In this blog I will use a question and answer format to further parse and explicate why I believe James Eagen Holmes is a "submergent personality" psycho, i.e. afflicted with submergent personality disorder. I will use actual evidence or assertions made about him by those who claim to have known him well, or worked with him, as well as other records now disclosed - such as that he was actually on academic probation at the University of Colorado, Anshutz campus in Aurora. All of this will comprise a further effort to make sense of an ultimately nonsensical act. The source work for most of the answers will be the psychotherapy anthology 'Psychotherapy of the Submerged Personality' edited and contributed to by Alexander Wolf, and Irwin Kutash.
Q. Could you give a background picture of personality disorders and how this 'submerged personality' disorder was chosen for Holmes?
A. The DSM-III, IV (Diagnostic and Statistic Manual of Mental Disorders) provides a classification of personality disorders and identifies 'clusters' within which specific disorders can occur. These include:
(A) Schizotypal, paranoid and schizoid personality disorders ('odd, eccentric' cluster)
(B) Borderline, narcissistic, histrionic and anti-social personality disorders ('dramatic, emotional, erratic')
(C) Submerged: Avoidant, dependent, obsessive-compulsive, passive aggressive personality disorders('anxious, fearful')
Each Cluster has discrete tendencies within itself:
(A) -> withdraw (no wants from others)
(B) -> exploit (want from others without seeing or responding to what others want from them)
(C) -> comply (want from others, but yields only to others' wants to avoid conflict)
The first task then, is to identify into which 'cluster' Holmes would fit, based on his documented behaviors.
We can immediately exclude Cluster A since Holmes DID have wants from others: namely recognition for sterling academic performance, as well as rewards commensurate with his attainments.
To the extent of our existing knowledge we possibly can eliminate Cluster B ('exploit') since we've no evidence thus far Holmes used any covert or overt ruses or gimmicks to attain his ends, his academic success for example.
This leaves cluster C as the most likely fit for him, and this means a decided preference to keep to himself (also being compliant with others to avoid conflict). This avoidant aspect is critical in a "submerged" in that he is terrified of possibly exposing either his authentic (submerged) ego or his maternal pseudo-ego for extended periods. (The latter likely to be perceived as 'soft', compliant and even unmanly by peers) Indeed, Wolf and Kutash (op. cit.) in their first chapter ('Historical and Theoretical Perspective', p. 13) emphasize that:
"A central characteristic quality of submergence is the need to be alone. The submerged personality cannot really reveal himself to anyone. The persons he claims as 'friends' are people who themselves, like him, have no close personal bonds. These have to subordinate themselves to his solitary need and ask for nothing in return. They must be loyal servants more than friends, providing only a listening silence for a man who has no interest in intimacy. His friends are to make no comment or to respond actively to his behavior."
This type of submergent is called "avoidant" and is said to lack "object relatedness". (Kutash and Greenberg, 'Place in the Diagnostic Spectrum', p. 47)
Q. SO how does this avoidant type submergent begin? What conditions create him?
A. Kutash and Greenberg provide the answer as follows (ibid.):
"In infancy the child is provided with satisfaction of all the basic physical needs such as food and physical comfort, but due to either a lack of parenting ability or life circumstance, the child is unable to receive much positive emotional stimulation or gratification. This scenario may be the result of a parent who is depressed or schizoid, or it may be due to a long term illness in which the child needs to be hospitalized. As the child enters the ego-emergence phase, independent strides are met with negative consequences such as punishment or anger.
This may be the result of having a parent who needs the child to remain a child in order to feel less threatened, or who needs the child to engage in activities that they themselves cannot fulfill."
The authors go on to note that as a result of this subjugation of innate personality to the parent's demands "ego development is thwarted". This is a result of a "complying pseudo ego" emerging which occurs as the individual's own authentic ego is submerged and is done to "stay out of harm's way". The submergent personality thereby exhibits little object relatedness since "they do not know how it feels to be gratified by another person".
Q. Isn't it possible the condition of Holmes is really Borderline Personality disorder?
A. Okay, first a cautionary note: We must acknowledge personality profiles may or may not be reliable. The problem always is that one or more personality 'disorders' can overlap - thereby obscuring the accuracy of a profile. It is quite possible that this could have occurred in the case of Holmes. In addition, it is dangerous to attribute violence -or propensity to violence, merely because one has a personality disorder. Not all personality disorders render a person prone to violence. Hence, after ascribing some personality disorder to a perp, one must inquire 'What was the trigger that converted a pathological mental disposition(that the subject may have lived with for years or decades) into overt acting out and mayhem?"
BPD - or borderline personality disorder, is now generally believed to have its genesis in 'schizophrenogenic mothers.'(Cauwels, J.M.: 1992, 'Imbroglio: Rising to the Challenges of Borderline Personality Disorder' W.W. Norton & Company.). Often, this can arise from incest- or some other form of emotional or physical abuse.
Some markers and indicators (op. cit.) include:
i) Borderlines tend to have significant sexual difficulties (p. 62)
ii) Borderlines crave attention.
iii) From 25% to 65% of borderlines have suffered separations from a parent, generally in preschool or adolescent years (p. 233)
iv) Families of BPDs tend to be isolated and self-contained. Thus borderlines have no external families by which to gauge the pathology of their own. (p. 235)
v) Borderline adolescent males tend to aggressively act out their impulses. These can include bouts of hyperactivity, stealing, truancy etc. (p. 144).
As far as we know, none of the above apply to Holmes. Further, all the evidence is that - as with most submergents - Holmes avoided conflicts whenever he could. He lacked the confidence or basic ego mastery to even challenge teasing, as one former schoolmate related on yesterday evening's news (ABC). He noted that even as Holmes was repeatedly teased the only response was a soft smile and maybe a cackle or laugh but no effort to muster a retort. A borderline personality would have no such hesitation.
Kutash and Greenberg also observe (p. 38):
"The borderline is intensely emotional, unstable, and unpredictable in responses. The submerged personality is usually predictable.....especially with regard to ambivalence (see previous blog), and paranoidal and sadomasochistic reactions.
While ambivalence is also seen in the borderline, it is less focused or centered. This is due to their etiologies being different. That is, the borderline has a damaged, split ego, the submerged individual has a submerged ego with two controlling pseudo-egos. Medication and hospitalization are often indicated in the borderline, this is not true of the submerged patient."
Q. I have read in today's paper that the police say there were no Batman comics or evidence of Batman infatuation in the guy's apartment. So they are saying there is no real connection to the Joker. What say you?
A. I say, or ask, how much psychology have the cops studied? How much research have they done? As much as me? I doubt it. The fact remains that the import of the "Joker" persona is NOT one of any comic or Comicon affiliation, or superhero heritage or even assimilation. It is rather, the choice of a pseudo-ego or rebellious counter ego to the dominating parental-mother ego that sucked this guy's life and psychic energy away. For whatever reason, Holmes elected to pick the "Joker" as the tag for this pseudo-ego and made that identification when he opened fire in the theater.
In doing so, he was not announcing any comic book affiliations or even knowledge (other than in a transitory and utilitarian way) but rather a choice for his aggressive, acting out pseudo-ego, the rebellious front man that wasn't taking any more shit from any dominant authorities or from anyone, period.
This was, in effect, the manifestation of the psychic embolism (created by the tension between the two pseudo egos) that erupted after years or decades of "compulsively accommodating to the needs of others" (p. 99, Wolf and Kutash) and the abiding "fear of not having the uniqueness of his authentic ego, even in its most naive grandiosity" to be valued. BUT ...the "Joker" and his actions would be valued if only negatively! I suspect the "Joker" persona had first been incepted when Holmes was faced with a lifetime working in the service industry - then it was kept on the psychological back burner should that ominous future ever be confronted again.
I suspect in this regard the "Joker" was hatched, at least in a rudimentary form, after Holmes received the shock of his young life on learning that - even after graduating with honors from UC Riverside in Neuroscience- the best job on offer was burger flipping at Mickey Ds! What a putdown! What humiliation! Well, Holmes temporarily salvaged the situation (and postponed release of the Joker) by finding an 'in' at the Univ. of Colorado, where he could pursue a Ph.D. and at least had the chance at a respectable future in neuroscience research. But it was not to be. While he skated through the baccalaureate work he met his match at the Ph.D. level.
Within a year he found himself on academic probation at the University of Colorado-Anchustz campus. He had "academic problems" according to campus spokewoman Jackie Brinkman. Maybe he failed all his first year tests, maye he bombed out in a preliminary research paper or a practice comp, or may he blew a seminar (which apparently he gave in May on RNA -related neurological markers). It doesn't matter what the immediate or specific source of failure was, the end result is that his grandiose self-concept now faced the imminent prospect of burger flipping . No Ph.D, no postdocs, leaving Colorado in disgrace...Mickey D here we come....or wait!
Time to release the "Joker"! In other words, the failure triggered the release of the aggressive pseudo self since the capacity for true creative work was denied him by the need for submergence of his authentic self - where the energy, insight and true intelligence resided to succeed. He could muddle by with this self submerged at lower levels, but not at this Ph.D. level.
More to come tomorrow.
Sunday, July 22, 2012
Saturday, July 21, 2012
Deconstruction of a Psycho: James Holmes
On gathering more of the back story on James Holmes, the psycho who killed 12 people at an Aurora CO movie theater and wounded 58 others, we find these markers:
- He was socially aversive, pathologically shy – according to a lab partner in Colo: Holmes’s “disposition was a little off” and that he could be socially awkward, one of the quieter people in the lab. He "spent much of his time immersed in his computer”
- He had some ideations of grandiosity as after he graduated from UC Riverside with Honors but learned the only job he could get was at a McDonalds
- He was accepted in the Fall of 2011 at a Univ. of Colorado campus (Anshutz, in Aurora) to do a Ph. D. in neuroscience.
- He dropped out in June because of reported “academic problems” (according to Jackie Brinkman, a spokesperson for the campus quoted in today’s NY Times)
- After dropping out, he purchased his weapons, and played violent video games in his apt.
- He adopted a rebellious persona which he called “the Joker” and had become this persona when he entered the Aurora theater to kill 12 and wound 58.
- His rigged apartment was designed to obliterate all traces of the persona he rejected.
I puzzled over this set of behaviors for some time, weighing whether the guy’s profile more fit in with a schizoid or schizotypal personality disorder. After some further rumination it clicked that here was a classic case of submerged personality disorder – so well explicated in the excellent book: ‘Psychotherapy of the Submerged Personality’ by Alexander Wolf and Irwin L. Kutash. As they observe, submergence is characterized by the development of two pseudo-egos in conflict with each other and the submergence or suppression of an intact ego called “the submerged ego”.
The “submerged ego” is the authentic one, which if allowed to come out would be consistent with the individual’s aspirations, goals and personality. It becomes submerged when a child’s behaviors and personality are greeted with tremendous hostility and rejection (as well as punishment) by a parent, usually the mother. The little one is then bereft of his moorings, parental love and acceptance until and unless he discharges the unwanted (by the parent) Self. Hence, to receive the desperately needed approval he must become an appendage of the parent, by introjecting her values, behaviors, priorities and even demeanor.
In the Wolf-Kutash anthology, Michael Lindenmann (p. 96, 'Identifying the Defensive Pseudo-Ego maneuvers in Psychotherapy') notes: "Throughout their lives these individuals will have been most consistently rewarded for what they know or for what they can do- for thinking and acting, but not much for feeling. They will have learned most to rely on their ability to reach intellectual or active solutions to their life problems with little consideration given to emotional needs or subjective reactions. Out of a profound fear of loss of connection with the mothering object, much attentive energy will have been focused on the wishes and reactions of others and away from oneself." And (ibid.):
"As a consequence, these individuals may act as though they do not really know how to be IN life" (emphasis mine). "There will be difficulties with assertiveness, confrontation, or the ability to express such feeling as anger or criticism. ....for all in all, repressing the authentic ego and accommodating to the mothering object, these individuals have become quite accustomed to setting their own emotional reactions aside and dissociating from their own authentic needs."
Lindenmann goes on to observe (p. 97): that "with the authentic ego repressed, developmentally stymied and unavailable for rich and authentic experience, these individuals will often report feeling cheated by life".
This feeling of being "cheated" is a natural accompaniment of the individual's loss of psychic energy via introjecting his or her mother's paranoid, narcissistic or depressive demands. While he thereby forms a defensive, maternal pseudo-ego it comes by way of enormous psychological cost. Following this, the submerged personality must invest more energy into a second pseudo-ego whose purpose is to protect the submerged ego and oppose the maternal pseudo-ego. This oppositional pseudo-ego is called "the rebellious pseudo-ego". The individual with a submerged personality then displays ongoing ambivalence between compliance with the mother (or other dominating parent) and rebellion against her.(Note: the rebellious pseudo-ego gives the illusion of finally having found real outlets for authentic aggression, emotion....but in reality it's a confection. The responses are nearly always out of proportion to the actual stimuli.)
Leaving home doesn’t necessarily liberate the personality from the control or domination of the introjected parental ego. Indeed, any authority – say a school administration or even a therapist thererin – may subsume this maternal ego in the submergent personality’s mind. Thus, I conjecture that Holmes, while in Colorado, perceived the university administration (and likely even his advisor) as coupled with the introjected ego. The “second pseudo ego” created to defend and protect his submerged ego was none other than “the Joker”.
Tragically, by the time Holmes’ protector ego (“Joker”) was released, it was out of control. Everyone then became identified with the introjected parental or authority ego. The warped perception of the defender ego then decided the only way to achieve liberation from the introjected “parent” was to eliminate all who were seen as in its way. In this case, all “normal”, i.e. non-submerged people. Those whose personalities had not been coerced into psychological lockdown and submergence by a dominating parent. An alternate possibility, perhaps more convincing, is that the retributional "Joker" persona felt outraged and murderously envious of those normal folk (say in socialized units present at the theater) who were not developmentally stymied and hence whose lives were available for rich and authentic experience.
Why would the Ph.D. level have been the one that finally triggered release of Holmes’ Joker? Good question! My belief is that Holmes, lacking an authentic personality, was unable to deal with the extraordinary research demands at the Ph.D. level which necessitate originality. I mean, even if the thesis advisor offers you a thesis subject, you still must have the ability to carry out an original theory! It’s not simply like piling up As and making “honors” at lower levels. No real originality is needed to make the "Dean's List", after all. Even brilliance, so-called, doesn't assure originality at a high research level! (Aside: we now know from a Denver 7 News report by Keli Rabon that Holmes failed a preliminary oral exam before pulling out of the neurosciences program at Colorado University. A day later he purchased his most lethal weapon, the Smith and Wesson MP15. )
The problem is that a submerged personality, because it is suppressed, will not be able to display the originality needed for ground-breaking research in the field. If it had a scintilla of originality potential, it wouldn’t be submerged and permit an introjected ego to occupy its psychological space! In Holmes’ submerged ego’s perceptions, he’d have been exposed as a fraud, cover blown. When it really counted, to do original research, he couldn’t cut the mustard. The interior or submerged ego was still hostage to parental demands and could find no way out.
We know from a recent survey (by the DSM-V background research group) that up to 26% of those over age 21 are described as “mentally ill” in this country. Even leaving out depression (10%) that leaves 16% or 1 in 6 with other serious disorders. Given there’s no way all of these millions can be locked up or effectively controlled (especially if they go off any meds), the only alternative is to find a way to regulate gun ownership via rigorous laws. Then it becomes less likely any of the outright misfits (like Jared Loughner, Seung Hui-Cho or James Eagen Holmes) will get hold of high capacity automatic weapons to effect mass murders!
Our two presidential candidates, in addition to calling for "prayers and condolences", need to do something even more effective: release their balls from the grip of the NRA gun lobby, so they can then USE those cojones to push for effective legislation to control automatic weapons and mega-capacity clips! Then maybe so many occasions for offering prayers and condolences wouldn't be necessary since our glorious leaders would be addressing the problem at its core....as opposed to offering symbolic pap which merely enables the cycle to continue!
- He was socially aversive, pathologically shy – according to a lab partner in Colo: Holmes’s “disposition was a little off” and that he could be socially awkward, one of the quieter people in the lab. He "spent much of his time immersed in his computer”
- He had some ideations of grandiosity as after he graduated from UC Riverside with Honors but learned the only job he could get was at a McDonalds
- He was accepted in the Fall of 2011 at a Univ. of Colorado campus (Anshutz, in Aurora) to do a Ph. D. in neuroscience.
- He dropped out in June because of reported “academic problems” (according to Jackie Brinkman, a spokesperson for the campus quoted in today’s NY Times)
- After dropping out, he purchased his weapons, and played violent video games in his apt.
- He adopted a rebellious persona which he called “the Joker” and had become this persona when he entered the Aurora theater to kill 12 and wound 58.
- His rigged apartment was designed to obliterate all traces of the persona he rejected.
I puzzled over this set of behaviors for some time, weighing whether the guy’s profile more fit in with a schizoid or schizotypal personality disorder. After some further rumination it clicked that here was a classic case of submerged personality disorder – so well explicated in the excellent book: ‘Psychotherapy of the Submerged Personality’ by Alexander Wolf and Irwin L. Kutash. As they observe, submergence is characterized by the development of two pseudo-egos in conflict with each other and the submergence or suppression of an intact ego called “the submerged ego”.
The “submerged ego” is the authentic one, which if allowed to come out would be consistent with the individual’s aspirations, goals and personality. It becomes submerged when a child’s behaviors and personality are greeted with tremendous hostility and rejection (as well as punishment) by a parent, usually the mother. The little one is then bereft of his moorings, parental love and acceptance until and unless he discharges the unwanted (by the parent) Self. Hence, to receive the desperately needed approval he must become an appendage of the parent, by introjecting her values, behaviors, priorities and even demeanor.
In the Wolf-Kutash anthology, Michael Lindenmann (p. 96, 'Identifying the Defensive Pseudo-Ego maneuvers in Psychotherapy') notes: "Throughout their lives these individuals will have been most consistently rewarded for what they know or for what they can do- for thinking and acting, but not much for feeling. They will have learned most to rely on their ability to reach intellectual or active solutions to their life problems with little consideration given to emotional needs or subjective reactions. Out of a profound fear of loss of connection with the mothering object, much attentive energy will have been focused on the wishes and reactions of others and away from oneself." And (ibid.):
"As a consequence, these individuals may act as though they do not really know how to be IN life" (emphasis mine). "There will be difficulties with assertiveness, confrontation, or the ability to express such feeling as anger or criticism. ....for all in all, repressing the authentic ego and accommodating to the mothering object, these individuals have become quite accustomed to setting their own emotional reactions aside and dissociating from their own authentic needs."
Lindenmann goes on to observe (p. 97): that "with the authentic ego repressed, developmentally stymied and unavailable for rich and authentic experience, these individuals will often report feeling cheated by life".
This feeling of being "cheated" is a natural accompaniment of the individual's loss of psychic energy via introjecting his or her mother's paranoid, narcissistic or depressive demands. While he thereby forms a defensive, maternal pseudo-ego it comes by way of enormous psychological cost. Following this, the submerged personality must invest more energy into a second pseudo-ego whose purpose is to protect the submerged ego and oppose the maternal pseudo-ego. This oppositional pseudo-ego is called "the rebellious pseudo-ego". The individual with a submerged personality then displays ongoing ambivalence between compliance with the mother (or other dominating parent) and rebellion against her.(Note: the rebellious pseudo-ego gives the illusion of finally having found real outlets for authentic aggression, emotion....but in reality it's a confection. The responses are nearly always out of proportion to the actual stimuli.)
Leaving home doesn’t necessarily liberate the personality from the control or domination of the introjected parental ego. Indeed, any authority – say a school administration or even a therapist thererin – may subsume this maternal ego in the submergent personality’s mind. Thus, I conjecture that Holmes, while in Colorado, perceived the university administration (and likely even his advisor) as coupled with the introjected ego. The “second pseudo ego” created to defend and protect his submerged ego was none other than “the Joker”.
Tragically, by the time Holmes’ protector ego (“Joker”) was released, it was out of control. Everyone then became identified with the introjected parental or authority ego. The warped perception of the defender ego then decided the only way to achieve liberation from the introjected “parent” was to eliminate all who were seen as in its way. In this case, all “normal”, i.e. non-submerged people. Those whose personalities had not been coerced into psychological lockdown and submergence by a dominating parent. An alternate possibility, perhaps more convincing, is that the retributional "Joker" persona felt outraged and murderously envious of those normal folk (say in socialized units present at the theater) who were not developmentally stymied and hence whose lives were available for rich and authentic experience.
Why would the Ph.D. level have been the one that finally triggered release of Holmes’ Joker? Good question! My belief is that Holmes, lacking an authentic personality, was unable to deal with the extraordinary research demands at the Ph.D. level which necessitate originality. I mean, even if the thesis advisor offers you a thesis subject, you still must have the ability to carry out an original theory! It’s not simply like piling up As and making “honors” at lower levels. No real originality is needed to make the "Dean's List", after all. Even brilliance, so-called, doesn't assure originality at a high research level! (Aside: we now know from a Denver 7 News report by Keli Rabon that Holmes failed a preliminary oral exam before pulling out of the neurosciences program at Colorado University. A day later he purchased his most lethal weapon, the Smith and Wesson MP15. )
The problem is that a submerged personality, because it is suppressed, will not be able to display the originality needed for ground-breaking research in the field. If it had a scintilla of originality potential, it wouldn’t be submerged and permit an introjected ego to occupy its psychological space! In Holmes’ submerged ego’s perceptions, he’d have been exposed as a fraud, cover blown. When it really counted, to do original research, he couldn’t cut the mustard. The interior or submerged ego was still hostage to parental demands and could find no way out.
We know from a recent survey (by the DSM-V background research group) that up to 26% of those over age 21 are described as “mentally ill” in this country. Even leaving out depression (10%) that leaves 16% or 1 in 6 with other serious disorders. Given there’s no way all of these millions can be locked up or effectively controlled (especially if they go off any meds), the only alternative is to find a way to regulate gun ownership via rigorous laws. Then it becomes less likely any of the outright misfits (like Jared Loughner, Seung Hui-Cho or James Eagen Holmes) will get hold of high capacity automatic weapons to effect mass murders!
Our two presidential candidates, in addition to calling for "prayers and condolences", need to do something even more effective: release their balls from the grip of the NRA gun lobby, so they can then USE those cojones to push for effective legislation to control automatic weapons and mega-capacity clips! Then maybe so many occasions for offering prayers and condolences wouldn't be necessary since our glorious leaders would be addressing the problem at its core....as opposed to offering symbolic pap which merely enables the cycle to continue!
Friday, July 20, 2012
Time to Reel in the U.S. A. Gun Culture Zealots
The horrific tragedy in Aurora, Colorado this morning, leaving at least 12 dead and 58 wounded, stands beyond belief in the annals of state mayhem. Hundreds of people throng joyously into an Aurora Century 16 cinema, to see the midnight premier of 'The Dark Night Rises' only to be greeted by gunfire 25 minutes into the film. The shooter, evidently armed with two large (0.40 cal) Glock automatic handguns, and a Smith and Wesson MP15 assault rifle, mowed down fleeing theater goers at will, as blood spattered all over the cinema floor. Many of those who survived did so not by fleeing (because the shooter waited for victims to bolt to the exit), but by lying low or playing dead between the seats.
We have seen such scenes play out before, as with the April, 1999 Columbine massacre at Columbine High School in Littleton, barely 20 miles down the highway from Aurora. In the wake of that tragedy in which 12 were killed and more than a dozen injured, there emerged a faint hope that once and for all the zealots of U.S. gun culture would be brought to heel. But it was a mirage. Quickly, the NRA called its main meeting in Denver, featuring spokesman Charlton Heston who gave his usual full-throated cry: "You can pry this gun from my cold, dead hands!"
Then there was the Virginia Tech massacre, and again a hope emerged to contain the zany zealots of gun culture, but nothing was done. The NRA lobby once more exercised its powerful influence on our lawmakers, but as usual they capitulated. It doesn't take a lot to capitulate, even a passive failure to veto an onerous piece of legislation that promotes gun insanity. Case in point, the 2009 credit card bill (which reined in interest rates and fees) but for which a "rider" amendment was attached by the Repugs allowing people to carry weapons into National Parks. By all rights this perfidy ought to have been forthwith vetoed by Obama, but it was signed into law. An opportunity to send a message to the insane gun zealots had passed, message not received. Bring whatever guns you want, into National Parks! We believe in "the Second Amendment"! Horse manure!
Given such wimpishness in facing the gun lobby and its defenders it's little wonder we stand out as having so many massacres, such as Columbine, Virginia Tech and now Aurora. It is evident that we are a nation that treats gun ownership, and by that I mean any kind, as more important than the lives of citizens. This perhaps is no surprise. Of all the nations on Earth, ours is the most lax in providing protection for citizen information, privacy. No wonder then we yearly suffer from a plague of not only identify theft, but serious incursions into our information and files. We don't even see a problem with the NSA setting up a monster 2 million square foot spy -atorium in Utah to spy on everything from Twitter messages, to cell phone texts to ....you name it. Hey, it's "national security'"! In our best interests! If we don't protect citizens at this basic level, why protect their life and limbs from insane gun- toting nuts? Bottom line: our politicos are more worried about "politics" and how it'll play in Peoria, or Pensacola...than the national welfare.
Then, no surprise at the spate of record -setting wacko gun legislation in individual states, such as we beheld in Florida- implementing a reckless law known as "Stand your ground". This nutso law basically confers the right of ultimate self protection (as in being judge, jury and executioner rolled into one) if a person feels or senses that his life is threatened. On this basis, we then beheld George Zimmerman acting "pre-emptively" to neutralize a vague threat that had become entrenched in his sense perceptions - triggering the fear circuits in his amygdala.
Zimmerman encountered Trayvon Martin (a young black kid in a hoodie) passing through his gated Sanford, FL neighborhood - and suddenly felt his life threatened. He insists Martin threatened to kill him by planting some blows on his head so he had to act, but then insists it was "God's plan" that he did so. (In an interview with Sean Hannity). Sorry, Georgie, but you don't get to invoke "God's plan " when you off somebody!
Now, think of laws like this all over the nation (we also have one in Colorado called "Make my Day" after the famous catch phrase in the first 'Dirty Harry' flick - where you can shoot and kill anyone entering or already inside your home if you believe he poses a threat to your life) and the inevitable results. Those include the perception that retribution is only a carry permit away.
My point is that the ease with which extremist gun culture is dignified by legislation, makes it feasible that gun use is legitimized in the public square. Add then one more ingredient: a wacko with grudges galore - maybe against his wife or girlfriend, maybe against a thesis advisor or boss, or perhaps against his peers....or even against life....and you have the formula for mass tragedy as beheld at Columbine, High School, at Virginia Tech and now at Aurora.
We still don't know what the Aurora shooter (James Holmes) back story is - other than he was supposedly pursuing a Ph.D. in neuroscience (if you can believe it), but we know the Columbine killers - Eric Harris and Dylan Kliebold- had grievances saved up for two years against the entrenched "jock culture" at Columbine, and also against the students (mainly girls) who adored it, fawned over it. In their televised diary Harris and Kliebold frothed at the mouth at what they intended to do, and the vengeance they'd wreak against jocks and jock lovers. They were as good as their word.
The Virginia Tech killer, Seung -Hui Cho, who killed 32, had a similar laundry list of grievances against those who bullied him. Add to that a serious mental instability and purchasing a Glock 19 and Walther P22 with the ease of buying chocolate bars, and you had the formula for massacre. The refrain heard by the NRA puppets in the wake was the usual one: "Guns Don't Kill People! People Kill People!" Yeah - nice try, but the part left out is that guns kill people more efficiently when used by people to kill other people.
If Harris, Kliebold or Cho had been limited to large knives, they'd never have wrought so MUCH carnage. Maybe five at most would have been killed before the perps were taken down. It was the availability of the automatic or semi-automatic weapons that conferred the massive kill numbers and kill -to-wounded ratio. Ditto in the case of the Century 16 slaughter.
And no, once more I am not an anti-gun lib. I have owned and used rifles and fired off shotguns as well in target practice. However, I've never owned anything automatic, with multicapacity clips!
I am not for banning all guns, but for regulating the use and magazine capacity to a rational standard. In other words, IF you really are a hunter, you don't require an AK-47 or an UZI! A true hunter, out for deer say, can get by very nicely with a good, old -fashioned Remington 30.06, the tried and true standard. If you need a weapon for protection, you do not need a Glock 9 or a Glock 19, you can get a .38 revolver and with enough shooting practice be just fine.
In other words, I am arguing for rational standards on gun ownership, not anything goes. I argue by similar analogy for rational pet ownership. No, you ought not be able to own as many jaguars, anacondas, Burmese pythons, or tigers as your little heart desires! THAT is irrational, and moreover those WILD animals can't be contained properly in captivity. That is also why so many pythons (estimated at 30,000) have now made their home in the Florida Everglades, not to mention hundreds of monitor lizards, because pet owners couldn't control them once they grew too large, or too feisty. (I won't even go into the character in Colo. whose pet python ate him several years ago, while he was sleeping with the snake in his queen bed.) Now, the "liberated" -by- owners pythons are upsetting the whole ecology of the glades.
In the same way, zealot gun crazies have upset rational gun ownership "ecology" and culture in this country by their extreme demands and desires. They make the rest of us appear also like crazies, because of their inordinate demands for weapons which do not fit any normal use for citizens.
Until our legislators finally get some balls, as opposed to kowtowing to the NRA and kissing their butts, we can expect to see more tragedies like today's here in Colorado. And that is a damned tragedy!
We have seen such scenes play out before, as with the April, 1999 Columbine massacre at Columbine High School in Littleton, barely 20 miles down the highway from Aurora. In the wake of that tragedy in which 12 were killed and more than a dozen injured, there emerged a faint hope that once and for all the zealots of U.S. gun culture would be brought to heel. But it was a mirage. Quickly, the NRA called its main meeting in Denver, featuring spokesman Charlton Heston who gave his usual full-throated cry: "You can pry this gun from my cold, dead hands!"
Then there was the Virginia Tech massacre, and again a hope emerged to contain the zany zealots of gun culture, but nothing was done. The NRA lobby once more exercised its powerful influence on our lawmakers, but as usual they capitulated. It doesn't take a lot to capitulate, even a passive failure to veto an onerous piece of legislation that promotes gun insanity. Case in point, the 2009 credit card bill (which reined in interest rates and fees) but for which a "rider" amendment was attached by the Repugs allowing people to carry weapons into National Parks. By all rights this perfidy ought to have been forthwith vetoed by Obama, but it was signed into law. An opportunity to send a message to the insane gun zealots had passed, message not received. Bring whatever guns you want, into National Parks! We believe in "the Second Amendment"! Horse manure!
Given such wimpishness in facing the gun lobby and its defenders it's little wonder we stand out as having so many massacres, such as Columbine, Virginia Tech and now Aurora. It is evident that we are a nation that treats gun ownership, and by that I mean any kind, as more important than the lives of citizens. This perhaps is no surprise. Of all the nations on Earth, ours is the most lax in providing protection for citizen information, privacy. No wonder then we yearly suffer from a plague of not only identify theft, but serious incursions into our information and files. We don't even see a problem with the NSA setting up a monster 2 million square foot spy -atorium in Utah to spy on everything from Twitter messages, to cell phone texts to ....you name it. Hey, it's "national security'"! In our best interests! If we don't protect citizens at this basic level, why protect their life and limbs from insane gun- toting nuts? Bottom line: our politicos are more worried about "politics" and how it'll play in Peoria, or Pensacola...than the national welfare.
Then, no surprise at the spate of record -setting wacko gun legislation in individual states, such as we beheld in Florida- implementing a reckless law known as "Stand your ground". This nutso law basically confers the right of ultimate self protection (as in being judge, jury and executioner rolled into one) if a person feels or senses that his life is threatened. On this basis, we then beheld George Zimmerman acting "pre-emptively" to neutralize a vague threat that had become entrenched in his sense perceptions - triggering the fear circuits in his amygdala.
Zimmerman encountered Trayvon Martin (a young black kid in a hoodie) passing through his gated Sanford, FL neighborhood - and suddenly felt his life threatened. He insists Martin threatened to kill him by planting some blows on his head so he had to act, but then insists it was "God's plan" that he did so. (In an interview with Sean Hannity). Sorry, Georgie, but you don't get to invoke "God's plan " when you off somebody!
Now, think of laws like this all over the nation (we also have one in Colorado called "Make my Day" after the famous catch phrase in the first 'Dirty Harry' flick - where you can shoot and kill anyone entering or already inside your home if you believe he poses a threat to your life) and the inevitable results. Those include the perception that retribution is only a carry permit away.
My point is that the ease with which extremist gun culture is dignified by legislation, makes it feasible that gun use is legitimized in the public square. Add then one more ingredient: a wacko with grudges galore - maybe against his wife or girlfriend, maybe against a thesis advisor or boss, or perhaps against his peers....or even against life....and you have the formula for mass tragedy as beheld at Columbine, High School, at Virginia Tech and now at Aurora.
We still don't know what the Aurora shooter (James Holmes) back story is - other than he was supposedly pursuing a Ph.D. in neuroscience (if you can believe it), but we know the Columbine killers - Eric Harris and Dylan Kliebold- had grievances saved up for two years against the entrenched "jock culture" at Columbine, and also against the students (mainly girls) who adored it, fawned over it. In their televised diary Harris and Kliebold frothed at the mouth at what they intended to do, and the vengeance they'd wreak against jocks and jock lovers. They were as good as their word.
The Virginia Tech killer, Seung -Hui Cho, who killed 32, had a similar laundry list of grievances against those who bullied him. Add to that a serious mental instability and purchasing a Glock 19 and Walther P22 with the ease of buying chocolate bars, and you had the formula for massacre. The refrain heard by the NRA puppets in the wake was the usual one: "Guns Don't Kill People! People Kill People!" Yeah - nice try, but the part left out is that guns kill people more efficiently when used by people to kill other people.
If Harris, Kliebold or Cho had been limited to large knives, they'd never have wrought so MUCH carnage. Maybe five at most would have been killed before the perps were taken down. It was the availability of the automatic or semi-automatic weapons that conferred the massive kill numbers and kill -to-wounded ratio. Ditto in the case of the Century 16 slaughter.
And no, once more I am not an anti-gun lib. I have owned and used rifles and fired off shotguns as well in target practice. However, I've never owned anything automatic, with multicapacity clips!
I am not for banning all guns, but for regulating the use and magazine capacity to a rational standard. In other words, IF you really are a hunter, you don't require an AK-47 or an UZI! A true hunter, out for deer say, can get by very nicely with a good, old -fashioned Remington 30.06, the tried and true standard. If you need a weapon for protection, you do not need a Glock 9 or a Glock 19, you can get a .38 revolver and with enough shooting practice be just fine.
In other words, I am arguing for rational standards on gun ownership, not anything goes. I argue by similar analogy for rational pet ownership. No, you ought not be able to own as many jaguars, anacondas, Burmese pythons, or tigers as your little heart desires! THAT is irrational, and moreover those WILD animals can't be contained properly in captivity. That is also why so many pythons (estimated at 30,000) have now made their home in the Florida Everglades, not to mention hundreds of monitor lizards, because pet owners couldn't control them once they grew too large, or too feisty. (I won't even go into the character in Colo. whose pet python ate him several years ago, while he was sleeping with the snake in his queen bed.) Now, the "liberated" -by- owners pythons are upsetting the whole ecology of the glades.
In the same way, zealot gun crazies have upset rational gun ownership "ecology" and culture in this country by their extreme demands and desires. They make the rest of us appear also like crazies, because of their inordinate demands for weapons which do not fit any normal use for citizens.
Until our legislators finally get some balls, as opposed to kowtowing to the NRA and kissing their butts, we can expect to see more tragedies like today's here in Colorado. And that is a damned tragedy!
Thursday, July 19, 2012
Notes on a Prostate Biopsy: Don’t Fear and Don’t Hyper Google!
One thing I’ve come away with after the biopsy yesterday is that if you’re faced with any significant medical procedure it’s best not to google yourself silly! At work already is the selective attention to ferret out negatives – and these are bound to pop up in spades- then they get magnified out of proportion. This is no less true of prostate biopsies than many other interventions.
The fact is that more than 900,000 men: your fathers, brothers, cousins, uncles.....will be faced with this same procedure this year, after being advised by their primary care physicians that it is indicated, most likely by rising PSA levels (mine doubled in one year). Never mind that eventually 75% of these biopsies turn out to be negative, right now they're the only thing that- given adverse indicators - may spare a guy from a gruesome end. I.e. if cancer IS present and “breaks out of the capsule”, to use the phrase of oncologists. (One thing that pushed me to getting it done even after I hesitated following the free PSA test was my wife’s description of her uncle’s final days in the throes of prostate cancer, after it had metastasized and spread to his bones, lungs, liver, etc.)
So on that basis I want to provide these notes in the belief that other guys, faced with a similar procedure, can take heart. My mistake, in the wake of accepting the need to get it done, was going nuts by compulsively googling and working myself into a fretful lather. If you must google , keep it under control: bring up two pages at most, and don’t be selective by focusing on only the worst case descriptions. Oh, and don’t google “prep enemas for prostate biopsy” either! (I made the mistake of doing that and learned about Fleet enema complications that I’d prefer to forget)
Now, some notes on what happened, which is another big reason I chose not to sedate. You can recall everything that goes on if you are fully conscious:
- ON arriving at the office, Urological Associates, I had to supply my consent form acknowledging risks, then make a trip to the restroom to supply a urine sample. This is done to ensure there’s no urinary infection in which case the procedure would be called off.
After waiting about twenty minutes, it was ‘showtime’ and they said my wife could accompany me if she wanted. As a retired medical professional (radiotherapy) this was her cup of tea as she would get to watch the ultrasound imaging screen as the procedure was carried out. Much less boring than sitting in a humdrum waiting room and reading page-curled magazines!
After undressing (you get to leave socks on) I got on a table and had to lie on my left side, with knees toward the chest. A surgical cover was placed over me, open at the back. First step was application of a numbing gel and shot of lidocaine. The pain was roughly equal to that from a dental injection on your gum before they start to drill. Probably less. After the lidocaine, I was given a few minutes respite before the ultrasound transducer was inserted and sound waves bounced off the prostate gland to get its mass, density, size. Nothing abnormal was detected in the imaging, though the technician did state that he was somewhat concerned that my PSA levels were so large for a prostate mass of about 36 g.
The ultrasound device was then removed and there was another 5-8 minute respite before the physician assistant was to arrive and perform a 12 -extraction needle biopsy. I talked with my wife during this interlude and she admitted she was shocked at the size of the needle used to administer the lidocaine. She asked if it hurt and I said ‘Only a bit’.
I don’t know exactly what I expected when I heard the knock on the door and knew it was the physician assistant. I suppose I expected someone older in lab whites. Therefore I was surprised to behold a young, blonde woman of about 30 in black pants suit. She smiled broadly – in a welcoming way – and shook my hand, telling me her name was “Jen” and she would be doing my biopsy. I began to worry about possible inexperience, but quickly got that under control as I reasoned she wouldn’t be doing this if she wasn’t trained extremely well. So, get over it! Also, that an attractive young woman was doing it!
Meanwhile, my wife was mesmerized by Jen's apparatus- the needle firing ‘gun’ - which was brought out after she donned her latex gloves. My wife observed intently as Jen loaded the needle for each extraction then re-secured it before each subsequent ‘hit’ ( I couldn’t see a damned thing. All the action was unfolding to my rear, and all I could see was a wall. )
I had some discomfort as the ultrasound probe (through which the needle to be delivered) was re-introduced. Jen told me that the greatest pain would be from the first hit, and it ought to die down somewhat after that. She advised me to take several long, slow, deep breaths and she’d alert me to when the first needle would strike. I waited, trying to stay calm and kept breathing long, deep breaths. Jen told me to inhale deeply as the first hit was on its way ……
When it arrived I gasped and my wife said later I yelped “AIEE!” Truthfully, the first thought was that I'd maybe made an error by not going for sedation after all. The needle sting (it penetrates the rectum wall) was maybe comparable to a large red ant’s on a sensitive area but even worse was the accompanying sharp, burning pain extending all the way from base to tip of penis. It was as if the urethra had briefly filled with acid. I commented on this, and related to Jen how it felt and also that there was a powerful feeling of almost imminent urination.
Jen explained that the penile sensation was "referred pain", i.e. from nerve associations and she had me take several more deep breaths. She told me I might “leak” (urine) but assured me the burning feeling in the penis would abate. She allowed me several more minutes to recover while doing deep breathing, obviously she’d witnessed this effect many times before. Finally, she asked me if I was ready for the second strike. In a hesitant voice, I replied, “I think so!” She advised to take a long, deep breath, then exhale.....
That next hit of the needle was nowhere as bad as the first, and as she promised, the pain ebbed with each subsequent strike. Maybe the lidocaine was finally working! 10 more strikes followed, and I was grateful it was over, but appreciative of the professional PA . After Jen detached the needle from the gun and removed the last tissue sample, carefully labeling it, she shook my hand and told me she hoped the results would be good. I thanked her and began to get up, but had to be helped. I surmised I was experiencing some mild dizziness from the antibiotic taken about an hour and half earlier (the bottle label declared, ‘may cause dizziness, do not drive or operate machinery’)
Thankfully, by the time I got dressed, the burning sensation had abated as well as the overpowering urge to urinate. I was advised to take it easy for at least the first 24-48 hours, and to expect blood in the urine for up to two weeks. Blood in the stool for up to a week, and blood in the semen from up to eight weeks. I was also told to call the office in case of fever or chills (denoting an infection) and also if there were any blood clots in the stools the “size of quarters”.
Needless to say, on my first post-procedure urination some two hours later, I was concerned at how much blood I’d see. Amazingly, there was nothing there…or at least none I could detect. This despite doing a no-no and popping a 1.2 grams Omega-3 capsule after breakfast, which I was told was a “blood thinner”. Who knew? I sure didn’t. You find something out every day. After a consult with my urologist, on whether I ought to be allowed to go forward with the procedure, the urologist gave a nod yes, so long as I’d remained off the aspirin for at least five days. I had.
My advice to other guys, is ‘go for it’. The procedure is nowhere as terrible as made out to be in a lot of the websites you likely will excavate from Google pages. The pain is tolerable and brief, and to me being aware of the experience is worth more than being clocked out like some zombie. Besides, if you’re in that state you won’t get to see the pretty physician assistant who may be doing the biopsy!
Now, it's a matter of waiting for the results. But I am already promising myself not to over-google potential treatments!
-----
Footnote: 1 day later. If there is any downside it's the bloody semen! I hadn't been prepared for it so was aghast at the sheer volume of blood on a first ejaculation after the procedure. (I forgot to mention that Jen had advised 'clearing out the blood' accumulated from the needle extractions as soon as possible.) I am hoping that I never see that much blood again! Still, don't let this scare you from getting a biopsy!
The fact is that more than 900,000 men: your fathers, brothers, cousins, uncles.....will be faced with this same procedure this year, after being advised by their primary care physicians that it is indicated, most likely by rising PSA levels (mine doubled in one year). Never mind that eventually 75% of these biopsies turn out to be negative, right now they're the only thing that- given adverse indicators - may spare a guy from a gruesome end. I.e. if cancer IS present and “breaks out of the capsule”, to use the phrase of oncologists. (One thing that pushed me to getting it done even after I hesitated following the free PSA test was my wife’s description of her uncle’s final days in the throes of prostate cancer, after it had metastasized and spread to his bones, lungs, liver, etc.)
So on that basis I want to provide these notes in the belief that other guys, faced with a similar procedure, can take heart. My mistake, in the wake of accepting the need to get it done, was going nuts by compulsively googling and working myself into a fretful lather. If you must google , keep it under control: bring up two pages at most, and don’t be selective by focusing on only the worst case descriptions. Oh, and don’t google “prep enemas for prostate biopsy” either! (I made the mistake of doing that and learned about Fleet enema complications that I’d prefer to forget)
Now, some notes on what happened, which is another big reason I chose not to sedate. You can recall everything that goes on if you are fully conscious:
- ON arriving at the office, Urological Associates, I had to supply my consent form acknowledging risks, then make a trip to the restroom to supply a urine sample. This is done to ensure there’s no urinary infection in which case the procedure would be called off.
After waiting about twenty minutes, it was ‘showtime’ and they said my wife could accompany me if she wanted. As a retired medical professional (radiotherapy) this was her cup of tea as she would get to watch the ultrasound imaging screen as the procedure was carried out. Much less boring than sitting in a humdrum waiting room and reading page-curled magazines!
After undressing (you get to leave socks on) I got on a table and had to lie on my left side, with knees toward the chest. A surgical cover was placed over me, open at the back. First step was application of a numbing gel and shot of lidocaine. The pain was roughly equal to that from a dental injection on your gum before they start to drill. Probably less. After the lidocaine, I was given a few minutes respite before the ultrasound transducer was inserted and sound waves bounced off the prostate gland to get its mass, density, size. Nothing abnormal was detected in the imaging, though the technician did state that he was somewhat concerned that my PSA levels were so large for a prostate mass of about 36 g.
The ultrasound device was then removed and there was another 5-8 minute respite before the physician assistant was to arrive and perform a 12 -extraction needle biopsy. I talked with my wife during this interlude and she admitted she was shocked at the size of the needle used to administer the lidocaine. She asked if it hurt and I said ‘Only a bit’.
I don’t know exactly what I expected when I heard the knock on the door and knew it was the physician assistant. I suppose I expected someone older in lab whites. Therefore I was surprised to behold a young, blonde woman of about 30 in black pants suit. She smiled broadly – in a welcoming way – and shook my hand, telling me her name was “Jen” and she would be doing my biopsy. I began to worry about possible inexperience, but quickly got that under control as I reasoned she wouldn’t be doing this if she wasn’t trained extremely well. So, get over it! Also, that an attractive young woman was doing it!
Meanwhile, my wife was mesmerized by Jen's apparatus- the needle firing ‘gun’ - which was brought out after she donned her latex gloves. My wife observed intently as Jen loaded the needle for each extraction then re-secured it before each subsequent ‘hit’ ( I couldn’t see a damned thing. All the action was unfolding to my rear, and all I could see was a wall. )
I had some discomfort as the ultrasound probe (through which the needle to be delivered) was re-introduced. Jen told me that the greatest pain would be from the first hit, and it ought to die down somewhat after that. She advised me to take several long, slow, deep breaths and she’d alert me to when the first needle would strike. I waited, trying to stay calm and kept breathing long, deep breaths. Jen told me to inhale deeply as the first hit was on its way ……
When it arrived I gasped and my wife said later I yelped “AIEE!” Truthfully, the first thought was that I'd maybe made an error by not going for sedation after all. The needle sting (it penetrates the rectum wall) was maybe comparable to a large red ant’s on a sensitive area but even worse was the accompanying sharp, burning pain extending all the way from base to tip of penis. It was as if the urethra had briefly filled with acid. I commented on this, and related to Jen how it felt and also that there was a powerful feeling of almost imminent urination.
Jen explained that the penile sensation was "referred pain", i.e. from nerve associations and she had me take several more deep breaths. She told me I might “leak” (urine) but assured me the burning feeling in the penis would abate. She allowed me several more minutes to recover while doing deep breathing, obviously she’d witnessed this effect many times before. Finally, she asked me if I was ready for the second strike. In a hesitant voice, I replied, “I think so!” She advised to take a long, deep breath, then exhale.....
That next hit of the needle was nowhere as bad as the first, and as she promised, the pain ebbed with each subsequent strike. Maybe the lidocaine was finally working! 10 more strikes followed, and I was grateful it was over, but appreciative of the professional PA . After Jen detached the needle from the gun and removed the last tissue sample, carefully labeling it, she shook my hand and told me she hoped the results would be good. I thanked her and began to get up, but had to be helped. I surmised I was experiencing some mild dizziness from the antibiotic taken about an hour and half earlier (the bottle label declared, ‘may cause dizziness, do not drive or operate machinery’)
Thankfully, by the time I got dressed, the burning sensation had abated as well as the overpowering urge to urinate. I was advised to take it easy for at least the first 24-48 hours, and to expect blood in the urine for up to two weeks. Blood in the stool for up to a week, and blood in the semen from up to eight weeks. I was also told to call the office in case of fever or chills (denoting an infection) and also if there were any blood clots in the stools the “size of quarters”.
Needless to say, on my first post-procedure urination some two hours later, I was concerned at how much blood I’d see. Amazingly, there was nothing there…or at least none I could detect. This despite doing a no-no and popping a 1.2 grams Omega-3 capsule after breakfast, which I was told was a “blood thinner”. Who knew? I sure didn’t. You find something out every day. After a consult with my urologist, on whether I ought to be allowed to go forward with the procedure, the urologist gave a nod yes, so long as I’d remained off the aspirin for at least five days. I had.
My advice to other guys, is ‘go for it’. The procedure is nowhere as terrible as made out to be in a lot of the websites you likely will excavate from Google pages. The pain is tolerable and brief, and to me being aware of the experience is worth more than being clocked out like some zombie. Besides, if you’re in that state you won’t get to see the pretty physician assistant who may be doing the biopsy!
Now, it's a matter of waiting for the results. But I am already promising myself not to over-google potential treatments!
-----
Footnote: 1 day later. If there is any downside it's the bloody semen! I hadn't been prepared for it so was aghast at the sheer volume of blood on a first ejaculation after the procedure. (I forgot to mention that Jen had advised 'clearing out the blood' accumulated from the needle extractions as soon as possible.) I am hoping that I never see that much blood again! Still, don't let this scare you from getting a biopsy!
Wednesday, July 18, 2012
Blogger Biopsy Blues
Well, as I am now about to begin preparations for the scheduled prostate biopsy in 4 odd hours, this will likely be the only blog for the day and possibly the next few days - depending on the aftermath, including pain, bleeding, pain meds etc. Obviously, if they prescribe Vicodin for the pain (can't take aspirin or any "blood thinners") I will likely be 'out for the count' for as many days as I'm on it. Hopefully not long as I don't want to get "hooked" on the stuff!
Some other updates for those interested:
- I have decided not to get any "sedation" on learning there is really no pain alleviation component involved. Ordinarily, e.g. as in a colonoscopy, fentanyl is incorporated to relieve pain, along with some versed for conscious sedation. In this case, they offer no fentanyl, only versed which is not an analgesic but an amnesia-genic. I.e. its prime function is to eliminate or remove memory of the experience. Not the pain. Having had a really bad experience before, in 1996, when only versed was employed in a colonoscopy, I have decided to forego it and just have the lidocaine (injection). Maybe this is a mistake, but we will see! (In the first blog I am able to do after this procedure I'll share my findings for others)
- The urologist I went to see a week ago is not the person who will perform the procedure, but rather a physician assistant who's been trained under his supervision. It appears now that since the constellation of trained professional urologists fell off the cliff (dropping something like 40%) back in the 1990s, more manpower (woman power?) has been called up to take up the demand. (Nearly all physician assistants are female). You can find out more on this issue from an abstract for a paper scheduled to be presented at a conference in October:
http://meeting.maaua.org/abstracts/2012/P21.cgi
In addition, the fact that now a preponderance of urological patients arrive from Medicare (nearly 60%) has dissuaded many from entering the specialty field. Not enough money! Hence, physician assistants have stepped in (median pay last year $94,000/ yr) compared to urologists ($220,000/yr) which sounds large but is a drop from 1995 ($430,000/ yr.)
The argument in the brochure (which is probably accurate) is that this incorporation leaves the urologist free to perform many other specific tasks, such as surgeries. (My urologist specializes in the Da Vinci Robotic procedure - which you can google.)
Anyway, this is my likely sign off for now. I ought to get the results in about a week - and let's hope there's no cancer.
Ciao!
Some other updates for those interested:
- I have decided not to get any "sedation" on learning there is really no pain alleviation component involved. Ordinarily, e.g. as in a colonoscopy, fentanyl is incorporated to relieve pain, along with some versed for conscious sedation. In this case, they offer no fentanyl, only versed which is not an analgesic but an amnesia-genic. I.e. its prime function is to eliminate or remove memory of the experience. Not the pain. Having had a really bad experience before, in 1996, when only versed was employed in a colonoscopy, I have decided to forego it and just have the lidocaine (injection). Maybe this is a mistake, but we will see! (In the first blog I am able to do after this procedure I'll share my findings for others)
- The urologist I went to see a week ago is not the person who will perform the procedure, but rather a physician assistant who's been trained under his supervision. It appears now that since the constellation of trained professional urologists fell off the cliff (dropping something like 40%) back in the 1990s, more manpower (woman power?) has been called up to take up the demand. (Nearly all physician assistants are female). You can find out more on this issue from an abstract for a paper scheduled to be presented at a conference in October:
http://meeting.maaua.org/abstracts/2012/P21.cgi
In addition, the fact that now a preponderance of urological patients arrive from Medicare (nearly 60%) has dissuaded many from entering the specialty field. Not enough money! Hence, physician assistants have stepped in (median pay last year $94,000/ yr) compared to urologists ($220,000/yr) which sounds large but is a drop from 1995 ($430,000/ yr.)
The argument in the brochure (which is probably accurate) is that this incorporation leaves the urologist free to perform many other specific tasks, such as surgeries. (My urologist specializes in the Da Vinci Robotic procedure - which you can google.)
Anyway, this is my likely sign off for now. I ought to get the results in about a week - and let's hope there's no cancer.
Ciao!
Tuesday, July 17, 2012
At Least Steve Rattner Tells the Truth on 'Morning Joe'
Joe Scarborough nearly caused my head to explode this morning (a terrible idea one day before a biopsy) as he remarked to sidekick Nita back in the MSNBC studio that Joe Biden and the Dems were just on a wretched campaign to try to "scare" seniors into supporting Obama. Scarborough blathered on five minutes further, concerning an "alleged war between the generations" fomented by the Reeps (Hint Joe, there is!) until finally, finally....a voice of reason stepped in, in the form of Steve Rattner.
Usually, I am not a big fan of Rattner's as he often displays decided Neoliberal tendencies, which the astute deep politics person can sniff out from a mile away. But today, after Scarborough's baloney, his response was most welcome!
He basically told Scarborough in so many words he was full of it, and also, to paraphrase - that if seniors as well as others really KNEW what was in the Ryan Budget that Mitt Romney intends to implement, they wouldn't be so gung ho to elect him!
Rattner went on to paint a devastating portrait of cuts to come, and again, let me reiterate, this is coming from a former finance maven, and certainly no Dem shoe- shiner or Obama groupie! Hence, his words need to be taken with more than the usual casual ear or nano-second attention span.
He predicted that seniors would be given $8,000 - 9,000 vouchers for Medicare, and their out of pocket costs would be at least 50% of all medical expenses, compared to roughly 20-25% today. Make no mistake this would be an absolutely catastrophic hit at the over 65 crowd, and I have blogged earlier on the repercussions:
http://brane-space.blogspot.com/2012/03/premium-support-medicare-still-terrible.html
Hence, it boggles the mind why any sensible senior would even remotely consider Romney as a possible solution. And if they say 'Well, we're thinking of the next generation!', well uh think again! Look at his Bain Capital outsourcing moves and his aspirations to cut taxes for corporations offshore. Don't you think that by adding 2 + 2 you can see that he intends to ship at least another 2 million jobs overseas in the name of profit? How do you think the younger generation - i.e. those engulfed with college debt- will fare?
Romney actually had an ardent indirect defender of his outsourcing, or assistance to effect it, in the letters section of today's local rag. (It was actually in the context of defending the U.S. Olympic Committee for choosing Chinese- made uniforms, but the argument can equally be applied to the rationale behind Bain's yen for outsourcing. ) The guy wrote:
"The foundation of capitalism is to produce a product or service that can be sold at a profit. In the case of the uniforms, it was simply a matter of choosing a manufacturer who would produce that product at the least cost to the Olympic Committee. That turned out to be China, as with most clothing sold in the United States."
Will wonders never cease! And no wonder the American pro-job destroyers like David Brooks are now crawling out of the woodwork, e.g.
http://www.salon.com/2012/07/17/david_brooks_begs_romney_please_defend_capitalism/
Anyway, Rattner then went on to warn that food stamps would likely be cut as much as one third, i.e. one third fewer people allowed to receive them. Just think of all the malnourished kids that will be left in Romney's wake!
Rattner also suggested changes to Social Security, most likely for the COLA. If his total forecast holds this country will be much MUCH worse off, especially if Mitt also goes ahead with his plans to increase defense spending 25%. I mean we already spend more on military bullshit than the next 25 nations in line, including China and Russia. I guess Romney is aiming for more military spending than all the other civilizations in the galaxy! (Or else he's aiming to send us into the dumpster of history in one tenth the time generally forecast)
Rattner, again, noted that if people knew the truth about the Ryan budget and Mitt's plans, there likely wouldn't be more than 10% poll support. I myself believe it's more than past time people wake up and smell the coffee. This idiotic visual of Romney being in a near dead heat with Obama has got to stop. People need to come to their senses, and cease the 2-bit fantasizing. Romney will not make your lives better, he will make them as bad or worse than those 2.6 million whose jobs his Bain Capital had a hand in outsourcing since 1994!
An entitled, brat-bully quarter billionaire-plus plus in charge of this country!? I would sooner move back to Barbados and eat sugar cane and bread fruit every day! Even if I had to live on a beach!
Usually, I am not a big fan of Rattner's as he often displays decided Neoliberal tendencies, which the astute deep politics person can sniff out from a mile away. But today, after Scarborough's baloney, his response was most welcome!
He basically told Scarborough in so many words he was full of it, and also, to paraphrase - that if seniors as well as others really KNEW what was in the Ryan Budget that Mitt Romney intends to implement, they wouldn't be so gung ho to elect him!
Rattner went on to paint a devastating portrait of cuts to come, and again, let me reiterate, this is coming from a former finance maven, and certainly no Dem shoe- shiner or Obama groupie! Hence, his words need to be taken with more than the usual casual ear or nano-second attention span.
He predicted that seniors would be given $8,000 - 9,000 vouchers for Medicare, and their out of pocket costs would be at least 50% of all medical expenses, compared to roughly 20-25% today. Make no mistake this would be an absolutely catastrophic hit at the over 65 crowd, and I have blogged earlier on the repercussions:
http://brane-space.blogspot.com/2012/03/premium-support-medicare-still-terrible.html
Hence, it boggles the mind why any sensible senior would even remotely consider Romney as a possible solution. And if they say 'Well, we're thinking of the next generation!', well uh think again! Look at his Bain Capital outsourcing moves and his aspirations to cut taxes for corporations offshore. Don't you think that by adding 2 + 2 you can see that he intends to ship at least another 2 million jobs overseas in the name of profit? How do you think the younger generation - i.e. those engulfed with college debt- will fare?
Romney actually had an ardent indirect defender of his outsourcing, or assistance to effect it, in the letters section of today's local rag. (It was actually in the context of defending the U.S. Olympic Committee for choosing Chinese- made uniforms, but the argument can equally be applied to the rationale behind Bain's yen for outsourcing. ) The guy wrote:
"The foundation of capitalism is to produce a product or service that can be sold at a profit. In the case of the uniforms, it was simply a matter of choosing a manufacturer who would produce that product at the least cost to the Olympic Committee. That turned out to be China, as with most clothing sold in the United States."
Will wonders never cease! And no wonder the American pro-job destroyers like David Brooks are now crawling out of the woodwork, e.g.
http://www.salon.com/2012/07/17/david_brooks_begs_romney_please_defend_capitalism/
Anyway, Rattner then went on to warn that food stamps would likely be cut as much as one third, i.e. one third fewer people allowed to receive them. Just think of all the malnourished kids that will be left in Romney's wake!
Rattner also suggested changes to Social Security, most likely for the COLA. If his total forecast holds this country will be much MUCH worse off, especially if Mitt also goes ahead with his plans to increase defense spending 25%. I mean we already spend more on military bullshit than the next 25 nations in line, including China and Russia. I guess Romney is aiming for more military spending than all the other civilizations in the galaxy! (Or else he's aiming to send us into the dumpster of history in one tenth the time generally forecast)
Rattner, again, noted that if people knew the truth about the Ryan budget and Mitt's plans, there likely wouldn't be more than 10% poll support. I myself believe it's more than past time people wake up and smell the coffee. This idiotic visual of Romney being in a near dead heat with Obama has got to stop. People need to come to their senses, and cease the 2-bit fantasizing. Romney will not make your lives better, he will make them as bad or worse than those 2.6 million whose jobs his Bain Capital had a hand in outsourcing since 1994!
An entitled, brat-bully quarter billionaire-plus plus in charge of this country!? I would sooner move back to Barbados and eat sugar cane and bread fruit every day! Even if I had to live on a beach!
Qbism and why Quantum Physicists Hate It
Consider standard quantum mechanics QM (for which the Copenhagen Interpretation applies) and operators are in one-to-one correspondence with the closed subspaces of the Hilbert space, H. Then if P is a projection, its range is closed, and any closed subspace is the range of a unique projection. If u is any unit vector, then P= [ Pu]2 is the expected value of the corresponding observable in the state represented by u. Since this is {0,1}- (binary) valued, we can interpret this as the probability that a measurement of the observable will produce the "affirmative" answer 1. In particular, the affirmative answer will have probability 1 if and only if Pu = u; that is, u lies in the range of P.
Now in the QBist or Quantum Bayesian view, this is not so. The quantum state assignments are relative to the one who makes them. So if I as a quantum Bayesian assert that: P= [ Pu]2 is the expected value of the corresponding observable in the state represented by u = 0 and the result is {0,0}, then P = 0.
Thus as N. David Mermin recently observed (Physics Today, July, p. 8):
“QBism eliminates the notorious measurement problem ….an agent unproblematically changes her probability assignments discontinuously whenever new experiences lead her to change her beliefs. It is just the same for her quantum state assignments. The change in either case is not in the physical system the agent is considering. Rather, it is in the quantum state the agent chooses by which to encapsulate her expectations.”
In other words, a large component of subjectivity enters the picture. But this is initiated, as Mermin points out, by the very choice of Bayesian probabilities ab initio. To fix ideas, the typical quantum physicist has a confirmed “frequentist” concept of probability. Hence, a probability is determined by the frequency with which event E appears in some ensemble K of events, all of which have been identically prepared in the same system.
For example, consider a system of ten coins, each of which is equally weighted, balanced to yield- for ten separate tosses:
H H T H T H H T T T
Then out of this ensemble of ten fair tosses, T appears as many times as H which is 5, so
P = E/ K = 5/ 10 = 0.5
Thus, the objective observer will assign a probability of P = 50% to a single event embodying any such coin toss and this will reflect the observer’s belief the event will occur at least half the time.
On the other hand, for the Bayesian the probability is not inherent in a similar system of events but is projected via different agents who may have different beliefs based on pre-supposition. Say Agent X has the pre-supposition a particular series of coin tosses is weighted toward tails to appear, for whatever reason, then his expectation will be: P(T) = 0.6 perhaps.
As Mermin points out (ibid.):
“This personalist Bayesian view of probability is widely held, though not by many physicists”
Of course, this implies a definite opposition between physics and other fields which employ Bayesian statistics.
Now, in formal quantum mechanics, arrival of states, probabilities is contingent on information, knowledge. For example, knowledge may be obtained using an Aspect-type device such (as depicted below) which acts to disperse the individual atomic "magnets" (net-spin atoms) and send them in pairs (always in pairs) to D1 and D2 simultaneously. The question is, what spin is detected by each detector at the instant of observation?:
D1 (+½ ) <-------------[D]------------->(- ½ )D2
The knowledge or information arrived at is correlations or anti-correlations, for the spin of an atom, say helium, captured at detectors D1 or D2.
If a ½ spin appears simultaneously we have correlation, otherwise anti-correlation.
Prior to the observation (actual detection), neither spin value can be known according to the Heisenberg Uncertainty Principle of Quantum Mechanics. That is, while the atomic magnets are in transit - from device to either detector - there is no definite information concerning which spin is going where. The reason has to do with what is called the superposition of states. To fix ideas, consider the whole atomic magnet in the device, before being ejected. If it’s a helium atom, then there’ll be one up spin and one down spin and we can write for simplicity:
U = å i {(ups)i + (downs)i}
The obscurantist claim that the outcome "depends on perspective" is rubbish, since it is the observation that determines the outcome, and there is only one.
In the orthodox (and most conservative) interpretation of quantum theory, there can be no separation of observed (e.g. spin) state until an observation or measurement is made. Until that instant (of detection) the states are in a superposition, as described above. There’s nothing mysterious or strange about this as it follows entirely from the mathematics. More importantly, the fact of superposition imposes on all quantum phenomena an inescapable ‘black box’. In other words, no information other than statistical can be extracted before observation.
The late physicist Heinz Pagels, for example, has referred (in his excellent book, The Cosmic Code) to quantum measurement theory as an ‘information theory’ and noted the entire quantum world is embedded into what we observers can know about it. Obviously such knowledge is obtainable exclusively from observational or experiment results. Since only one apparatus is used, like I've shown there are no "differing perspectives" only one - at the instant of observation.
However, in QBism or quantum Bayesianism this gets chucked: Keep the set up for the experiment as shown and change observers for each sequence of say N trials. QBism asserts that each switch introduces a different probable outcome based on each observer’s belief about the system and how he makes state assignments.
Worse, in QBism there’a a bifurcation between the world –universe in which an agent or observer lives and her experience of it. This disconcerting aspect arises, according to Mermin:
“From a failure to realize that like probabilities, like quantum states, like experience itself….the split belongs to the observer.”
Each has its own split. Worse, an uncontrolled complementarity of experience enters with respect to any other observers. If “Judy” has experiences and observations that are macroscopic (i.e. related to the large scale world of planets, stars etc.), “Roy” will experience microscopic reality (the world of atoms, electrons and Higgs bosons!) To quote Mermin:
“Each split is between an object (the world) and a subject (an agent’s irreducible awareness of his or her own experience):
Mermin also makes the point, which I tend to agree with, that “ambiguities only arise if one fails to acknowledge that the splits reside not in the objective world but at the boundaries between that world and the experiences of the various agents who use quantum mechanics.”
Fair enough, but a couple questions: 1) Does this mean that the ‘Many worlds’ interpretation is now kaput? And 2) Does QBism indicate an objective difference between the microtubules of agents, with said entities evidently tied to consciousness and hence “irreducible awareness” ?
At least QBism does take care of one riddle, first posed by Einstein: Can a quantum wavefunction be collapsed by the observations of a mouse?
QBism answers ‘NO!’ since – according to Mermin – “the mouse lacks the mental facility to use quantum mechanics to update its state assignments on the basis of its subsequent experience?”
Hmmmmmm…But what if it’s a genetically engineered mouse, with the DNA of a human like Einstein spliced into its own?
Now in the QBist or Quantum Bayesian view, this is not so. The quantum state assignments are relative to the one who makes them. So if I as a quantum Bayesian assert that: P
Thus as N. David Mermin recently observed (Physics Today, July, p. 8):
“QBism eliminates the notorious measurement problem ….an agent unproblematically changes her probability assignments discontinuously whenever new experiences lead her to change her beliefs. It is just the same for her quantum state assignments. The change in either case is not in the physical system the agent is considering. Rather, it is in the quantum state the agent chooses by which to encapsulate her expectations.”
In other words, a large component of subjectivity enters the picture. But this is initiated, as Mermin points out, by the very choice of Bayesian probabilities ab initio. To fix ideas, the typical quantum physicist has a confirmed “frequentist” concept of probability. Hence, a probability is determined by the frequency with which event E appears in some ensemble K of events, all of which have been identically prepared in the same system.
For example, consider a system of ten coins, each of which is equally weighted, balanced to yield- for ten separate tosses:
H H T H T H H T T T
Then out of this ensemble of ten fair tosses, T appears as many times as H which is 5, so
P = E/ K = 5/ 10 = 0.5
Thus, the objective observer will assign a probability of P = 50% to a single event embodying any such coin toss and this will reflect the observer’s belief the event will occur at least half the time.
On the other hand, for the Bayesian the probability is not inherent in a similar system of events but is projected via different agents who may have different beliefs based on pre-supposition. Say Agent X has the pre-supposition a particular series of coin tosses is weighted toward tails to appear, for whatever reason, then his expectation will be: P(T) = 0.6 perhaps.
As Mermin points out (ibid.):
“This personalist Bayesian view of probability is widely held, though not by many physicists”
Of course, this implies a definite opposition between physics and other fields which employ Bayesian statistics.
Now, in formal quantum mechanics, arrival of states, probabilities is contingent on information, knowledge. For example, knowledge may be obtained using an Aspect-type device such (as depicted below) which acts to disperse the individual atomic "magnets" (net-spin atoms) and send them in pairs (always in pairs) to D1 and D2 simultaneously. The question is, what spin is detected by each detector at the instant of observation?:
D1 (+½ ) <-------------[D]------------->(- ½ )D2
The knowledge or information arrived at is correlations or anti-correlations, for the spin of an atom, say helium, captured at detectors D1 or D2.
If a ½ spin appears simultaneously we have correlation, otherwise anti-correlation.
Prior to the observation (actual detection), neither spin value can be known according to the Heisenberg Uncertainty Principle of Quantum Mechanics. That is, while the atomic magnets are in transit - from device to either detector - there is no definite information concerning which spin is going where. The reason has to do with what is called the superposition of states. To fix ideas, consider the whole atomic magnet in the device, before being ejected. If it’s a helium atom, then there’ll be one up spin and one down spin and we can write for simplicity:
U = å i {(ups)i + (downs)i}
The obscurantist claim that the outcome "depends on perspective" is rubbish, since it is the observation that determines the outcome, and there is only one.
In the orthodox (and most conservative) interpretation of quantum theory, there can be no separation of observed (e.g. spin) state until an observation or measurement is made. Until that instant (of detection) the states are in a superposition, as described above. There’s nothing mysterious or strange about this as it follows entirely from the mathematics. More importantly, the fact of superposition imposes on all quantum phenomena an inescapable ‘black box’. In other words, no information other than statistical can be extracted before observation.
The late physicist Heinz Pagels, for example, has referred (in his excellent book, The Cosmic Code) to quantum measurement theory as an ‘information theory’ and noted the entire quantum world is embedded into what we observers can know about it. Obviously such knowledge is obtainable exclusively from observational or experiment results. Since only one apparatus is used, like I've shown there are no "differing perspectives" only one - at the instant of observation.
However, in QBism or quantum Bayesianism this gets chucked: Keep the set up for the experiment as shown and change observers for each sequence of say N trials. QBism asserts that each switch introduces a different probable outcome based on each observer’s belief about the system and how he makes state assignments.
Worse, in QBism there’a a bifurcation between the world –universe in which an agent or observer lives and her experience of it. This disconcerting aspect arises, according to Mermin:
“From a failure to realize that like probabilities, like quantum states, like experience itself….the split belongs to the observer.”
Each has its own split. Worse, an uncontrolled complementarity of experience enters with respect to any other observers. If “Judy” has experiences and observations that are macroscopic (i.e. related to the large scale world of planets, stars etc.), “Roy” will experience microscopic reality (the world of atoms, electrons and Higgs bosons!) To quote Mermin:
“Each split is between an object (the world) and a subject (an agent’s irreducible awareness of his or her own experience):
Mermin also makes the point, which I tend to agree with, that “ambiguities only arise if one fails to acknowledge that the splits reside not in the objective world but at the boundaries between that world and the experiences of the various agents who use quantum mechanics.”
Fair enough, but a couple questions: 1) Does this mean that the ‘Many worlds’ interpretation is now kaput? And 2) Does QBism indicate an objective difference between the microtubules of agents, with said entities evidently tied to consciousness and hence “irreducible awareness” ?
At least QBism does take care of one riddle, first posed by Einstein: Can a quantum wavefunction be collapsed by the observations of a mouse?
QBism answers ‘NO!’ since – according to Mermin – “the mouse lacks the mental facility to use quantum mechanics to update its state assignments on the basis of its subsequent experience?”
Hmmmmmm…But what if it’s a genetically engineered mouse, with the DNA of a human like Einstein spliced into its own?
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