Bob Schwartz

Category: Health

You don’t miss your water till your well runs dry: Learning the need for personal contact in a social media world

Social media began as a supplement to other media and social life. Social media came in some domains to dominate.

Some have observed that social media are out of balance, supplanting personal face-to-face. An emblematic modern picture shows people sitting around the same dining table, each one with a phone in front of them, busily “talking” to someone else not present.

Right now, in large parts of America and the world, that gathering of friends and family is a memory. Social media is the primary, to some extent only, means of mingling and gathering, whether for personal relations or for business.

At least for some isolated people, there may be a sense that they took live and in-person socializing for granted, just a little bit.

They say you don’t miss your water till your well runs dry. In the next chapter of this unprecedented novel, people will get back to getting together, gathering around that table. Maybe a little balance will return, and the phones will be put down.

If You Pray, Pray for Dr. Fauci

In her New York Times column today, Maureen Dowd interviews Dr. Anthony Fauci.

If you have been paying attention, you know that 79-year-old Dr. Fauci has been the trusted national voice of fact and reason in response to the pandemic. He is currently director of the National Institute of Allergy and Infectious Diseases, and has served six presidents.

In the interview, we learn that Dr. Fauci has been working 18-hour days, and at one point worked four or five days on three hours sleep each day. Because as a doctor, scientist and public servant he wants us to understand, wants us to behave appropriately, and wants as few Americans as possible to suffer and maybe die.

Part of that interview:


Thank God the Doctor Is In

By Maureen Dowd

March 21, 2020

WASHINGTON — It’s not easy being a national treasure.

“I’m exhausted,” confessed Tony Fauci when I reached him Thursday evening in the middle of another 18-hour workday.

“I have changed my tune a bit, probably thanks to my wife,” said the 79-year-old director of the National Institute of Allergy and Infectious Diseases. “About a week ago, I was going about four or five days in a row on about three hours of sleep, which is completely crazy, ’cause then I’ll be going on fumes. The last couple of nights, I’ve gotten five hours’ sleep, so I feel much better.”

He said he misses the endorphins of power walking, and he is wracked when he gets home at midnight and it’s too late to answer calls and emails.

“I gotta get rid of this guilt feeling,” he murmured about that moment’s 727 emails.

He said he has not been tested for the coronavirus but takes his temperature every day and usually has it taken another couple times before White House press conferences and meetings in the Oval.

When I spoke with him, he had been missing from the White House briefing for two days and Twitter blew a gasket, with everyone from Susan Rice to Laurence Tribe seeking an answer to the urgent query, “Where is Dr. Fauci?”

Donald Trump, the ultimate “me” guy, is in a “we” crisis and it isn’t pretty. The president is so consumed by his desire to get back his binky, a soaring stock market, that he continues to taffy-twist the facts, leaving us to look elsewhere — to Dr. Fauci and governors like Andrew Cuomo and Gavin Newsom — for leadership during this grim odyssey.

Dr. Fauci chuckled at speculation that he was banished due to his habit of pushing back on Trump’s hyperbolic and self-serving ad-libbing.

“That’s kind of funny but understandable that people said, ‘What the hell’s the matter with Fauci?’ because I had been walking a fine line; I’ve been telling the president things he doesn’t want to hear,” he said. “I have publicly had to say something different with what he states.

“It’s a risky business. But that’s my style, Maureen. You know me for many years. I say it the way it is, and if he’s gonna get pissed off, he’s gonna get pissed off. Thankfully, he is not. Interestingly.”

The first time I talked to Dr. Fauci was during a panic in the mid-80s about stopping another virus, the cause of the heartbreaking AIDs crisis. Then, as now, he was honest, brave and innovative. He told me that he tries to be diplomatic when he has to contradict the president about what “game-changer” cures might be on the horizon and whether everyone who wants to be tested can get tested.

“I don’t want to embarrass him,” the immunologist says, in his gravelly Brooklyn accent. “I don’t want to act like a tough guy, like I stood up to the president. I just want to get the facts out. And instead of saying, ‘You’re wrong,’ all you need to do is continually talk about what the data are and what the evidence is.

“And he gets that. He’s a smart guy. He’s not a dummy. So he doesn’t take it — certainly up to now — he doesn’t take it in a way that I’m confronting him in any way. He takes it in a good way.”

On Friday, a trigger-happy Trump was so quick to talk up the fabulous possibilities of an antimalarial drug in combating the virus that Dr. Fauci had to pump the brakes, taking the microphone to explain that we do not know yet because controlled testing is needed.

The president returned to the lectern to press his unscientific case and compliment himself: “I’m a smart guy,” he said. “I feel good about it. And we’re going to see. You’re going to see soon enough.”

Probably thinking about all his government staffers working round-the-clock, Dr. Fauci could not help rubbing his forehead and cheek — going against his own advice to the public — when Trump cracked a joke about the “Deep State Department.”

Though the scientist listens respectfully when the president and the vice president are talking, he somehow manages to emit an “Oh my God, please don’t say that” vibe when the two men scamper over the line. When Mike Pence went into false-hope overdrive, saying, “I just can’t emphasize enough about the incredible progress that we have made on testing,” Dr. Fauci and Dr. Deborah Birx, the administration’s virus response coordinator, exchanged a whispered aside that sent the internet into a frenzy.

Dr. Fauci assured me that, despite their crosscurrents and an early overconfidence about how easy it would be to control the path of the virus, the president “absolutely” now gets the threat of “the invisible enemy,” as Trump calls the virus.

Music: O-o-h Child (things are gonna get easier), The Five Stairsteps

O-o-h Child

Ooh child
Things are gonna get easier
Ooh child
Things’ll get brighter
Ooh child
Things are gonna get easier
Ooh child
Things’ll get brighter

Some day
We’ll put it together and we’ll get it undone
Some day
When your head is much lighter
Some day
We’ll walk in the rays of a beautiful sun
Some day
When the world is much brighter

DSM-5: Antagonism and Narcissistic Personality Disorder

 

DSM-5

This post was first published more than two years ago. It refers to no individual by name, but since it is regularly viewed by dozens of people each week, I am confident the message got through. Now that the issue of this personality disorder is finally at the top of the news, here it is again for those who may have missed it. Still no name mentioned, but there is no doubt what it suggests.

Mental health is a serious matter and mental health practitioners are serious professionals. These are not to be treated lightly and off-handedly.

The Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5) is the “bible” of the mental health profession: “a classification of mental disorders with associated criteria designed to facilitate more reliable diagnoses of these disorders.” It is not a reference to be thrown around and used casually by non-professionals.

The DSM can nonetheless be fascinating, especially when certain strong behavioral traits observed in others seem to closely match the traits and possible related disorders referenced in the DSM.

With the above caution and caveat, here are selections from DSM-5 about the Personality Trait Domain of Antagonism. More from the DSM about the way this may or may not relate to Narcissistic Personality Disorder will follow in a subsequent post.

Personality trait: A tendency to behave, feel, perceive, and think in relatively consistent ways across time and across situations in which the trait may be manifest.

Personality trait facets: Specific personality components that make up the five broad personality trait domains in the dimensional taxonomy of Section III “Alternative DSM-5 Model for Personality Disorders.” For example, the broad domain Antagonism has the following component facets: Manipulativeness, Deceitfulness, Grandiosity, Attention Seeking, Callousness, and Hostility.

Antagonism: Behaviors that put an individual at odds with other people, such as an exaggerated sense of self-importance with a concomitant expectation of special treatment, as well as a callous antipathy toward others, encompassing both unawareness of others’ needs and feelings, and a readiness to use others in the service of self-enhancement. Antagonism is one of the five broad personality trait domains defined in Section III “Alternative DSM-5 Model for Personality Disorders.”

Manipulativeness: Use of subterfuge to influence or control others; use of seduction, charm, glibness, or ingratiation to achieve one’s ends. Manipulativeness is a facet of the broad personality trait domain Antagonism.

Grandiosity: Believing that one is superior to others and deserves special treatment; self-centeredness; feelings of entitlement; condescension toward others. Grandiosity is a facet of the broad personality trait domain Antagonism.

Deceitfulness: Dishonesty and fraudulence; misrepresentation of self; embellishment or fabrication when relating events. Deceitfulness is a facet of the broad personality trait domain Antagonism.

Attention seeking: Engaging in behavior designed to attract notice and to make oneself the focus of others’ attention and admiration. Attention seeking is a facet of the broad personality trait domain Antagonism.

Callousness: Lack of concern for the feelings or problems of others; lack of guilt or remorse about the negative or harmful effects of one’s actions on others. Callousness is a facet of the broad personality trait domain Antagonism.

Hostility: Persistent or frequent angry feelings; anger or irritability in response to minor slights and insults; mean, nasty, or vengeful behavior. Hostility is a facet of the broad personality trait domain Antagonism.

Dylan Thomas for Big Pharma

The Pharmaceutical Research and Manufacturers of America have a new public relations campaign. It is no secret that Big Pharma is not wildly popular, given the perception that pricing is surreal and marketing is out of control.

The inarguable point of the ad is that pharmaceuticals save and extend lives. To make that point, it uses the most moving poem of Dylan Thomas, one of the great modern poets:

Do not go gentle into that good night,
Old age should burn and rave at close of day;
Rage, rage against the dying of the light.

Though wise men at their end know dark is right,
Because their words had forked no lightning they
Do not go gentle into that good night.

Good men, the last wave by, crying how bright
Their frail deeds might have danced in a green bay,
Rage, rage against the dying of the light.

Wild men who caught and sang the sun in flight,
And learn, too late, they grieved it on its way,
Do not go gentle into that good night.

Grave men, near death, who see with blinding sight
Blind eyes could blaze like meteors and be gay,
Rage, rage against the dying of the light.

And you, my father, there on that sad height,
Curse, bless, me now with your fierce tears, I pray.
Do not go gentle into that good night.
Rage, rage against the dying of the light.

My request is emphatic and simple. Whatever the merits or demerits of Big Pharma, find some other way to make your case, and please leave Dylan Thomas out of it. He is way out of your league.

DSM-5: Paranoia

DSM-5

I did not think that I would be returning to the DSM quite so soon after my recent post.

The caveat in my last post about the DSM bears repeating. Mental health is a serious issue. Using diagnostic tools and terminology merely for entertainment and “pop psychology” can be careless. On the other hand, these tools can help provide insights that may be useful, particularly when the subject and the subject matter are very important or even critical.

Non-professionals talk loosely and colloquially about paranoia. The DSM approaches this clinically and scientifically:

Paranoid Personality Disorder

Diagnostic Criteria

A pervasive distrust and suspiciousness of others such that their motives are interpreted as malevolent, beginning by early adulthood and present in a variety of contexts, as indicated by four (or more) of the following:

  1. Suspects, without sufficient basis, that others are exploiting, harming, or deceiving him or her.
  2. Is preoccupied with unjustified doubts about the loyalty or trustworthiness of friends or associates.
  3. Is reluctant to confide in others because of unwarranted fear that the information will be used maliciously against him or her.
  4. Reads hidden demeaning or threatening meanings into benign remarks or events.
  5. Persistently bears grudges (i.e., is unforgiving of insults, injuries, or slights).
  6. Perceives attacks on his or her character or reputation that are not apparent to others and is quick to react angrily or to counterattack.
  7. Has recurrent suspicions, without justification, regarding fidelity of spouse or sexual partner.

Diagnostic Features [selected]

They suspect on the basis of little or no evidence that others are plotting against them and may attack them suddenly, at any time and without reason.

They are preoccupied with unjustified doubts about the loyalty or trustworthiness of their friends and associates, whose actions are minutely scrutinized for evidence of hostile intentions.

They may refuse to answer personal questions, saying that the information is “nobody’s business.”

They read hidden meanings that are demeaning and threatening into benign remarks or events. For example, an individual with this disorder may misinterpret an honest mistake by a store clerk as a deliberate attempt to shortchange, or view a casual humorous remark by a co-worker as a serious character attack.

They may view an offer of help as a criticism that they are not doing well enough on their own.

Individuals with this disorder persistently bear grudges and are unwilling to forgive the insults, injuries, or slights that they think they have received.

Minor slights arouse major hostility, and the hostile feelings persist for a long time.

Because they are constantly vigilant to the harmful intentions of others, they very often feel that their character or reputation has been attacked or that they have been slighted in some other way.

They are quick to counterattack and react with anger to perceived insults.

DSM-5: Antagonism and Narcissistic Personality Disorder

 

DSM-5

Mental health is a serious matter and mental health practitioners are serious professionals. These are not to be treated lightly and off-handedly.

The Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5) is the “bible” of the mental health profession: “a classification of mental disorders with associated criteria designed to facilitate more reliable diagnoses of these disorders.” It is not a reference to be thrown around and used casually by non-professionals.

The DSM can nonetheless be fascinating, especially when certain strong behavioral traits observed in others seem to closely match the traits and possible related disorders referenced in the DSM.

With the above caution and caveat, here are selections from DSM-5 about the Personality Trait Domain of Antagonism. More from the DSM about the way this may or may not relate to Narcissistic Personality Disorder will follow in a subsequent post.

Personality trait: A tendency to behave, feel, perceive, and think in relatively consistent ways across time and across situations in which the trait may be manifest.

Personality trait facets: Specific personality components that make up the five broad personality trait domains in the dimensional taxonomy of Section III “Alternative DSM-5 Model for Personality Disorders.” For example, the broad domain Antagonism has the following component facets: Manipulativeness, Deceitfulness, Grandiosity, Attention Seeking, Callousness, and Hostility.

Antagonism: Behaviors that put an individual at odds with other people, such as an exaggerated sense of self-importance with a concomitant expectation of special treatment, as well as a callous antipathy toward others, encompassing both unawareness of others’ needs and feelings, and a readiness to use others in the service of self-enhancement. Antagonism is one of the five broad personality trait domains defined in Section III “Alternative DSM-5 Model for Personality Disorders.”

Manipulativeness: Use of subterfuge to influence or control others; use of seduction, charm, glibness, or ingratiation to achieve one’s ends. Manipulativeness is a facet of the broad personality trait domain Antagonism.

Grandiosity: Believing that one is superior to others and deserves special treatment; self-centeredness; feelings of entitlement; condescension toward others. Grandiosity is a facet of the broad personality trait domain Antagonism.

Deceitfulness: Dishonesty and fraudulence; misrepresentation of self; embellishment or fabrication when relating events. Deceitfulness is a facet of the broad personality trait domain Antagonism.

Attention seeking: Engaging in behavior designed to attract notice and to make oneself the focus of others’ attention and admiration. Attention seeking is a facet of the broad personality trait domain Antagonism.

Callousness: Lack of concern for the feelings or problems of others; lack of guilt or remorse about the negative or harmful effects of one’s actions on others. Callousness is a facet of the broad personality trait domain Antagonism.

Hostility: Persistent or frequent angry feelings; anger or irritability in response to minor slights and insults; mean, nasty, or vengeful behavior. Hostility is a facet of the broad personality trait domain Antagonism.

Healing and Magic: We Are Not Alone

White Tara

All of our religious traditions—Judaism, Buddhism, Christianity, and all others—include an element of healing. Healing of body, heart and mind. The Gospels, for example, contain many important stories about healing, from curing chronic illness to reversing death itself.

We invoke the power to heal in various ways. In Judaism, the Mi Shebeirach is recited:

May the one who blessed our ancestors, Abraham, Isaac and Jacob, Sarah, Rebecca, Rachel and Leah, bless and heal those who are ill. May the Blessed Holy One be filled with compassion for their health to be restored and their strength to be revived. May God swiftly send them a complete renewal of body and spirit, and let us say, Amen.

In Buddhism, White Tara, an important embodiment of compassion, is invoked:

The liberator of suffering shines light upon me to create an abundance of merit and wisdom for long life and happiness.

Is this magic we are engaged in? If you take magic to be a call to illegitimate and evil powers, as some traditions do, then this might have to be classified as something else. If you take magic to be the recognition of a seeming powerlessness in the face of things as they are and an attempt to borrow and employ the power we believe in, then magic it is.

This invocation of the power to heal—by ourselves, in a family, in a community—is a way of practicing that we are not alone. When healing is needed, that is something we want to know.

For JRK.

The Weird Randomness of Life

The Catcher in the Rye

I went to the gym this morning for my regular morning workout. The TV was on, but nobody was there. I saw that the remote control was gone. I climbed on a chair, pushed the power button and turned the TV off.

On further search for the remote, I discovered a handbag on the seat of stationery bike. I didn’t want to pry, but I peeked in to see if the remote had ended up there. Instead, I saw a copy of The Catcher in the Rye by J.D. Salinger.

Are people still reading The Catcher in the Rye? They should and apparently they are. It is a great and famous novel. Once upon a time controversial, when it was published in 1951, because Salinger included the word “fuck” multiple times.

After this novel, another novel, and a book of stories, Salinger disappeared, like the remote control. He is considered the most reclusive and mysterious of contemporary fiction writers. W.P. Kinsella included a character based on Salinger in his novel Shoeless Joe, which became a character in the movie version Field of Dreams. The character in the movie is played by James Earl Jones, a big black man with a booming voice. Salinger was a white Jewish man, as far as we can tell regular size and regular voice.

In high school, I wrote a book report on The Catcher in the Rye, one that was supposed to be read aloud. The English teacher was one of those young, hip women, so I thought it would be alright. I was a little concerned about some of the quotes, specifically the ones that included the word “fuck.” In that class was a girl who was a friend, not a girlfriend, who read it before class and urged me to read it just as it was. She was a popular and cool girl, but mostly I wanted to seem cool to her because she was pretty and had really big breasts.

So I read the report out loud. This is one of the passages I read. The confused and questioning adolescent Holden Caulfield says:

I went down by a different staircase, and I saw another “Fuck you” on the wall. I tried to rub it off with my hand again, but this one was scratched on, with a knife or something. It wouldn’t come off. It’s hopeless, anyway. If you had a million years to do it in, you couldn’t rub out even half the “Fuck you” signs in the world. It’s impossible.

I wasn’t particularly confused, but I was punished. Someone in the class took offense and told the principal. I was called down to his office, and despite his liking me a lot and despite my record as a star student, he believed some sort of sanction for my indiscretion was necessary. The sentence was that my entry into the National Honor Society was to be delayed one year.

If I had it to do all over again, I would know that none of this mattered. I read the book, still love it, and maybe my book report led someone else to read it. If I was somebody else, then or now, I might have said something to the principal that was clever and super-meta, such as “Go fuck yourself.” I didn’t and wouldn’t.

On the other hand, if I go down to the gym tomorrow, and still can’t find it, I might say to myself—only to myself and not out loud—“Where’s the fucking remote?”

Opioids and Heroin: Where Does It Hurt?

There is bipartisan agreement that we have a national problem of opiodd and heroin addiction. But few politicos are willing to discuss the hard questions.

The political consensus is that we address the addicts and how to treat and end their addiction. Which is a good and humane objective.

But there are two other aspects the politicos are less willing to take on.

Supply chain

The old school war on drugs went for the top of the supply pyramid. Think El Chapo. In the case of opioids, that supply chain leads up from pharmacies to doctors to pharmaceutical companies. But if you listen to the grandstanding from Democrats and Republicans, you hardly if ever hear the legal producers of the drugs called to account. It is true that product makers are not unconditionally responsible for how people ultimately use their products—not alcohol makers, not cigarette makers, not gun makers. But at least those suppliers can be spotlighted as significant stakeholders.

Where does it hurt?

Pain killers are a blessing to those who suffer from chronic physical pain or from intermittent severe physical pain. That kind of pain is a damnable thing, and we should all be glad that we have developed such a solution.

Millions of those who use painkillers, prescription and otherwise, are not in physical pain. But many of them are in psychic pain, whether out of loss, desperation, frustration, purposelessness, difficult circumstances, or just boredom. It is convenient but not completely helpful to lump these into “mental Illness” for which increased funding and access could be made available. This kind of pain is not illness; it is just a response to a condition or injury, no different than the hurt that might come from being hit over the head really hard.

Politicos don’t want to talk about this. The solutions to this kind of pain involve changes in society and in people’s lives that require lots of self-awareness, lots of politically tricky analysis, lots of controversial proposals that go beyond better addiction services. And lots of hard questions that politicos don’t want to ask, let alone try to answer. Such as:

Where does it hurt?