Saturday, February 01, 2003

The deaths of astronauts are always so sad. Via CalPundit. Of course, their deaths are sad because they were human beings with families, but I think an astronaut's death pains our collective consciousness more than a death in a car crash.

But we love astronauts, because they do what we believe humans should do, what we all want to do: seek out new worlds, and in the process transcend their own limitations. You know, the Star Trek mission.

There are lots of ways to do this besides sending ships into space--through art and through science, for example. But astronauts makes it literal and palpable, and we can live vicariously through them, see the earth from the moon as they saw it, and feel like our own limitations are fewer because of the work they have done. (See this post...) And when they die in the process it not only resonates with our sympathy for them, but our sympathy for ourselves as vulnerable creatures who are forbidden from so many spheres.

(Of course, the art/science/exploration method of transcending limitations is the Dedalus method. There's another way--rather than trying to penetrate the boundaries of other spaces, you can open up your own boundaries to penetration. That's the Bloom method. Just thought I would give equal time.)

My thoughts go out to the families and friends of the dead, who were doing good work in the world and gave their lives doing it. They were very brave.
Wow, this is interesting. The Volokh Conspiracy blogs the case of a professor who refuses to write letters of recommendation for students who apply to graduate school in medicine or biology if they do not accept the theory of evolution as the most empirically supported explanation for the origin of species. Some Creationists are suing.

CalPundit supports the professor. Mark Kleiman doesn't.

I was planning to write in defense of the professor, but I was forced to hesitate when offered other examples of miracles a scientist might accept, like the Virgin Birth. To me, accepting the Virgin Birth did not seem nearly as contrary to the claims of medical science as that of Creationism. But then I realized what the fundamental difference is between accepting the Virgin Birth as a literal truth and rejecting evolution. A scientist could say he believes literally in the Virgin Birth as a divine miracle that interrupted empirically observed biological laws for just long enough to deliver Christ to the Earth. But he wouldn't reject the laws themselves in saying so. The Catholic obstetrician who believes literally in the Virgin Birth isn't about to believe that the girl with a perfectly intact hymen she examines could possibly be pregnant. However, if a Creationist says he disbelieves Darwin's explanation for the origin of species AND rejects the idea that mutation + natural selection could be creating new species today, then he is not just admitting the possibility that the divine can sometimes supercede natural law as we observe it (which would not interfere with his work as a scientist), he's actively denying the existence of an empirically observed process that is foundational to the understanding of biology, and thus medicine. The very nature of a miracle is that it defies the rules, but then, calling something a miracle implies the existence of rules. These are the rules someone must generally accept to be a scientist, or if a scientist rejects the rules, she must have some more compelling empirical evidence than "because the Bible says so." These are the rules that the Creationist denies. I know a lot of Creationists think they have empirical evidence, but that is because they've already willed themselves not to believe the most logical explanation for a set of facts.

Basically, I totally support without qualification the professor's decision to refuse to recommend Creationists to graduate programs in biology; the medical school case is slightly more complicated.

Mark Kleiman points out that there are some areas of biology (mostly micro) in which Darwin isn't an issue. My answer: yes, but it's not unreasonable to base a recommendation for a student on his basic fitness for the field, even if there were some subdivisions of it he might eke by in.

On the subject of medical school, he says:

And applying the rule to medical school is just pointlessly nasty; of course there are insights to be gained from Darwinian medicine, but since most physicians don't know about them and most med schools don't teach about them, a creationist med student wouldn't be at any practical disadvantage whatever. My oncologist's views on paleontology aren't of much more importance to me than my auto mechanic's.

Really? Most physicians don't know about, say, mutating strains of bacteria that become more and more resistant to antibiotics? I wouldn't want such a doctor prescribing me drugs. I don't totally reject his premise that you can be a Creationist and a good doctor; there are lots of kinds of doctors. It may even be of practical importance that there be Creationist doctors, because some fundamentalist Christians might only feel comfortable receiving medical care from someone with religious beliefs similar to theirs. If this were a policy that was uniformly applied by every medical school, I might be more concerned. But it isn't even a policy of one medical school--it's a policy of a professor who is using his individual discernment to determine whether a student demonstrates an ability to evaluate a set of facts objectively. Yes, he's an employee of the University, but the whole point of professor recommendations is that they are based on the individual professor's evaluation of the student's capacities. If the professor was basing his judgment on a superficial, immutable, or irrelevant characteristic, that would be grounds for a lawsuit. But he's not--an acceptance of evolutionary processes is not superficial, it's not immutable, and it's not irrelevant; in fact, it's a bedrock principle.

Maybe the professor should change the question for applicants to medical school: rather than asking the students about origins (which aren't that relevant to medicine), he should ask them about current processes (which are): if a student refuses to acknowledge that there are genetic mutations, and some of them make organisms better fit for their environment, and those organisms are selected to survice and reproduce, and sometimes through generations the organisms mutate so far from their ancestors that they can no longer reproduce with other organisms similar to their ancestors, and we call those organisms a new species, THEN it is appropriate to make an individual judgment that the student is not a good candidate for medical school.

Mark Kleinman goes on in several paragraphs to say that one can be a Biblical literalist and be a scientist; successful physicists have accepted as fact that Joshua ceased the rotation of the Earth (I think I demonstrate above why the acceptance of a miracle is not inconsistent with being a scientist, but a rejection of the rule to which that miracle was an exception is), to point out that religious beliefs can be a metaphor (but no one's trying to deny the person who takes the Bible metaphorically a recommendation), and then to say that the scientist who says “I don’t believe in evolution” may actually just be reaffirming the unique-to-humans existence of a soul, and he says he doesn’t think it’s a silly mistake to tie that to a specific paleontological (a word?) belief. I actually disagree that it’s not silly. If your only reason for rejecting the Darwinian explanation for the origin of species is the necessity of the human soul, that’s silly, since there’s no reason why it’s necessary to believe that God created the Heavens and the Earth in six days in order to arrive at the conclusion that humans uniquely possess a bit of divinity. The mind can accommodate belief in a soul and belief in evolution, and if your mind can’t, then yes, you are silly.

Update, which is not actually an update, because I didn’t get around to posting this last night when I wrote it because a friend came over: Mark Kleiman has a new post which makes me feel like my opinion converges a bit more with his then it did last night:

I agree that for applicants to medical schools, the question should limit itself to current process and not to origins, since the paleontological record isn’t relevant to medicine. But it is reasonable for the doctor to ask that they demonstrate an acceptance of evolutionary processes as they function in medicine, up to and including speciation, or provide empirical reasons why they don’t (and since their empirical reasons will be junk, that won’t fix the problem). It’s not just a loyalty oath. It’s an illustration of your willingness to evaluate evidence on “how” questions (how do species arise? How does a plant photosynthesize?) openly and honestly, without letting your religious beliefs, pardon the expression, corrupt that evaluation. If Prof. Dini would have rejected the math professor whom Mark Kleiman offered as an example, he would have been wrong, though I’m not sure MK is right that Dini would have rejected him—he still accepts evolutionary processes; to say that God intervened (to give humans a soul?) in a manner outside (but not in contradiction to?) the processes of evolution need not be incompatible with science in the slightest. Mark Kleiman says medicine is a profession, not a science. Well, yes, but in fact, people do go on from medical school to become researchers as well as doctors (right?), and the professor is most immediately not recommending him to the profession, but to the school. The absolutely essential thing to functioning well in school is the ability to reason and to evaluate evidence with an open mind. There are lots of other factors that ought to be evaluated when admitting people to medical school, like the compassion and commitment someone might ultimately bring to her work as a doctor, but since there are lots of paths to take from medical school, the first and only absolutely necessary qualification is the reason-and-evaluate qualification.

In conclusion, I have to say that Mark Kleiman writes like someone who has never known a real fundamentalist Christian. I’m not talking about someone who believes in the existence of miracles. I’m talking about a hard-core, Creation science, every word of the Bible is literally true (even though the gospels contradict each other), and by the way, anyone who disagrees with me (even other Christians) will burn in Hellfire right after they die and this thought fills me with inordinate glee type. I have had extended and even intimate acquaintance with several, and their religious beliefs do interfere with their ability to reason, and would severely handicap them in any scientific pursuit. But yes, they probably could set a broken bone.

A Real Update: CalPundit has more. I essentially agree.

Friday, January 31, 2003

I just came back from my first ever visit to the gynecologist!

[The pipe organ plays a distressed chord as every woman within a ten block radius whips her head in my direction and they all shout in unison, “You’ve never been to the gynecologist?!”]

Well, I have now, but that is about the reaction I’ve gotten from friends every time I’ve mentioned the subject in the last four years. As a matter of fact, I was talking with a friend of mine a few months ago, and she told me about how she was so wounded by some criticism she’s received in her masters program that she went out and got so drunk that she got alcohol poisoning and spent the entire next day prostrate and vomiting, but she was afraid to go to the health center in case it got her kicked out of her program. I heard this story and I responded, trying very carefully not to lecture or to judge, “Honey, I don’t think it’s a good idea for you to get so drunk you get alcohol poisoning. I think you should not do that in the future.” Later in the conversation I mentioned that I had never been to the gynecologist and she responded, “YOU’VE NEVER BEEN TO THE GYNECOLOGIST?!” I thought about it, and I decided there weren’t any particular hangups that were keeping me from going. I mean, for a while I was embarrassed to go because I was a virgin (no, I don’t need to be told how unutterably stupid that is, but I was embarrassed nonetheless), but that’s not an issue now. But I think the only thing that’s been keeping me away is my general distaste for/avoidance of doctors and doctors appointments. I sort of feel like I know I’m healthy because I feel healthy, and I don’t need any doctor’s opinion about it. I also often don’t like to take medicine, even just ibuprofen, even when I’m in pain. There was a period in my life when I would get urinary tract infections, and they felt bad enough that I would always go to the doctor, who would always give me a prescription for antibiotics (which then would always give me a yeast infection). Once I couldn’t get to a doctor, so I just drank lots of water and cranberry juice, and when I realized it was going away by itself I was so pissed that all along I need never have taken an antibiotic—my doctors didn’t tell me that there was another option.

Anyway, I waited two hours to see my gynecologist, who is Dr. Lillian Nash, an adorably diminutive and wrinkly woman. It was like having a WASPy Dr. Ruth sticking foreign objects into my vagina. (I saw Dr. Ruth speak, you know. She even answered a question of mine submitted anonymously—it was about how to achieve orgasm when being fingered by your partner, which at the time I had never done. Her answer sucked, I thought. She told me I should take his hand and guide him. Nothing like that ever worked for me; it was always awkward and unsexy and not at all more satisfying than my partner’s own efforts.) She told me all about the plot of this Anne Perry novel while I got my pap smear. I told her I had never been to the gynecologist before, so I guess she thought she had to talk me through it, so she would say things like, “Now I’m just looking for your cervix. I know it must be in here somewhere. Where’d it go? Aah! There it is.” There was one thing that was a little weird: I asked for a full battery of STD tests (another thing I’ve never done), and when I said that I didn’t think it was likely that I had any STD’s, but I wanted to be sure, she said, “I’m sure you don’t.” How does she know? All I told her was that I was once sexually active but I’m not now. For all she knows, a year ago I was banging a different guy every night without a condom. I guess she know that’s unlikely because I said I’d never been pregnant, but I think the real reason for her judgment is that she thinks what everyone thinks about me, that I “look innocent.” Still, I don’t think it’s great for doctors to be saying anything in that makes it the slightest bit less likely that someone will want to take an STD test.

Thursday, January 30, 2003

As long as I'm obsessively responding to things Eve Tushnet wrote, I'm going to take issue with this column for the Jewish World Review, in which Eve says that she gave up feminism because she realized she wants gender, and she wants certain roles and constructive behaviors to belong, recognizably, to each one.

She's doing something that anti-feminists often do. I understand the political motivation for it when anti-feminists do it. I don't understand why Eve is doing it, because she's clearly not anti-feminist. In fact, by any definition I can come up with, she radiates feminism to me.

That's what anti-feminists do: they narrowly (yet vaguely) construe feminism, and then announce that feminists reject X principle that makes a lot of sense. When they do it, they never actually articulate what their definition of feminism is (that's why I added "yet vaguely" in parentheses), so their definition can't be contradicted. But their audience is left with the vague sense that "feminism is bad."

Of course there are feminists who reject the whole notion of gender, but there are lots of others who don't. The thing about the term "feminism" is that it's just about as broad as "postmodernism." I've heard people make snotty remarks about postmodernism, and then I wonder what precisely they can mean--all thought, art, culture and criticism since the 1950's that is not deliberately atavistic? If they said, "I reject the notion that one cannot know the good" or something like that, that would be at least specific, but I also think you could find people who could fairly be called postmodern who also rejected that notion. Same with feminism. The only workable definition is that it's "the radical notion that women are people," cheesy as it may sound. To prove that there are people who proudly self-identify as feminists but who also like gender, let me provide an example:

I LOVE gender.

Here is a song that I identify with heartily. Here are some of the lyrics:

I'm a girl, and by me that's only great!
I am proud that my silhouette is curvy
That I walk with a sweet and girlish gait
With my hips kinda swively and swervy.

I adore being dressed in a something frilly
When my date comes to get me at my place
Out I go with my Joe or John or Billy
Like a filly ....who is ready... for the race!

When I have a brand new hair-do
With my eye lashes all in curl
I float like the clouds on air do
I enjoy being a girl

When men say I'm cute and funny
And my teeth aren't teeth but pearl,
I just lap it up like honey
I enjoy being a girl

I flip when the fellow sends me flowers
I drool over dresses made of lace
I talk on the telephone for hours,
With a pound and half of cream upon my face

I'm strictly a female female
And my future I hope will be
In the home of a brave and free male
Who'll enjoy being a guy having a girl like me.

It will only be a treat for those who know me very well to see my living room rendition of that song (alas, it is my fate to be an undiscovered star--once my friend Susan, after seeing me pole dance while singing the part of Sally Bowles paid me an excellent compliment--i"f you could sing, you could be a musical comedy star"...but 'tis not to be). Now, it's possible that in its original setting (Flower Drum Song), it was sexist, but the lyrics taken by themselves are not. Why? Because they're descriptive, not prescriptive, and a lot of women (like me) can have a great time with heterosexual femininity, and we wouldn't give it up for anything. Of course, I think feminism pretty much always demands that there be flexibility in gender roles, and I think that people should be allowed to pick and choose from the costume box, but if they decide to put on a costume of pink lace, and they also have a vagina, there's nothing anti-feminist about that. Eve, of course, also believes in flexibility--there's nothing more feminine than Cher in a motorcycle jacket. (By the way, "I Enjoy Being a Girl" also has frisson by virtue of the brassy, powerful voice of the singer on the original cast recording.) IEBAG is a fun costume; I can wear it, and a drag queen can wear it. Neither is inconsistent with feminism.
So Take Back the Media is organizing a campaign to expose advertisers on the Rush Limbaugh show, and apparently it's working.

Via Joe Conason.

I actually don't agree with these tactics when employed by the Left or Right. If they were just broadcasting the fact that the companies were advertising, and writing to the companies and urging them to stop, that would be one thing. But if everyone took the tack of boycotting advertisers in media outlets because they didn't like the content of programming, then whoever has the most buying power would be able to determine the content of any free (i.e. advertising sponsored--and all us bloggers rely on advertising sponsored media as primary sources) media. Ultimately, that would not be good for the Left. I was really upset once when my aunt used my email address (and thus my name) to write one of her "I'll boycott your company unless you stop advertising in the anti-Israel NYT" letters (I don't remember if it was the Times she was protesting in that instance), for several reasons, but especially because I just don't support this tactic.
By the way, does anyone want my job?

I do research and administrative support for a women's rights non profit in New York. The projects I work on deal with federalism, civil rights, and child care issues. You should be a good writer and be able to demonstrate internet and library research skills. If you don't have any public interest/women's rights stuff in your background, if you want to be considered you should be able to demonstrate genuine passion in your cover letter and your interview. If you have a Masters, you're probably overqualified, but you could give it a shot. You'd start the first week in March.

Anyway, I don't want to say where I work because I don't want to be stalked, but if you think you're interested, email your resume to me, and I'll look it over and decide whether you're genuinely interested, and then I'll forward you the opening and you can apply formally.

Wednesday, January 29, 2003

Some things Eve Tushnet said about me and topics I brought up.

Some things Vaguely Right said about me and topics I brought up.

I'll get back to them later in some form or another.

Things I find endearing:

That Vaguely Right posted a somewhat rambly, confused, insomniac post, instead of his usual ultra-carefully reasoned fare. You may notice from my blog that I am very long and rambly and confused, and often insomniacal. I'm glad someone else wants to use their blog to work things out.

That this boy, Zander, has made up acronyms that stand for ruefully disdainful nicknames for certain members of his biological family. Well, "disdainful" isn't quite right, since there's obvious pain there. That's why I added ""ruefully," but it doesn't quite modify "disdainful" enough. As someone who has not the most stable of families, I relate. Go take his poll. He should, however, stop using "LOL." Even his young age is no excuse for that.

I'm such a narcissist. I find something endearing when it is just like me!

Oh, and Eve...I wasn't responding so much to you because I was angling to get on your blogroll (not that I mind...), but because I find you so provocative and interesting. Which reminds me of one thing I like about blogging, or rather, reading blogs. Often you read pundits in newspapers who disagree with you, and they just seem like assholes. George Will, William F. Buckley...maybe in person they are warm and genuine, but they sure don't come off that way to me. Sometimes bloggers who disagree with you are the same way. I basically write off anyone who uses the word "idotarian" and I'm sure right wingers don't find much to admire in, say, Roger Ailes. But because blogging allows a lot more personality to creep in than writing for a newspaper does, sometimes you find someone like Eve who is so obviously not only intelligent, but warm, tolerant, and humane, and who also disagrees with you about a lot of things. And it makes the other side seem less...well...like The Other. It feels more like we're engaged in some meaningful conversation, out of which new and important things will come. Or maybe not. But at least I get periodically reminded of the humanity of people who disagree with me.

Aaah, it reminds me of a song...
Which reminds me of another song I like better...

Okay, you know it's time for the Queen to retire to her chambers when she starts dragging out the Irish (too narrow--Celtic--still too narrow--British Isles) folk music.

But actually, as long as I've started, I might as well go all the way. One last song.

I wish my blog had MP3 capacities...
I died laughing. Just died.

I think this must be the funniest (and most depressingly dead-on) parody of the Bush administration I have ever seen.

There aren't any misspellings though.

via David Chess.
via Jeanne D'Arc and CalPundit (who both have intelligent things to say), a Catholic Bishop publically asked that Gray Davis stop taking communion because he supports abortion rights:

Here's what I think is wrong with this, er, well, one of the things: It is not, to my knowledge, the aim of the Catholic Church at the current moment to become the governing athority in any of the nations in which it has a significant presence. (Correct me if I'm horribly wrong about this, but I don't think so.) It is supposed to be a moral authority, to guide people's actions. Obviously, Gray Davis has never had an abortion. (Does the Church know whether he's ever directly assisted anyone in obtaining one?) So the Church's objection is to...what? That he thinks that there should not laws prohibiting abortion? I could (maybe) understand the Church's position if Gray Davis were going around saying that abortion was great--but the mere fact of believing that something should not be prohibited by law does not constitute a moral endorsement of it. The Church doesn't like adultery either; should Gray Davis not take communion because he doesn't believe in jailing adulterers?

I realize the situations are a little different; by their logic, if life begins at conception and a fetus is a baby, then abortion is murder, and it's wrong to oppose murder. But adultery and homicide are both mortal sins in the eyes of the Church. Gray Davis could privately find abortion repugnant, but feel that as an elected official who represents the will of the people and as a government officer who must abide by the law, he can't regard abortion as any different than any other kind of medical care. And it really strikes me as wrong on many levels that the Church is saying he shouldn't take communion if he wants to (as indeed he must in order to ethically perform his office) maintain a separation between his private religious morality and his public ethical duty. I suppose the Church could object that he ran on a pro-choice platform, back in the day when he had no obligation to the people, but even then, his opinion on the proper sphere of secular law's authority could be totally different from his moral judgments. I said in the comments to the TalkLeft post about Regina McKnight that I think it is in fact immoral to put yourself at risk of being addicted to drugs (though of course there are many circumstances preceding drug addiction that make me very sympathetic to the people who suffer from it); it puts you in a position not to be able to control the harm you do to others. For that matter, (this will sound a bit Catholic of me) I think it's a sin against life; to abuse your own body, to destroy your physical and mental health to the point that you will be unable to do with your gifts what you could, in work or in love, is to devalue the gift you've been given and to show horrendous ingratitude to the force (whatever its nature) that gave it to you. But at the same time, I don't think drug addiction should be criminal. Why can't the Catholic Church understand the distinctions between the two spheres--religious and legal--and understand that one's views in one sphere might not be identical to one's views in another? Does it actually reject the separation of church and state?

And for that matter, it was quite crass of that bishop to make a public recommendation that Gray Davis stop taking communion. He could say in public that he believes it is inconsistent for politicians to support Roe v. Wade and say they are Catholic (though it isn't, for reasons I just outlined), but the condition of Mr. Davis's soul and whether or not he is fit for communion is a matter that should be left between him and his priest. That the bishop made it otherwise strikes me as very crass and calculating.

In case you didn't click through to Jeanne D'Arc, she makes an excellent point about the Church's choice of this strand out of the moral web to try to influence in this manner and how it casts doubt on the true moral focus of their endeavor.

I'll echo her: why don't they say that any Catholic politician who endorses preemptive war should not take communion? Is its true goal saving lives, or exercising power? And over whom would they want to have power? Hmm...
I continue to be outraged and disgusted by the cruel and inhumane punishment visited upon Regina McKnight. I emailed the staff at my job about it, and one of my colleagues responded with this web page from the Drug Policy Alliance--you might visit it if you are interested in further information on the subject of pregnant women prosecuted for drug use.

This is just so galling to me.

Here's some other interesting stuff from the site--an article from Reason entitled "Fight Terrorism--Grow Your Own Pot" as a response to the drugs help terrorism ads and an article about the ineffectiveness of false scare tactics in school drug prevention programs. I can totally testify to that. A mildly scarred D.A.R.E survivor, I would totally snort when Officer Wilson would try to tell us things like, "you will definitely become addicted to cocaine after one use." When they lie, they diminish their credibility about the real harmful effects of drugs. And as someone who has lived with more than one productive, energetic marijuana smoker, I'm not inclined to accept that marijuana *makes* the user characterologically incapable of accomplishing anything, even when not high, another thing they told us. In junior high I had to write a pledge to remain drug free. I considered writing an essay about why I refused to take the pledge, but then I decided that junior high was hard enough without bringing the wrath of D.A.R.E. on my head. Pick your battles, I thought.

Tuesday, January 28, 2003

TalkLeft on the woman sent to jail for 12 years because she used cocaine during her pregnancy and her baby was stillborn. I comment at some length.
my site meter's gone crazy. it thinks it's wednesday.
How I wish I had someone to play this with tonight.
Anyone want to go to Paris? You can fly there from NYC for $200 round trip on Lufthansa till the end of March (excluding taxes, etc.) It's on Travelocity.

Just a little PSA for the lucky readers of my blog.
here's an interesting Times article on affirmative action at service academies. There may be a pro-Michigan amicus brief coming from some military officers.

Monday, January 27, 2003

wow, first child care and now psychoactive medication. It's fun when people in the blogosphere start talking about things I have profound interest in, either inherently or because I sort of fell into it through my work.

Psychoactive medication I have an inherent interest in.

CalPundit says he likes a Virginia Postrel post that I found pretty dumb. Here is the TNR article on ADHD that inspired Virginia Postrel.

The first half of this post is on ADHD, the second on depression.

I do think ADHD exists. But the way the TNR article blithely asserts that "even a cursory examination of the existing literature or, for that matter, simply talking to the parents and teachers of children with ADHD reveals, the condition is real, and it is treatable," is unjustified. I've performed more than a cursory examination of the existing literature, and the conclusion I came to was that it was real, but it was vastly overdiagnosed. "Simply talking to the parents and teachers of children with ADHD" wouldn't prove that ADHD exists. It might prove that their kids had serious problems, and even that Ritalin managed to alleviate them, but it wouldn't mean that the thing causing those problems was the lack of behavioral inhibition mechanism Russell Barkley describes (another thing that article does wrong is fail to identify its experts as people who make an excellent living treating, talking about, writing about, and selling videos about ADHD. I'm not saying they're corrupt, but journalists should describe the relevant details about their experts, rather than acting as if they're just citing a random authority, so readers can come to their own conclusions about their biases). Maybe the kids have an emotional disturbance that manifests itself in poor attention and inhibition (or whatever). It's sort of like how the fact that sometimes people forget abuse does not prove a repression mechanism (another thing that may not exist, or if it does is probably way overdiagnosed. People just forget a lot more than one would think). Since I do think ADHD exists, I'm not going to argue that point (though it's worth mentioning that some studies have found as many as 28% of kids on Ritalin are also taking two or more other psychotropic drugs, which might suggest that there's more of a behavioral problem stew than one isolatable disorder), but I think the author puts too much faith in his conversations, unless his conversations were systematic, large scale diagnostic interviews with kids, teachers, and parents.

The TNR article goes on: "Often the best diagnostic test for an ailment is how it responds to treatment."
Well, it's true that often sick people who respond to the same treatment have the same ailment, but if behavior was incorrectly pathologized in the first place, the fact that drugs change the behavior does not mean there was truly an ailment. My sobriety responds excellently to alcohol. The fact that alcohol gets rid of sobriety for both me and the next gal pretty much equally well indicates that we were both sober to begin with. It doesn't mean that sobriety was an ailment.

Yes, ADHD makes kids calmer and enables them to focus better. (Caffeine also improves focus unless taken in too great a does, and it possibly works in a similar way to Ritalin, but just because caffeine helps you focus does not mean your previous lack of focus was a disease.) Some of those kids were pathologically hyperactive and inattentive, and it's proper that they should be medicated. However, one of the problems with ADHD (and also with depression; Virginia Postrel tells the untruth that clinical depression is fundamentally different from something ordinary people experience--I'll get to that later) is that it almost certainly exists on a continuum. Everybody had problems with concentration and self control. In some people on the tail end of a bell curve, it's so bad that it will interfere with their life functions so much that we decide medication will make them a lot happier and more productive. The problem is deciding at what point on the bell curve it's bad enough to medicate--in the worst 1%? the worst 10%? The other problem--which the TNR article shrugs off when it says it doesn't matter that there's no way to objectively detect the presence of ADHD--is that the criteria for ADHD are incredibly subjective (this is a problem with a lot of psychiatric disorders). Persistent inattention? Frequent fidgeting? What is truly pathological? ADHD critics aren't just talking out of their asses when they worry that we are pathologizing ordinary childhood behaviors. When you read some of the percentages of children who are on medication in some schools, it's fair to wonder about the criteria we're using to define pathology. Here's an NIH press release detailing results of a survey in which 15% of white boys had been diagnosed with ADHD, and 10% were being medicated. The NIH don't wonder if the children are being overmedicated, they just say, "Impact of Attention Deficit-Hyperactivity May Be Underestimated." If we find certain behaviors so troubling that they need to be medicated out of existence, but they are found in 15% of the white male population, that to me rings bells that we are overpathologizing difference, and maybe we need to be thinking about different ways to respond to some of these kids.

Fumento could stand to talk to some actual clinicians who dissent from his Ritalin boosterism. This paragraph is very flawed:

Barkley and Rapoport say research backs her up. Randomized, controlled studies in both the United States and Sweden have tried combining medication with behavioral interventions and then dropped either one or the other. For those trying to go on without medicine, "the behavioral interventions maintained nothing," Barkley says. Rapoport concurs: "Unfortunately, behavior modification doesn't seem to help with ADHD." (Both doctors are quick to add that ADHD is often accompanied by other disorders that are treatable through behavior modification in tandem with medicine.)

It's been a while since I've read the MTA study, but this article does a good job of summarizing the results. Yes, it's true that a higher percentage of kids who are only on meds normalize than of kids who only get behavior modification treatment (but many kids in the behavioral modification group did improve). Medication only outpaced behavior modification in improving the primary ADHD symptoms--inattention and hyperactivity. They were equally effective in treating aggression and defiance, etc. As time passed, however, the positive effects of behavioral modification maintained, while the effects of medication diminished a little. But one of the most important things this paragraph leaves out is that combination behavioral/medical treatments are better than medication alone, and it's a little bit silly that Barkely criticizes behavioral interventions as having no lasting effects, because the only reason drugs have lasting effects is because kids keep taking them! There's no evidence of improvements that last even if the medication is discontinued (if drugs are used alone, without other therapies) for any psychotropic drug that I know of. (I could be wrong, but I've never heard of one.) Finally, another huge piece of information about treatment this paragraph omits is that the dropout rate was a higher in the medication alone groups than it was in either the behavior modification or the combined treatment group, and parents and teachers reported higher levels of satisfaction with those treatments. This is a typical (sometimes willful) mistake people make in interpreting the results of treatment studies: they don't consider the dropout rate as part of the overall failure rate of the treatment, even though if people can't stick with the treatment protocol, it doesn't do them much good. I don't have a copy of the study with me, so I can't look at the raw numbers and see whether behavioral treatment becomes more effective than just medication if you consider the dropout rate, but it's a possibility. What to conclude? That combined treatment is probably best in most cases, but in all cases the individual needs and responses of the child and family should be considered, and that Fumento is publishing this simplistic near-advertisement for Ritalin is not just bad journalism, it's socially irresponsible.

The article goes on (I could fulminate all day) to brush off statistics about communities where Ritalin prevalance is huge, not by actually refuting these stats, but by saying that there are also communities where it's underprescribed. Yes it's bad (and not particularly surprising) that the poor and minorities have less access to medical care, including psychiatric care. I'll stipulate that there are probably kids who could benefit from Ritalin but don't get it. Fumento does not demonstrate enough intellectual honesty to do what I just did--acknowledge that if there are communities where 20% of white boys are being drugged (!) that is a huge problem. And sentences like this are just absurd: "A report in the January 2003 issue of Archives of Pediatrics and Adolescent Medicine did find a large increase in the use of ADHD medicines from 1987 to 1996, an increase that doesn't appear to be slowing. Yet nobody thinks it's a problem that routine screening for high blood pressure has produced a big increase in the use of hypertension medicine." But there is a difference between ADHD and hypertension. Hypertension you can measure, so you can be pretty sure you're not giving medicine to people don't need it. And despite what the "it's chemical" brigade will tell you, there is a difference between physiological and psychiatric disorders. There's usually not a danger of doctors unjustly pathologizing one end of normal when treating physiological disorders (well, sometimes there is, like when endocrinologists give little girls infertility-causing hormones because they're afraid they'll grow up to be too tall). The diagnosis of psychiatric disorders is usually much more subjective and therefore much more subject to error, or to becoming a tool for the imposition of cultural norms on healthy people. I'm not saying I'm a Szaszian who believes psychopathology doesn't exist, but I do believe in actively critiquing the psychiatric establishment, which has a time-honored tradition, from Freud to the present day, of abusing its power to determine what is disease and what is not.

On to Virginia Postrel. I can't permalink, but scroll down the the post entitled "mental treatments." People who suffer from mental disorders often claim some kind of special credibility on the subject, when in fact their diagnosis often motivates them to talk about the disorder in a certain way, and they actually have less credibility, or at the very least, no more credibility than a non-sufferer who chooses to educate herself. This paragraph is just wrong:

I don't know much about ADHD, although the anecdotal experience I've heard from parents backs Mike's case. But I do know about depression, and it's completely distinguishable from ordinary sadness. The paralyzing despair it induces has absolutely nothing to do with anything happening outside your head. You can have a perfectly happy life and be depressed and, conversely, a miserable life with no depression.

No, actually, clinical depression is not completely distinguishable from ordinary sadness. It's different in its severity and its duration, but it's not a completely different phenomenon. Depression is often (perhaps even in a majority of cases--I really need access to some full text psyc journal databases) triggered by an external event. What distinguishes clinical from nonclinical depression is simply the sufferer's resistance to improvement. If profound feelings of sadness (or anhedonia--loss of pleasure) along with some other behavioral, cognitive, and somatic symptoms persist for two weeks, then the DSM IV says you're clinically depressed. In fact, clinical depression, like ADHD, probably exists on a continuum of human experience, with happiness being on one end of the affective scale, normal sadness being in the negative range, and severe depression being on one end. Here are the DSM IV diagnostic criteria for clinical depression. For those of you who think you have never been clinically depressed (I think I'm in that category), but have felt very upset for some sustained period in your life (say, a week), I would ask: were you irritable during that period? did your appetite change? did your sleep patterns change? were you fatigued?\\ (probably as a result of your answer to the last question)? did you feel guilty? have trouble making decisions or concentrating? Your answer to some of those questions is probably yes. Mine was yes to all of them. The very fact that the diagnostic criteria specify that these symptoms only indicate depression if it's not a natural response to a major trauma, like the death of a loved one, is an indication that clinical depression is not something utterly distinct from what normal people experience. Because depression, like ADHD, probably exists on a continuum, as with ADHD we have the difficult question of deciding what to pathologize, what to medicate. That last sentence of Virginia Postrel's is either badly written, or nonsensical, or both. Does she mean that the external circumstances of your life can appear happy to the outside observer and you can become depressed? That might make more sense. You can't be happy and depressed however. You just can't, and if you are clinically depressed, you won't be able to function well enough to maintain the appearance of having a happy life either.

VP is motivated to say that clinical depression is something fundamentally, qualitatively different from what ordinary people experience to justify to herself that she takes drugs to alleviate it. I don't think it's wrong that she takes drugs; I don't know enough about her psychological health to be a judge of that. I do think it's wrong if she takes drugs without at least periodic therapy. People who pop pills in place of (instead of addition to) real psychological work have a tremendous incentive to believe their depression is nothing more than a physiological disease, and they are taking the medicine to correct it. But "it's chemical" is a nearly meaningless statement when talking about depression or any other psychiatric disorder. Unless you believe in a soul or some other supernatural explanation for human consciousness, which of course, many people do; I, however, am not one of them, every mental state is chemical. Love, despair, jealously, and genius are all reducible to the position of cells and molecules in our brains. Yes, taking a drug can change the composition of chemicals in your brain and make you feel better. For some people, it is absolutely necessary to their life function and I would not deny them medication. However, learning to think differently, to examine your own motivations, to behave in ways that make you more creative or that let love into your life, to learn to be kinder and more generous towards others also will alter the position of cells and molecules in your brain, and they will also make you feel better. And I am a liberal who is not at all unsympathetic to the suffering of the mentally ill or the merely neurotic, but yeah, it bothers me that people in this society use drugs as a substitute for the hard work of self examination and self improvement. Never, absolutely never should drugs be a substitute for (good) therapy, and Virginia Postrel is full of shit when she says that "biological treatments...undermine the claims of therapists;" they do nothing of the kind, for reasons I just stated: that a mental state has a biological underpinning does not mean that therapy cannot also alter the chemical composition of your brain. And when you do it through therapy (or through religious counseling, or whatever) rather than with drugs alone, you've actually changed your values, your actions, your self concept in a way that you accomplished yourself and that can last even when you're not in direct treatment, which no medication for depression can claim to do. New research is revealing that even schizophrenia, which is the stereotypical example of the highly heritable "biological" disease, is treatable with cognitive therapies that allow people to recognize their delusions and function much better than they can with medication alone.

My mother started taking Zoloft, I don't know, maybe a year ago. When I heard this I told her, "Mom, I think you're doing this as a substitute for addressing the ways your life is fundamentally unfulfilling." She said, "I know. That doesn't bother me." My mom lives in a small, very religious town where it's hard for her to find friends who truly share her values. She's totally given up on finding a romantic partner. It's actually pretty hard for me to imagine her finding a romantic partner, at least one that she would be willing to be reciprocally attracted to (given what I've heard her say), but she could have definitely changed her life so she lived in an area where she could have had friends she related to, and where she could volunteer for causes she cares about, like environmental activism, population control, and reproductive rights (which she really can't do in half Catholic, half born again Los Banos, CA). I've heard her talk frequently about how much she likes Santa Fe. I asked her over and over again why she didn't try to move there, and she was just convinced that it would be financially devastating, that she'd go back to the bottom of a pay scale. But she's bilingual, which is already an asset, and she didn't even try to look into her options, like getting a Special Ed credential, or finding a job as an educational administrator--or something, I don't know. My point is she didn't look, because she has a very pessimistic self-denying personality (and I hope to god I don't turn into her. sometimes she says she was like me when she was young and that scares the fuck out of me). So instead of trying to do the best thing for her life, she takes Zoloft, which takes the edge off. her doctor just gave it to her when she asked for it. Asked her a couple of questions and then got out his pad. Didn't suggest she see a therapist at all. Forgive me if I find this a little, well, depressing. When she visited me in New York at one point I made some offhanded comment about "depressing suburban life." "Not all suburban life is depressing," my mom retorted. "My suburban life isn't depressing." "Mom," I said. "You're on Zoloft. I don't think you get to be the poster child for emotional fulfillment in suburbia." "Oh yeah," she said. Then she sort of giggled. "It's a low dose." In contrast, my friend Susan takes Zoloft. She is prone to very bad depression, and I don't doubt that she needs it. But Susan also has a lot of problems with the way she thinks about herself and the way she interacts with others (problems very similar to mine, actually, but more severe). She's in therapy to deal with these problems. She's doing the work my mom isn't, and she every day aspires to a better life than the one she's living. Yes, some people are genetically predisposed to feel really bad some of the time, and sometimes that lasts long enough to be clinical depression. But not a single one of these people does not have problems with the way they see themselves and the world that need to be addressed in some sort of counseling. Not one. Some people's depression is untraceable, at least in proportion, to anything that happened in their past. But there's no such thing as depression that does not have cognitive, affective, and behavioral components (that's why it's a mental disorder!) that need to be addressed with cognitive, affective (in addition to medication), and behavioral treatments. And if you're not doing the work, you're lazy. The drug that makes it all okay is all you're willing to invest in. You're living the unexamined life, and even if you've improved your affect enough so that you're life feels happier, Socrates would say that your life is still not worth living.

That was harsh. But I meant it. I've written too much, but I feel strongly about this. Now I must go to bed.



So, via CalPundit I find out about Project Implicit, which tests implicit value judgments that you may not be aware of, and being the quiz whore that I am, I went over to check it out. The first division I got was New York vs. California, and I was totally psyched, because I want to find out if I like New York or California better (I suspect I'm an unreconstructed Californian, but maybe I'd surprise myself), but then my computer crashed in the middle. Then I got mean versus vegetables, an issue on which I have a pretty damn clear preference. It asked me all these wacky questions first, like "How likely do you think the average person is to hide his negative feelings about vegetables in order to gain social acceptance." I had no idea. But then in the association portion of the test it found I had no clear preference. (The way the test worked was this: I had to first place pictures of vegetables and meat in the meat or vegetable category, then place words with negative or positive value associations in the good or bad category, then place alternating words and food pictures in the "meat or good" or "vegetables or bad" category, then do the reverse, put words and food pics in the "vegetables or good" or "meat or bad category." I assume the test thinks that if it takes me longer to perform the tasks during the "meat or bad" runthrough than the "meat or good run through," I like meat better. But since I have a pretty strong preference for veggies, maybe their methodology's flawed. Or maybe I'm just at the tail end of some distribution curve...
I can see both sides of this issue. Signs was quite dumb, yes, but also sort of creepy and enjoyable.

I do have to say that any movie with that "something bad happens, and he loses his faith, something good happens and he gets it back" storyline is pretty dumb. If happy coincidences are the basis of your faith, but unhappy ones will destroy it, well, then, you're as likely to lose your faith again as to keep it. I mean, I understand that irrational individuals (or characters) might make decisions this way, but the guiding philosophy of the movie as a whole seemed to be that we can believe God exists because sometimes things work out. Anyone with a theology that actually incorporates an occasional observation about the way the world is would have to grapple with the fact that a lot of the time they don't.

Also, why the hell didn't the aliens invade a more congenial planet? And don't tell me they didn't know their fatal flaw; it was established early (by the guy in the truck) that they *did* know it. Stupid aliens.

I was genuinely scared through a lot of it, though, and I cried in the scenes with Mel's dying wife. But I also cried at the end of Armageddon.
Electrolite is talkin' 'bout "America the Beautiful." I liked his refutation of the standard objection to that song as a potential national anthem--that it's about landscape and not ideas. I usually buy into that line, too, but he just cited plenty of lyrics that were about ideas.

Anyway, my reason for commenting is that he may not have access to this particular piece of trivia: the lyrics to "America the Beautiful" were written by a progressive, lesbian feminist, an English professor named Katherine, no less.

Sunday, January 26, 2003

This is a good post by Jeanne d'Arc, but I don't think she has effectively argued for affirmative action. There may well be other good arguments for affirmative action, but the story she told much more effectively supports the conclusion that academia should use more qualitative, less numerical methods for evaluating intelligence, capabiliy, and potential, which I agree that it should, and it's sort of alarming to me that the essay is such a small portion of the University of Michigan's admissions criteria. But the next poor girl who had bad grades and whose parents didn't go to college might not have had Jeanne's abilities. There was nothing about her socioeconomic background that predicted for them that I can see. If she had told a story about how her background from a less educated poor family had allowed her to tell her schoolmates a thing or two about the world, that would have been an argument for affirmative action.

It's also sort of puzzling that, if it's true that one of the reasons she did badly in school was that she couldn't take multiple choice tests, she did so well on the SAT's.