, make up myelin. Myelin, a protein that insulates the long 'arms' of nerve cells, called axons, helps the conduction of neural signals throughout the nervous system.

The bad news, this was in mice; the good news, once we have such a proof of concept, human applications will follow. 

Rodney Brooks thinks (as do I) that the most likely scenario for the emergence of AGI (artificial general intelligence) is an eventual symbiotic merger/condominium of biology and technology:

I, Rodney Brooks, Am a Robot

I argue that an artificial intelligence could evolve in a much different way. In particular, I don't think there is going to be one single sudden technological “big bang” that springs an AGI into “life.” Starting with the mildly intelligent systems we have today, machines will become gradually more intelligent, generation by generation. The singularity will be a period, not an event.

...

But I expect the AGIs of the future—embodied, for example, as robots that will roam our homes and workplaces—to emerge gradually and symbiotically with our society. At the same time, we humans will transform ourselves. We will incorporate a wide range of advanced sensory devices and prosthetics to enhance our bodies. As our machines become more like us, we will become more like them.

Robin Hanson takes a fascinating look at the Economics Of The Singularity:

The world economy, which now doubles in 15 years or so, would soon double in somewhere from a week to a month.

I knew the world was getting richer, but doubling in 15 years?  That is remarkable and a fact that has been lost on most people who only note the rising price of energy and food.

On to politics

Disabilities: Past, Present, & Future

One of the most interesting cultural phenomena that arose in the latter half of the last century was the movement toward equality of previously devalued groups.  This began with the enfranchisement of women, accelerated with the civil rights movement, and came to fruition with the homosexual rights movement.  In all these cases, there has been, and continues to be, a tendency in the more extreme precincts of the movements, to idealize the formerly devalued while devaluing the formerly idealized, (ie, the white men heterosexual community.)  Such reaction formations will almost certainly be seen from a future historical perspective as a necessary part of resolving historical conflicts toward the once marginalized. 

More recently there has been an analogous struggle taking place with groups once thought of as disabled.  Among the Disabled Rights groups there are additional factors that will make the outcome much different from the current resolutions we are groping toward in terms of the social place of women, blacks, and homosexuals.

This was seen in striking fashion in a post I wrote over two years ago, The Idealization of Defect, in which I discussed the psychology behind the desire of deaf parents to have a deaf child.  For many of the deaf, not only did they vehemently deny that they had a disability, but they insisted that deaf culture was superior to hearing culture and wanted their children to be apart of deaf culture.  The issue has gained poignancy because in recent years Medical science has begun to be able to treat certain types of deafness (cochlear implants) and many parents now face the question of seeking treatment for their deaf child.

New York Magazine has a report about the early stages of a similar struggle taking place within the Autistic Community.   In a surprisingly decent report, The Autism Rights Movement, [HT: Siggy] Andrew Solomon discusses how "A new wave of activists wants to celebrate atypical brain function as a positive identity, not a disability. Opponents call them dangerously deluded."  It is a long article and a brief excerpt can not do it justice but the salient points are several-fold:

Government Run Health Care

(Time pressures today require that I be brief today.)

Medicare is often held out as the model for a government run health care system in America.  It is true that Medicare allows all of the elderly to receive medical care that they can afford.  It is also true that the Medicare system will probably either be bankrupt or will bankrupt our country (with the assistance of our other entitlement programs) and that in one way or another future benefits will have to be cut.  Yet there is another problem with Medicare that is likely to cause serious, and increasing disruptions, over time.  Although it is always tricky to generalize from small sample sizes, my experience as a Physician who has accepted Medicare since I finished my Residency in 1981 may be instructive.

For many years, I was comfortable with Medicare, willing to accept a 10-20% reduction in my fees in order to serve  a population that often lacked the financial wherewithal to afford private Psychiatric treatment.  For much of that time, the paperwork was minimal and the hassles of accosting the coverage were tolerable.

That all began to change several years ago.  Over time Medicare fees stagnated while private practice fees increased.  By the early part of this century, the Medicare reduction represented 40-50%.  I continued to be a provider because I had a number of older patients and was committed to their treatment.  Several years ago, I stopped taking on new Medicare patients.  The problems worsened.  Over the course of the last 3-4 years, the Medicare reduction has gone from 50% to almost 70%!  Worse, last year I had to engage a billing service because I had been driven to distraction by Medicare's increasing problems actually paying their bills.  The billing service costs me an additional 8% of my fee.  Since I only have a few patients on Medicare at this point, this is more an inconvenience (and I have never had a problem offering to reduce my fees when a patient cannot pay a full fee) than a practice destroyer (though Doctors who rely on Medicare for a larger percentage of their practice are in genuine financial trouble.) 

I had already decided to drop out of the system altogether at the end of this year when the most recent Medicare insult occurred.  For those fortunate enough to be unaware of the minutiae of Medical treatment and insurance, some information:  last year the Government and Insurance companies introduced the NPI (National Provide Identifier) number meant to replace Medicare provider numbers and all other provider numbers.  I dutifully acquired one and began to include it on my Medicare forms for reimbursement, as directed.  Apparently, sometime in May, the Medicare administrators in their great wisdom decided, without bothering to inform anyone, that forms that included the NPI and the old Medicare Provider Number would no longer be accepted.  All of my Medicare billing from January through April has been returned unpaid because the system will not even look at a form that has any information on it that is not in accord with whatever regulations they have promulgated that day.

As of the end of December, 2008, there will be one less Doctor participating in Medicare.  I doubt I am alone in my disgust and annoyance.  Keep this in mind when you hear politicians talk about the wonders of a government run health care system.

Also keep in mind that if we want our brightest young people to continue to put the effort and time into their medical studies required to become a Doctor and continue to expect them to graduate with loans nearing $200,000, we had better think carefully before we set up a Medical system that is partially designed to minimize their compensation. 

The Curdling of Women's Liberation

Women's liberation has been one of the outstanding successes of the Judeo-Christian West.  In a relatively brief historical moment, women became equal partners in society and all opportunities were opened to them.  The removal of legal and conceptual barriers to full participation in society was a triumph that essentially doubled the amount of human intellect available to address our species problems.  Unfortunately, removing legal barriers is not the same as dissolving all social inequalities, nor does the removal of legal barriers to opportunity ensure equality of outcome for people with different sets of abilities.  This bitter piece of reality has caused endless anguish for those who need to deny that we are born and raised with disparate abilities and has caused endless mischief for our society under the ministrations of those who are deeply troubled by unequal outcomes.

Over three years ago I discussed the Lawrence Summers kerfuffle, in which he wondered aloud whether or not some of the disparity in male and female participation in the highest echelons of science reflected a relative lack of interest by women and "issues of intrinsic aptitude."   I wondered about the level of outrage form the left:

... the point of the (Summer's) talk was to raise uncomfortable questions about whether or not inherent attributes of men and women were involved in the relative paucity of women in the sciences.  This is not a terribly controversial point of view outside of Academia and such bastions of liberal thinking as the New York Times.  Only people as bright and talented as Professors and Newspaper editors could convince themselves there are no innate differences between men and women.  Since there is a growing body of data supporting the fact that men and women's brains are wired differently in some fundamental areas, it is hard to see how the question Summers raised could be so distressing.

I concluded that the belief in an absolute equality of abilities between men and women was a religious belief and offered a brief thought experiment:

In effect, the meme suggests that there are no inherent differences (Nature) between men and women and all differences in outcome can be attributed to social influences (Nurture).  If you have any doubts that this is a religious belief rather than a fact based opinion, do the following thought experiment.  Imagine yourself in a room full of Homosexual activists.  Imagine yourself giving a talk in which you suggest that Homosexuality is the outcome of a complex interaction between a child's inherent constitutional make up (Nature), including the structure of his brain, and his emotional development in relation to his early childhood and parenting experiences (Nurture).  The idea that Homosexuality is genetic (any time you read that something is "genetic" take it with  a large grain of salt; as I once read, genes encode for proteins, not behavior) is a "given", scarcely more open to discussion than the idea that women and men are not equal.

I would suggest that a great many of the core beliefs of the Liberals and the Left are no longer supported by the data available to us in laboratories or in nature (history).  Liberalism has become a religious philosophy.

Unfortunately the aftermath of the Summer's affair has been disastrous for reality and science.  He lost his job, the Academy seems as bereft of sense as ever, a $50 million diversity center was established at Harvard, and their new President is a champion of "diversity." 

It is a curious fact that the diversity police are worried about promulgating their nonsense theories (ie, that there is no particular difference between men and women) even while men and women are increasingly acting like they have been neutered in the West and females are becoming endangered species in much of the East.  The one culture where this is conspicuously not so is also instructive.