Map of life expectancy at birth from Global Education Project.

Wednesday, January 31, 2018

None dare call it treason

I do. So does Rick Wilson. Read the whole thing but here's a taste:

The Republican Party’s head-first dive into breathless conspiratorial fantasies in defense of Donald Trump is a brand-defining moment as the Party of Lincoln morphs into the Party of LaRouche. Listening as members of Congress, the Fox News/talk-radio world and the constellation of batshit-crazy people drawn to Esoteric Trumpism adopt increasingly baroque theories to protect The Donald isn’t just depressing; it’s tragic. A diseased slurry of fake news, post-Truth Trumpism, and Russkie agitprop infects the Republican Party. It’s an ebola of wild-eyed MK-ULTRA paranoiac raving, spreading to every organ of the Republican body politic.

This loon-centric new world of crazy talk has dissolved the old ideological skeleton of the GOP and reduced it from the Conservative Party of Ideas to the Crackpot Party of Infowars. Covering up the connections among Donald Trump, his campaign officials, and family members with Russia, and this president’s efforts to obstruct justice and derail special counsel Robert Mueller will come at a still-untallied cost to our nation, our institutions, and the dignity and reputation of the GOP. It’s going to get worse as Mueller closes in.
Let's be clear about this. The Republicans in Congress -- not just Devin Nunes but all of the Republicans on the House Intelligence Committee, Paul Ryan, Mitch McConnell, and every single member who doesn't speak out loud and clear to denounce them, is a traitor. The Republican party spent decades representing themselves and the true patriots, denouncing Democrats as "soft" on Communism, then on terrorism.

Now they are working actively to undermine and cripple some of the most essential institutions and norms of democratic governance, including federal law enforcement, the judiciary, and the independent media, in order to prevent the nation from learning the truth: that the president was installed in office by a foreign adversary to which he continues to be a servant. That he is a stooge of Vladimir Putin and that our republic is in peril.

They are traitors. 

Update: John McCain, Not a Traitor. Credit where it's due.

Monday, January 29, 2018

Mirabile dictu!

Jeffrey Toobin finally admits what everyone outside of the Faux News bubble knows. The New York Time, however, is stubbornly oblivious.

CNN senior legal analyst Jeffrey Toobin says he regrets his role in pushing a “false equivalence” between Hillary Clinton's scandals and President Trump's controversies during the 2016 election. In an interview on Larry Wilmore’s “Black on the Air” podcast published earlier this month, Toobin told Wilmore that he feels he is “somewhat responsible” for a media climate that falsely compared Clinton and Trump.

“I think there was a lot of false equivalence in the 2016 campaign,” Toobin told Wilmore, the Washington Post reported Monday. “Every time we said something, pointed out something about Donald Trump, whether it was his business interests, or ‘grab 'em by the pussy,’ we felt like, ‘Oh, we gotta … say something bad about Hillary. I think it led to a sense of false equivalence that was misleading, and I regret my role in doing that,” he added.
The horrors about Cheeto Benito kept raining down at the rate of three to ten a day, and the press couldn't keep up. They'd report it and move on to the next one, while perseverating about the e-mails as if they were a  combination of Watergate and Benedict Arnold, because they had to "balance" everything they reported about Dump with something negative about Hillary. That is an insane concept of journalism. However, an apology is hardly enough.

Sunday, January 28, 2018

Sunday Sermonette: Gerontology edition

So what are the moral lessons of the Bible so far? They seem to be:

Revenge murder must go unpunished. Anyone who tries to punish someone who commits murder for vengeance will himself face severe vengeance.

Men can have multiple wives.

People should not know good from evil. That they learned good from evil was a crime for which humanity is eternally punished.

Women are subordinate to their husbands.

Did I miss something? Anyway, here is the next chapter of Genesis. It keeps getting weirder.

This is the written account of Adam’s family line.
When God created mankind, he made them in the likeness of God. He created them male and female and blessed them. And he named them “Mankind” when they were created.
When Adam had lived 130 years, he had a son in his own likeness, in his own image; and he named him Seth. After Seth was born, Adam lived 800 years and had other sons and daughters. Altogether, Adam lived a total of 930 years, and then he died.
When Seth had lived 105 years, he became the father of Enosh. After he became the father of Enosh, Seth lived 807 years and had other sons and daughters. Altogether, Seth lived a total of 912 years, and then he died.
When Enosh had lived 90 years, he became the father of Kenan. 10 After he became the father of Kenan, Enosh lived 815 years and had other sons and daughters. 11 Altogether, Enosh lived a total of 905 years, and then he died.
12 When Kenan had lived 70 years, he became the father of Mahalalel. 13 After he became the father of Mahalalel, Kenan lived 840 years and had other sons and daughters. 14 Altogether, Kenan lived a total of 910 years, and then he died.
15 When Mahalalel had lived 65 years, he became the father of Jared. 16 After he became the father of Jared, Mahalalel lived 830 years and had other sons and daughters. 17 Altogether, Mahalalel lived a total of 895 years, and then he died.
18 When Jared had lived 162 years, he became the father of Enoch. 19 After he became the father of Enoch, Jared lived 800 years and had other sons and daughters. 20 Altogether, Jared lived a total of 962 years, and then he died.
21 When Enoch had lived 65 years, he became the father of Methuselah. 22 After he became the father of Methuselah, Enoch walked faithfully with God 300 years and had other sons and daughters. 23 Altogether, Enoch lived a total of 365 years. 24 Enoch walked faithfully with God; then he was no more, because God took him away.
25 When Methuselah had lived 187 years, he became the father of Lamech. 26 After he became the father of Lamech, Methuselah lived 782 years and had other sons and daughters. 27 Altogether, Methuselah lived a total of 969 years, and then he died.
28 When Lamech had lived 182 years, he had a son. 29 He named him Noah and said, “He will comfort us in the labor and painful toil of our hands caused by the ground the Lord has cursed.” 30 After Noah was born, Lamech lived 595 years and had other sons and daughters. 31 Altogether, Lamech lived a total of 777 years, and then he died.
32 After Noah was 500 years old, he became the father of Shem, Ham and Japheth.

These are actually the descendants of Seth, we have seen information about Cain's descendants earlier. Here we have another reminder that God is a lousy prophet. He warned Adam that if he ate the fruit of the tree of knowledge of good and evil, he would die the same day, but he lived 930 years. One suspects that an error of some kind occurred in transliterating numbers. I have tried to do some research on this and haven't had any luck finding an explanation. We know from archaeological evidence that the average life span among people in that area and age was about 45, that is 5% of the typical ages we are seeing here. The maximum lifespan of humans was not much less than it is today, it was generally considered to  be about 70, but we wouldn't expect all but one of these people to be so lucky. I was able to determine that the numbering system was derived from the Egyptian hieratic system, which uses powers of ten but doesn't have place values like the decimal system. Rather, there is a separate hieroglyph for each power of ten. The symbol for 10 resembles the letter n, so 40 would be nnnn. There is a different symbol for 100. Possibly some scribe misread these symbols and people's ages also got exaggerated a bit. Anyway this is all awfully silly. 

Thursday, January 25, 2018

Physician, heal thyself

Two essays in today's NEJM about physician burnout, which they are allowing you unsubscribing rabble to read. Wright and Katz put a lot of blame on electronic health records, which is a common sentiment. EHRs were supposed to make life easier for physicians, but apparently the demands of documentation take a lot of time and come between the physician and humane contact with patients. The argument is often presented unclearly -- after all, physicians had to create paper records in the past, and if anything EHRs ought to make documentation easier. But the problem seems to be that the functionality of EHRs has caused health systems to demand more of physicians in the way of clerical work. I think EHRs may be something of a scapegoat -- in general the days when physicians were independent entrepreneurs is largely over. Now they are salaried employees of big corporations that are incentivized to squeeze more productivity out of them, even as Medicare and particularly Medicaid are screwing down levels of reimbursement.

Dzau and colleagues discuss some of the consequences of burnout, which include harm to patient care and even suicide. Physicians are at high risk for suicide. We think of the profession as highly lucrative, highly prestigious, and glamorous. The first two are certainly true, but the third generally is not. It's an extremely demanding job and for people who take it seriously and care about their patients, it can be very emotionally burdensome.

I think that solutions have to start with redefining the job. We can't afford to pay more for health services in the U.S., so we aren't likely to decrease the clinical load any time soon, but we can take  a lot of it off of physicians and put it onto nurse practitioners and physician assistants. This crisis is mostly located in primary care and there are lots of ways to reorganize primary care to make it more effective, and more patient centered, while actually reducing the M.D. workload. We can also have more scribes doing documentation in appropriate circumstances, although this needs to be carefully managed. Continuing to improve the design of EHRs can't hurt. We also need to re-align financial incentives to get more medical school graduates pursuing primary care careers. I'm happy to hear other thoughts about this. But it's an under-recognized crisis that threatens to be a serious problem for public health.

Wednesday, January 24, 2018

Charlie Pierce is shrill

Extremely shrill. Unfortunately, I expect the USOC, USA Gymnastics, and University of Michigan to survive with a person or two here and there losing a job but not much more than that.

Olympic gymnastics is a machine to make coaches and administrators rich by exploiting the unpaid labor, and abusing the bodies and psyches, of little girls and teenagers. Larry Nassar cashing in for sexual gratification on top of that is beyond the eloquence even of the great Charlie Pierce to adequately describe. But the institutions who enabled and protected him are largely indistinguishable from the Catholic church and Penn State football. Same damn thing. Keep the gravy flowing, that's all that matters.

Just because Nassar will only come out of prison feet first doesn't mean we've begun to seek justice.

Tuesday, January 23, 2018

Tuesday sermonette

I spent a good part of Sunday in the emergency department of Yale New Haven Hospital -- as a visitor, not a customer. That place is weird as hell, let me tell you.

Anyway, here's the rest of Genesis 4.

19 Lamech married two women, one named Adah and the other Zillah. 20 Adah gave birth to Jabal; he was the father of those who live in tents and raise livestock. 21 His brother’s name was Jubal; he was the father of all who play stringed instruments and pipes. 22 Zillah also had a son, Tubal-Cain, who forged all kinds of tools out of bronze and iron. Tubal-Cain’s sister was Naamah.
23 Lamech said to his wives,
“Adah and Zillah, listen to me;
    wives of Lamech, hear my words.
I have killed a man for wounding me,
    a young man for injuring me.
24 If Cain is avenged seven times,
    then Lamech seventy-seven times.”
25 Adam made love to his wife again, and she gave birth to a son and named him Seth, saying, “God has granted me another child in place of Abel, since Cain killed him.” 26 Seth also had a son, and he named him Enosh.
At that time people began to call on the name of the Lord
So, first of all, marriage is not between one man and one woman. It is rather unlikely that these occupations various occupations are entirely hereditary. And whatever being avenged seven times means, being avenged seventy-seven times is even stranger. Lamech took revenge on his attacker it seems. He gets away with it, but anyone who tries to get revenge on him will be in deep doo doo. What is the moral or theological significance of this? The conclusion seems to be that whoever commits murder first gets away with it, and anyone who tries to punish them is the real criminal. Contrast that with what we are usually taught to think about the Ten Commandments.

Apparently Adam hasn't gotten any for a few years, but now he does and he gets another son and a grandson. And all this time, it seems, people have not been worshiping God. Now all of a sudden they do.

So, these stories continue to be both muddled and ridiculous. (Again, where are all these wives coming from?) Their significance as moral instruction, theology or cosmology is also entirely obscure when it isn't offensive. It doesn't really matter, however, because this material is never read in church and preachers in general ignore it. Christians never have to think about it. People who claim to be fundamentalists or biblical literalists inevitably cherry pick the passages they pay attention to.

Monday, January 22, 2018

Sorry . . .

For the lack of a sermonette yesterday. I had a family emergency. I'll try to get it posted tonight. (I originally wrote "I'll try to get it up tonight," then realized that might be misinterpreted.)

Friday, January 19, 2018

Thought experiment

What if Barack Obama had an affair with a porn star while Sasha was 4 months old, then paid her $130,000 through a shell company to keep quiet about it just before the 2008 election, and it all came out one year into his presidency? We could throw in that he had her spank him with a rolled up copy of Mother Jones.

We could also throw in a couple of hundred other things, such as that the FBI is investigating whether the Russians gave Planned Parenthood money to support his candidacy. But let's just leave it at the above. And note that in this scenario yes, the Democrats control both houses of Congress. What do you think would be happening right now?

Thursday, January 18, 2018

The Dam Breaks

This is an extraordinary moment in socio-cultural history. The flood of women coming forward to speak truth about Harvey Weinstein somehow dislodged a blockage in the collective psyche. Bill Cosby, all of the academic sexual harassment scandals, and even the candidacy and, incredibly, election to the presidency of Der Gropenfuhrer wasn't enough. Actually, I think it's because of the latter disaster that the fall of Weinstein was possible.

Here's an essay in NEJM about sexual harassment in the medical profession. When doctors were all men and nurses were all women I assume nurses had to put up with this but now female physicians and medical students have found that they're still just women who seem to have wandered into the frat house. Dr. Jagsi describes her research on sexual harassment in medicine and says this:

The many heartfelt messages I’ve received from strangers since publishing my research reinforce these intuitions. The brave physicians who’ve contacted me say they remained silent and questioned their self-worth after their experiences, wondering whether they brought it on themselves. . . . In fact, none of the women who’ve contacted me have reported their experiences. They speak of challenging institutional cultures, with workplaces dominated by men who openly engage in lewd “locker-room conversation” or exclude them from all-male social events, leaving them without allies in whom to confide after suffering an indignity or a crime.
The pathology runs so deep that women in positions of power have been complicit. Here's from the Detroit News investigating the case of Larry Nassar and Michigan State:

Nassar put his fingers inside[16 year old gymnast] Boyce during weekly visits with him at his university office, and in a room near where the gymnasts practiced at Jenison Field House. After a long appointment with Nassar at Jenison, a coach asked Boyce what was happening during that time. Boyce told the coach, who insisted that Boyce tell MSU’s then-head gymnastics coach, Kathie Klages.  Boyce . . . still remembers the green carpet in Klages’ office and telling her Nassar had been “fingering” her during visits. . . .

Klages, who was MSU women’s gymnastics coach for 27 seasons, brought several of Boyce’s fellow youth program gymnasts into her office and asked them if Nassar did the same to them. One of them said he had. That woman, who spoke to The News on condition of anonymity, was 14 then, and remembers knowing before the meeting they would be talking about Nassar.
 “I remember feeling — finally a female would be an advocate for me, and tell my dad and my mom and I won’t have to tell them about this awkward thing,” said the woman, now 35, who has filed a civil lawsuit against Nassar and MSU. “Finally we’re going to get help, something will change and we won’t have to go back to him. But that wasn’t the case. Instead, I felt very shamed.” Boyce also felt intimidated and humiliated, and remembers what Klages said about filing a report. “She said, ‘I can file this, but there are going to be serious consequences for you and Nassar,’” Boyce said.
Now powerful men, more than I can count, have faced a reckoning. But whether anything will change for women in lowly positions -- retail, restaurant and hotel workers -- whose harassers are not famous -- remains to be seen. It will help when the vile and repulsive Donald J. Trump faces justice.

Monday, January 15, 2018

Remembering MLK

I was just short of my 14th birthday when Martin Luther King was murdered. (This is not the occasion to get into it in any detail, but I am quite sure we do not know the full story of his death.)

So the civil rights movement happened during my formative years. I actually remember hearing a story about the freedom riders on the radio, and asking my mother to explain it to me. I don't recall that she did that very well. She seemed to imply that they were the troublemakers, rather than the white supremacists who attacked them. If you don't know the story you can read about it here. This happened in 1961, when I was in kindergarten. The Montgomery bus boycott, which brought King to prominence, happened in 1955-56, when I was an infant. So the freedom rides were the earliest events in the movement of which I have a direct memory. Whatever my mother may have thought about the freedom rides specifically, she, and my entire family, were ardent supporters of the movement. We were on the right side of history.

I was deeply inspired by King. My life turned out the way it did because I wanted to fight for the ideals he died for. But I realize now that I have lived in a protected environment, going to schools with a progressive ethos, working for community based organizations and then for Tufts and Brown. Wherever I have been, it's been an assumption that hardly needs articulating that racism, discrimination and social inequality are evils, and that the proper business of every human is to work for justice. I did not understand how far from universal those values had become.

I knew, obviously, that there were powerful racist politicians in the south: Strom Thurmond, Jesse Helms, and that crowd. And when George Wallace ran for president, he managed to turn out quite a crowd for a parade in the Massachusetts city where I lived at the time. But this was during the backlash to the civil rights movement, of course, and Wallace got no traction nationally. Later, even in this century, we had a clownish Boston city counselor at large who was an overt racist, but that's because there were eight at-large members and he only needed to finish 8th. All his votes came from South Boston, the notoriously racist Irish-American enclave. (Ironic, to be sure, since the Irish in Boston originally occupied the caste position later occupied by African Americans.) But then even Southie changed and Dapper O'Neill lost his last election.

I had thought that the culture was continuing to change in the right direction and that despite an increasingly archaic minority, the rejection of racism had become an unassailable norm. I was wrong. It was there, festering away just under the surface. And it turned out that nearly half of the electorate could go to the polls and vote for a vile, repulsive, ignorant, sexist, foul-mouthed racist pig. Well, at least we know.

Sunday, January 14, 2018

Sunday Sermonette: Competitive Creation?

If you thought Genesis 1-3 had continuity problems, get a load of this.

Adam made love to his wife Eve, and she became pregnant and gave birth to Cain. She said, “With the help of the Lord I have brought forth a man.” Later she gave birth to his brother Abel.
Now Abel kept flocks, and Cain worked the soil. In the course of time Cain brought some of the fruits of the soil as an offering to the Lord. And Abel also brought an offering—fat portions from some of the firstborn of his flock. The Lord looked with favor on Abel and his offering, but on Cain and his offering he did not look with favor. So Cain was very angry, and his face was downcast.
So this is already weird. God, it seems, prefers meat to vegetables. Who knows why? This seems unreasonable since presumably God knows what business Cain is in and that he doesn't happen to have any animals to slaughter. God is also regularly having conversations with people.
Then the Lord said to Cain, “Why are you angry? Why is your face downcast? If you do what is right, will you not be accepted? But if you do not do what is right, sin is crouching at your door; it desires to have you, but you must rule over it.”
Now Cain said to his brother Abel, “Let’s go out to the field.” While they were in the field, Cain attacked his brother Abel and killed him.
Then the Lord said to Cain, “Where is your brother Abel?”
“I don’t know,” he replied. “Am I my brother’s keeper?”
So offering the vegetables to God was a sin. At the same time, God is not omniscient.
10 The Lord said, “What have you done? Listen! Your brother’s blood cries out to me from the ground. 11 Now you are under a curse and driven from the ground, which opened its mouth to receive your brother’s blood from your hand. 12 When you work the ground, it will no longer yield its crops for you. You will be a restless wanderer on the earth.”
13 Cain said to the Lord, “My punishment is more than I can bear. 14 Today you are driving me from the land, and I will be hidden from your presence; I will be a restless wanderer on the earth, and whoever finds me will kill me.”
A strange concern since there are only two other people in the world, right? Cain's parents.
15 But the Lord said to him, “Not so; anyone who kills Cain will suffer vengeance seven times over.” Then the Lord put a mark on Cain so that no one who found him would kill him. 16 So Cain went out from the Lord’s presence and lived in the land of Nod, east of Eden.
17 Cain made love to his wife, and she became pregnant and gave birth to Enoch. Cain was then building a city, and he named it after his son Enoch. 18 To Enoch was born Irad, and Irad was the father of Mehujael, and Mehujael was the father of Methushael, and Methushael was the father of Lamech.
I don't know what "vengeance seven times over" would be. Later Christians, and Mormons, interpreted the "mark of Cain" to be dark skin, BTW, and claimed it meant all dark-skinned people are cursed. However, as it turns out God didn't really mean it when he cursed Cain, who does not become a restless wanderer in the earth after all. He builds a city, in fact.  He does so after meeting a woman who was presumably the product of a separate creation by some other god over in Nod. Enoch also finds a wife somewhere, as do the other named descendants. Who populated the city of Enoch? I count twelve people, including the unnamed wives, but that includes Cain's great-great-great grandchildren.

While this is utterly ridiculous, it also seems quite pointless.

Friday, January 12, 2018

Shithole country

The Asshole-in-Chief wants immigrants to come to the U.S. from Norway. Funny thing, though -- nobody in Norway wants to move to the U.S.

Norway is ranked first in the world in the UN Human Development Index. (The U.S. is ranked 10th.) The standard of living in Norway is among the highest in the world, and the society is highly egalitarian. Health care is free for everybody, people are guaranteed 46 weeks of paid parental leave, and Norway is the happiest country on earth.

Oh yeah. They're socialist. The state owns 30% of the value of the stock exchange, including big stakes in oil, hydroelectric, aluminum, petroleum, telecommunications and other key industries. So no, they don't want to come to this shithole country.

Thursday, January 11, 2018


My Ex is from Santa Barbara, and her father still lived there while we were together. We'd go there every year at Christmas time. (Which was good, it got me out of Christmas, she's Jewish). Montecito is a neighboring town, really part of what you might call Greater Santa Barbara.

The area is - or was I should say - really paradisaical. The climate is said to be the most equable anywhere. Or again, it was. In late December it was balmy, with people playing beach volleyball and dining out of doors, rosy sunsets over the ocean and most years, little rain. (Every so often a stormy pattern would set up, but that didn't happen when I was there.) In the summer, it didn't get too hot because the ocean was cold due to the Humboldt current. The architecture is beautiful and the town is full of great things to do - excellent restaurants, museums and historical sites, a fabulous botanical garden, a bird sanctuary. The mountains loom behind and you could hike through spectacular scenery.

In fact my girlfriend's father was president of the local Sierra Club and he had written a guide to local trails. We'd go hiking at least once every year and there were always fascinating discoveries -- an abandoned olive ranch, the monarch butterfly grove (the location is not publicized), other wonders.

The city of Santa Barbara itself was threatened by a wildfire a few years ago, but it didn't make it down to the coast. This year, as you know, the largest wildfire in recorded California history roared through Santa Barbara County and destroyed a good part of it. It spared the city but did major damage in Montecito. And now following a rainstorm that fell on the burned out mountainsides, more of the town has been destroyed by mudslides. The images are apocalyptic, almost impossible to take in. Hundreds of homes were destroyed and untold numbers of people are dead. The major coastal highway is closed and will be for many days. People are still trapped without food, water or utilities.

The climate there is no longer so equable. There have been bouts of extreme heat, alternating drought and storminess, howling wind. And that's why Montecito has slid toward the ocean. But of course this has nothing to do with human activity. Just ask a Republican.

Sunday, January 07, 2018

Sunday Sermonette: Dust

Here's the second half of Genesis 3. As I said, it's starting to get more interesting.

16 To the woman he said,
“I will make your pains in childbearing very severe;
    with painful labor you will give birth to children.
Your desire will be for your husband,
    and he will rule over you.”
The Hebrews were a patriarchal society, to say the least. This Just So story justifies the order of society. But how can a just God punish all of Eve's descendants for her single act of disobedience? 
17 To Adam he said, “Because you listened to your wife and ate fruit from the tree about which I commanded you, ‘You must not eat from it,’
“Cursed is the ground because of you;
    through painful toil you will eat food from it
    all the days of your life.
18 It will produce thorns and thistles for you,
    and you will eat the plants of the field.
19 By the sweat of your brow
    you will eat your food
until you return to the ground,
    since from it you were taken;
for dust you are
    and to dust you will return.”
 This is quite odd since humans are evidently already mortal, inasmuch as they haven't eaten of the Tree of Life. It is certainly the human condition that we must work for our daily bread -- or rather at least some of us must. But the ancient Hebrews probably didn't have a leisure class.
20 Adam named his wife Eve, because she would become the mother of all the living.
21 The Lord God made garments of skin for Adam and his wife and clothed them. 22 And the Lord God said, “The man has now become like one of us, knowing good and evil. He must not be allowed to reach out his hand and take also from the tree of life and eat, and live forever.” 23 So the Lord God banished him from the Garden of Eden to work the ground from which he had been taken. 24 After he drove the man out, he placed on the east side of the Garden of Eden cherubim and a flaming sword flashing back and forth to guard the way to the tree of life.
Here's another oddity. God never actually commanded the people not to eat from the Tree of Life. Now all of a sudden he doesn't want them to do it, but they could have at any time! This story is muddled in many ways, but it seems to be trying to explain basic facts of the people's condition: labor, mortality, and patriarchy. Anthropologists have learned that hunter-gatherer people actually work less than agriculturalists, and have more egalitarian societies. Of course they are mortal, but nevertheless perhaps this story does have some resonance with actual history. The fall, however, did not consist in eating from a tree; but rather in learning to plant and reap.

Friday, January 05, 2018

The ontological status of the psychiatric diagnoses

I don't know whether it will surprise you that I am not particularly concerned with whether Orange Julius has a diagnosable mental illness, or if so what specifically that might be. And I think that Bandy Lee, the Yale forensic psychiatrist who recently briefed members of congress on the question, and who does think it is very concerning, makes my case.

In the linked interview, she says that the Resident is dangerous, but that she can't diagnose him without personally interviewing him. However she does think that he should be made to submit to a psychiatric evaluation because it's critical to determine if he is mentally ill. At the same time, most mentally ill people aren't dangerous and most dangerous people aren't mentally ill.

Right. So what difference does it make? We already know that his behavior is outrageous and terrifying, that he's incompetent, that he makes terroristic threats, disgraces the nation and demean his office, and that people are scared to death that he'll start World War III in a snit over some slight, real or perceived. Do I need to give him a label from the DSM-V? What would that change?

Congress has ample grounds to impeach him right now. But they won't do it. He'd probably merit a label of narcissistic personality disorder and likely be diagnosed with moderate dementia. So what? Everybody knows that already. Putting a label on it won't change anything.

Wednesday, January 03, 2018

What is "conservatism"?

Career congressional staffer Mike Lofgren tries to make sense of a political movement that unites religious fanatics with libertarian plutocrats and racists. This is a long essay which will reward your careful attention. I won't try to summarize it -- do read. But here are three excerpts that can serve as a road map.

I have written elsewhere how the GOP now predominantly views itself as a populist movement—a fake populism that directs the wrath of its followers downward against the marginal, and outwards against foreigners, rather than upward against the powerful. In reality, it pursues an economic policy entirely dedicated to the further enrichment of our American plutocracy on the backs of everyone else. Some have given up on this welter of contradictions, saying that there really is no such thing as a Republican Party platform. But all these programmatic inconsistencies can be reconciled at a more fundamental level than political programs. It lies at the level of personal psychology and barely expressible belief.

Donald Trump did not hijack American conservatism; in him it reached its logical culmination. The defining characteristics of post-1980 conservatism—its authoritarianism; denigration of reason and education; obsession with power at all costs; Manichean, black and white thinking; apocalyptic, religious fundamentalist mentality; paranoia and sense of being besieged even when in power; and gangsterish deceit, bad faith, and lack of principle, whether practiced by a transparent swindler like Trump or a supposed intellectual like Newt Gingrich—must lead to nihilism and mindless destruction. . . .

Trump did not fall from the sky upon an innocent American people. Public suspicion and cynicism toward government, other groups in society, and democracy itself, have been steadily growing since the 1960s. While this would have happened in any case (and a little cynicism about what any government is up to can be healthy), the intensity of the suspicion and cynicism has been stoked at every turn by conservative propagandists, to the point where these feelings have congealed into paranoia and nihilism.
The stark truth is that, as in 1939, we face the prospect of the destruction of the liberal project of the Enlightenment and the Democratic West. Resistance must be massive and unflinching.

Monday, January 01, 2018

Back from retreat

I had the week off -- the university was closed -- and I suppose I could have spent it madly blogging but instead I wound up contemplating. It has been difficult for me this past year to keep up a blog that's supposed to be about public health when the sorts of subjects I might write about from the standpoint of my expertise are overwhelmed in importance by the crisis facing our democratic polity. And that is also a crisis facing all of humanity.

Ezra Klein describes the evident derangement of the person who 47% of the electorate thought should be president, and Charlie Pierce piles on. But it is not his dementia, or even his ignorance and narcissism that disturbs me the most, it is his moral depravity. The discovery that a large percentage of the electorate is actually attracted to bullying, racism, sexism, stupidity and vulgarity  was unnerving. What is even more unnerving is that these people are impervious to reality. Facts and logic don't matter to them, just the angry, obnoxious style. Here's Politico's Michael Kruse visiting Johnstown.  He interviews one voter who agrees that Trump hasn't actually kept any of his promises, but it doesn't matter to him:

Del Signore is by his own admission not a person who’s focused on policy specifics. . . . The 61-year-old Johnstown native proudly planted a Trump sign in the ground in front of his catering company. And nothing that’s happened in the past 12 months, he told me when we met for lunch on Italian buffet day at the Holiday Inn, has lessened his enthusiasm for the man who so energized him.

“Everybody I talk to,” he said, “realizes it’s not Trump who’s dragging his feet. Trump’s probably the most diligent, hardest-working president we’ve ever had in our lifetimes. It’s not like he sleeps in till noon and goes golfing every weekend, like the last president did.” I stopped him, informing him that, yes, Barack Obama liked to golf, but Trump in fact does golf a lot, too—more, in fact. Del Signore was surprised to hear this. “Does he?” he said. “Yes,” I said. He did not linger on this topic, smiling and changing the subject with a quip. “If I was married to his wife,” Del Signore said, “I don’t think I’d go anywhere.” . . .

A Catholic whose wife goes to church every Sunday, whereas he, “shame on me,” does not, Del Signore told me toward the end of our lunch that some people at church told his wife that Obama is the antichrist. “She comes home and tells me these things that they tell you in church,” he said. I asked him whether that’s what he thinks. “I don’t know,” he said. “Some people say that.” If Obama, I asked, is the antichrist—whose arrival is said to precede the second coming of Christ—what would that make Trump? “The savior?” Del Signore suggested.
Here's Digby on the delusionality of the Trump "base":

Nearly half of registered Republicans believe Hillary Clinton’s failed presidential campaign is implicated in a satanic child abuse ring operated from beneath a Washington, D.C., pizzeria, according to the results of a new poll released this week. . . .Basically, most Republicans based upon zero evidence, believe that President Barack Obama was a Muslim plant, probably a terrorist and that Hillary Clinton, the 2016 Democratic nominee for president and former Secretary of State, is a child sex trafficking pedophile. But the Russia investigation, headed by the former director of the FBI and endorsed by every Intelligence Official free to speak on the record, is a hoax.
Equally as disturbing is the decision of the Republicans in congress to circle the wagons, and try to undermine the FBI investigation of Russian interference in the 2016 election. This is treason. And for the sake of what? Holding on to the idiot vote so their rich donors don't have to pay taxes and are free to pollute the environment, defraud consumers, and exploit their workers.

Under the circumstances I often despair of sitting down and typing out true facts based on evidence and reason. But that's all I know how to do.