Setting Doctor / Patient Expectations

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If we have healthcare by the free market system in this country, which I am told is the case, then it should be possible for one to have a contract with one's doctor in order to set expectations and obligations clearly.  In my experience, this is not done, and all the obligations are on the part of the patient, with the doctor being able to do whatever they damn please.

Although you will hear about such things as a "Patient's Bill of Rights" to the best of my knowledge no such thing exists in any serious form, at least not that it would have protected me in any of the dozens of cases where I might very well wish to be protected.

Having made this mistake many times in the past, here is a short list of things I would like known and agreed to up front.

1. The doctor will not release information about the patient without the patient's written consent.  This happens all the time when a doctor sells his practice to someone else.

2. The doctor understands that he is responsible for delivering proper prescriptions on a schedule and that failure to do so will cause the patient damage.

3. The doctor understands that he/she is responsible for advocating for patient in any dispute or misunderstanding with the pharmacy and any failure to do so will cause the patient damage.

4. The doctor understands that when he/she goes out of town or is unavailable for any reason, that another doctor is made available to cover and will know enough and be comfortable with prescribing the appropriate medication in his or her absence.

5. In the event that the doctor and patient must discontinue their relationship for any reason, that the doctor will still provide prescriptions and interaction with the pharmacy for at least six months (and this term may have to be more).

6. The doctor will understand that this responsibility is serious and he/she can not just say "oh thats not important".

I am tired of having to deal with these irresponsible scum in order to get the medication I need to live my life.

Are Interpretations of Silence a Form of Delusion of Reference?

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I do perhaps 99 percent of my social interaction via "electronic mediation" whether that be texting, email, Facebook, telephone or instant messaging.  Sometimes a friend does not reply and then time passes and he/she does not reply to another message and then months go by and he/she does not respond to another message (email, whatever) that may be particularly chosen to be easy to reply to and relevant, entertaining, whatever to his/her interests.

Obviously I wonder if I am being ghosted.  But there are lots of reasons a friend might be doing this beyond the possibility that one is being ghosted, ostracised or rejected.  He/she may be going through a particularly intense time in their family or in their career or in other areas of their life. They might be helping a friend or themselves get through a serious illness. They might be travelling or trying to make a deadline that is not happening for them.  There are lots of things that may be going on.  After all, it is likely that you are not the center of interest in their life even if you are a friend for many years.

But since sometimes you are being ghosted, or at least that has happened to me in the past, and so the question is, is it a delusion of reference to interpret silence as a signal of social rejection? Maybe "delusions of reference" lite?

Delusions of Reference on Wikipedia
https://en.wikipedia.org/wiki/Ideas_of_reference_and_delusions_of_reference

[Addendum: the best algorithm I have found for evaluating if you are ghosted, is as follows: You send short emails at a constantly increasing interval: e.g. 1 week, 1 month, 3 months, 6 months, etc. Each email is constructed to be easy to respond to. No major questions that require thought. Then if you still dont hear from him after some long period of time, you assume you are ghosted and try not to worry about it.]

[Addendum: my friend got back to me, so I am not exactly ghosted, and he is probably just very busy.  However, it definitely makes me wonder if I have overstepped some bound, so we will see.]

Sadistic (Ex-) Friends

As many of you know, I recently experienced a very disturbing example of "kiss up, kick down" in which an old friend unleashed a flurry of emails at me listing all the ways I fell short, in his humble opinion.

Most of these shortcomings were false, but some were the necessary result of poverty.  In other words, it is true that the poor can not compete in most ways with the rich, so what?

But what was his motivation for this?  What was it all about?  My conclusion is that my friend of 30 years, a successful entertainment industry executive, is simply a sadist.  At some point, my number was up, and he decided to fuck me because he thought it was fun.

I mean, why not?  There is no downside to messing with me.  Like pulling wings off flies.

Republicans, Holocaust Denial and the Epistemological Crisis in America

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Today, #45 will sign one of the most insane and egregious so-called tax reform bills in American history.

Although we have not had enough time to analyze and understand all the ways that this bill violates any norm of rational human behavior we know enough to draw some conclusions.

1. We have an epistemological crisis in this country. It does not matter what is true or not true, the Republicans will believe it is true.

2. They are very similar to Holocaust Deniers who do not understand that the existance of the Holocaust is not at all debatable. They will never be convinced.

3. And just like the deniers of the Holocaust, this makes them dangerous to all of us.

4. But whatever the answer is, if there is an answer, discussion and the dialectic process is inoperative. There is no point in discussing anything with them. They are outside reason.

Value of a Psychiatrist in our Late Capitalist Society

A friend, who is aware of the stress I am going through, suggested I go see a psychiatrist he knows down here. The good news is that my friend wants to help. The bad news are the details, so lets go through it.

I think my friend knows all this, by the way.

The short version is to skip to item 10.

1. The doctor he recommends is an adult psychopharmacologist, I already have a psychopharmacologist. About six months ago, I was thinking of changing, but now I plan to stick with the one I have until I leave the area at the end of the year. (This particular recommended psychopharmacologist is also semi-retired and expensive).

2. Psychopharmacologists are good for one thing, prescribing drugs, period. My psychopharmacologist already prescribes the maximum of the drugs I intend to take. (Note: I would take more if I could, but I cant, so I have to deal with that).

3. There is a more general kind of shrink called “a therapist”. Some of them can prescribe drugs, some dont. In my experience, they are useful for one thing: the rent-a-pal phenomenon. When you talk to a shrink once a week, you tend to lean less on your friends for moral support. This is valuable! But time consuming and expensive.

4. Doctors cost money. I dont have the money to spare.

5. The money could be spent on many other things, like travelling to Sf to see an ex girl friend. That might cheer me up more than any doctor.

6. The problems I deal with at this time of life comes from trauma experienced in my 30s and afterwards. That trauma results in anxiety attacks today when I am not in control of where I live or how I am going to afford to live.

7. Therefore, if you want to help, and my friends do want to help, you should listen and say something cheerful, or (this is much more difficult....) you should help me find a job, or arrange for a place for me to live, or give me money or introduce me to someone who can. Unfortunately, that is easier said than done, especially in today's world.

8. We live in a corrupt, late-capitalist society. Money is necessary to solve problems. Shrinks are a tool which used judiciously, can be helpful. But, like lawyers, they are not a panacea and they run on money. At the end of the day, money may not buy happiness, but money, or a steady job, or both, will buy stability and some satisfaction. This is not the only path but it is a good one and very straightforward.

9. I recognize that most people can not provide this help for their friends, or when they do, only in very limited amounts. I have sampling error here. There was a time when I could give people jobs, two different times in fact, but those times are past for me and may have never existed for my friends. Your good wishes and thoughts are appreciated.

10. But the biggest mistake here is to think that doctors are good for anything and the patient knows nothing, even after a life time of dealing with this.

11. Send money!  Just kidding, sortof.  Thank you!

The Uses of Snowden: Passports are Given and Passports are Taken Away

[revised 8/27/2013]

One commonly held theory is that Snowden is useful for stimulating dialog and discussion in America on a variety of topics, and that this process of discussion is valuable independent of whether or not Snowden is actually the traitor that he wants to be or is merely guilty of narcissistic self-delusion.

For a quick review of Narcissistic Personality Disorder see here:

http://en.wikipedia.org/wiki/Narcissistic_personality_disorder

But whether actual traitor or merely a self-proclaimed martyr, his public travel dysfunction has stirred up at least three notable topics, none of them particularly to do with national security or surveillance. The topics are

1. What is a Passport and when can it be revoked ?

2. How does the rest of the world see our death penalty and use of torture ?

3. What is the UN Universal Declaration of Human Rights and what does it mean?

We will take this one piece at a time. First, the Passport.

1. The Passport

When Snowden's passport was revoked, righteous indignation spewed from the usual sources accusing the US Government of doing something illegal or immoral. So what is a passport and do you have a right to one? A passport is three things, two of them formal and one of them implied.   It is first identity paperwork and second a request that courtesy be shown the holder of the passport when travelling in another country.    By convention and by treaty it has accrued a third meaning, which is the de facto right to travel internationally at all.  The passport has a long history but as we know it in its modern incarnation it came into existence during WWI in order to control the passage of people of various nationalities across borders in Europe.  This specific need for border control evolved into the right to travel internationally in general.  No passport or diplomatic papers of some sort meant no international travel, for the most part.

The most famous fictional "letter of transit" for Victor Laszlo travelling through Casablanca

As it is currently conceived of, a passport is issued by a country's foreign service, in this case our Department of State, at their discretion and it may be revoked at their discretion. In our country, failure to pay child support is cause to revoke someone's passport, even if that passport is required for them to make a living, or to exercise any of their other interests or rights to travel. It can be pulled without recourse to law and is so pulled every day of the week in this country. So why shouldn't they pull the passport of someone who claims to be violating American law and releasing classified information ?

Furthermore, not having a passport is not a barrier to travel if another country wishes you to visit them.  Those countries can issue one of several types of diplomatic documents (usually temporary) that will enable someone without a passport to travel to them. They do it all the time, when they want to. In the case of Snowden, I guess they didn't want to.  (Of course a little pressure on them by our Government might have been applied behind the scenes, do you suppose?)

If Americans wish to change the process by which a passport can be revoked and the rules involving who can have a passport and what their rights are, I am all for it. But that would be a major change and would probably require the cooperation of congress and the courts.

But maybe a better question is why a "government" is necessary to have a passport at all?   How many people who are alive today chose the government they live under?   Is it perhaps 1% of the people?   I certainly did not choose this oppressive government that protects the rich and humiliates the poor. Why should governments have such control over international travel at all beyond what they permit at their own borders?

Recall, a passport is identity and a request for courtesy, combined with an implied third meaning: which is the right to travel internationally.   Why not have another, presumably international, body, certify the identity of a person and negotiate by treaty (1) the right to travel?  Maybe the UN could do this and actually be good for something beyond getting their diplomats immunity from traffic tickets in NYC. 

In parts II and III we will go over how the world sees our death penalty and how that affects the Snowden matter and then review the UN Universal Declaration of Human Rights, which Snowden has accused the US of being in violation of. He is right, by the way, we are. They all are. All countries are.

Just wait until you read this thing.

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1. So far as I know treaties are made by sovereign countries and their descendants (e.g. when Soviet Russia picked up the treaties of Imperial Russia).   So is the UN allowed to make treaties of this type? What is funny about this question is that I do not have a clue what the answer is, but I suspect the answer is "its complicated".

Recalling the Days When People Were Merely Called Eccentric

These days I am always careful to look whomever I am with in the eye. Why is that, you may wonder. Well, it used to be, back in the days when people were merely neurotic, I developed an affectation of not looking people in the eye. Beats me where it comes from, I think it has to do with being a little shy. But be that as it may be, these days if you do not look someone in the eye, you obviously have Asperger's Syndrome, and thus must be a barely functioning victim of an autism spectrum disorder. Thus I always make sure to look whomever I am talking to in the eye, at least once, during a conversation. Clever, eh?

I wish that my colleagues and peers would maybe realize that these DSM classifications are not to be thrown around casually, and that doing so is not only incorrect, it is also rude.

Perhaps we could return to a simpler, more innocent time, when someone was merely eccentric and colorful if he was a non-conformist.   That would be ever so much more accepting and positive, don't you think?   This trend of badly diagnosing someone's mental disorders and accusing them of it (or discussing it behind their back) is neither helpful nor accurate.

Eccentricity

Also, and I hate to mention this, but those who live in glass houses should not throw tactical nuclear weapons. It seems to me that the last five people I know who have "diagnosed" me with Aspergers should perhaps look to their own house first.

Even a casual study of the history of such things, these labels for eccentricity, show that society moves fast here.  One period's classification, for example, "moron", becomes a later periods' schoolyard insult.

In fact, I am "in touch" with my mental disabilities, if that is what they are, I think I have a good handle on them.  I am well aware that I am in many respects an outlier.  Some of the issues that some would see as a disability, I have become quite fond of, anyway.   The problem is not their diagnosis or management, per se, it is paying for their management in a society that seems to thrive on punishing the poor.   In other words, my problem is not ADD/ADHD or whatever, my problem today is cash flow.

Thus if you want to be a help, rather than throw diagnosis at me, throw money and that would certainly help me to be better adjusted.   Just trying to be practical here.

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The Diagnostic and Statistical Manual of Mental Disorders on Wikipedia
http://en.wikipedia.org/wiki/Diagnostic_and_Statistical_Manual_of_Mental_Disorders

DSM-IV TR (Text Revision)
http://www.psychiatry.org/practice/dsm/dsm-iv-tr

DSM-V (In Development)
http://www.dsm5.org/Pages/Default.aspx

Eccentricity
http://en.wikipedia.org/wiki/Eccentricity_(behavior)

Outlier
http://en.wikipedia.org/wiki/Outlier

The New Sport of Reading Crazy Internet Comments

[Revised 12/31/2012 to add details about the comments]

There is a new sport in town, a new dance craze if you will, everybody can enjoy it. The sport is reading the comments of the biped mammals to a topical news article. For every rational response, there is at least one irrational one, or so it seems.  Topics that set them off include Radiation and Nuclear Power, 911, Obama, Climate Change and Global Warming, and the Economy.

The irrational comments fall into a number of categories, they represent a broad diversity of insanity. It would not be fair to characterize it all as right wing ranting because there is, depending on the topic, a certain amount of left wing insanity as well. It depends on the topic.

In this case, the topic is a lawsuit filed by crewmen of the USS Reagan who participated in the humanitarian efforts during the nuclear meltdown in Japan. They are claiming that the Tokyo Power company deliberately lied about the level of radiation exposure and caused the plaintiffs unnecessary harm.

See http://www.bloomberg.com/news/2012-12-27/tokyo-electric-sued-by-u-s-sailors-exposed-to-radiation.html

Go to the bottom of the article, there will be a few comments, and click on "load more comments". Keep clicking until you have had enough.

Here is a summary of some of the comments: