I read and enjoyed this book a while back, but I neglected to review it. My thought was that it was far enough in the product's life-cycle that whatever can be said for it, good or ill, had already been said.
I am writing now only quickly to say that this book is amazing. While my marginal notes show that I didn't completely agree with Taleb's method or conclusions, this book has amazing impact. I am, even at my young age, pretty ossified in my positions about how the market works for all participants. What this book did is make me reevaluate those positions that were once set in stone. I have to admit, this is no easy task. I even sought out, and bought (though not yet read) the book that was the biggest influence on Taleb, The Misbehavior of Markets: A Fractal View of Financial Turbulence. I look forward to seeing the basis for the thought in The Black Swan.
I advise you to purchase this book to help you reevaluate your views on the market. Even if you don't agree with him, Taleb's book will make you stronger by forcing you to engage with his mode of thinking. I write this because I came across an unexpected and unqualified endorsement by another respected radical thinker: Daniel Kahneman in his recent Thinking, Fast and Slow. It seems counter-intuitive at first, but both men are in the same project but coming from different angles: How does the market fail, and why.
December 10, 2011
Untitled for the Holidays
I have written
Many poems –
About you;
And
About death.
They were mine;
Personal and unshared.
But this poem,
This poem is yours –
About both.
For the first time.
Yours.
But you can’t
Hear it.
Many poems –
About you;
And
About death.
They were mine;
Personal and unshared.
But this poem,
This poem is yours –
About both.
For the first time.
Yours.
But you can’t
Hear it.
November 2, 2011
Americans in Paris -- Charles Glass
Wars don't just happen at the front lines. They don't just happen at policy level with Kings and Presidents and Generals in the back office.
They also take place on the home-front.
Glass examines the home-front through the eyes of people who were out of place -- in Paris.
Through an exhaustive look at the world of Paris as lived by Americans during and just before the Nazi occupation, we get a different sense of the war than I have ever been presented. It is in depth, and we see how several Americans lived and survived the unique challenges. Some rose to the challenge, others did their best to survive. Their stories are here. They are many, and the lens of focus moves around so at times it is difficult to recenter the thread of the narrative. However the book unfolds in chronological time, so if you have a background of the history, it is easy to keep track of the temporal aspect. The book is interesting and novel, but maybe not necessary. Perhaps there are too many 'stars'. Perhaps there are too few.
They also take place on the home-front.
Glass examines the home-front through the eyes of people who were out of place -- in Paris.
Through an exhaustive look at the world of Paris as lived by Americans during and just before the Nazi occupation, we get a different sense of the war than I have ever been presented. It is in depth, and we see how several Americans lived and survived the unique challenges. Some rose to the challenge, others did their best to survive. Their stories are here. They are many, and the lens of focus moves around so at times it is difficult to recenter the thread of the narrative. However the book unfolds in chronological time, so if you have a background of the history, it is easy to keep track of the temporal aspect. The book is interesting and novel, but maybe not necessary. Perhaps there are too many 'stars'. Perhaps there are too few.
October 28, 2011
Hedgehogs Unite
I was a precocious child. I was very confident with myself. I used to do this thing to emphasize my point. On every syllable of whatever I was talking about, I would take my right forefinger and point it into my left palm for emphasis. If I was certain at that point that David Bowie was born in Wisconsin, I would say Dav-POKE-id-POKE-Bow-POKE-ie-POKE-was-POKE-from-Wis-POKE-con-POKE-sin.
That is not to say that David Bowie was actually born in Wisconsin, but that I was sure that he was. In Gardner's terms, I was fox. My previous self wasn't to be trusted. I understand. That kid who was me was often wrong. The problem was that he was too sure of himself, which often led him to be wrong.
It is far better, in the context of this book, to be the proverbial hedgehog. While the fox knows one big thing and focuses all his or her explanations in the context of that big thing, the hedgehog...hedges. There are multiple layers which lead to complexity in forecasting the future events.
The problem, in Gardner's view and as a society, is that the fox is more often wrong. But the fox is often more often of one note, allowing his predictions to be strong and easily explainable. He is often more likely to be spectacularly wrong. But that appears what we want. Sometimes someone who will examine everything is locked out as a pundit because it takes more than a minute and a half or 500 words to make a cogent and balanced point. Hedgehogs have no voice.
Gardner brings in example after example to show western society's [reference for foxes, and their objective lack of ability in predicting the future from past events. He shows that "Experts" are most likely to be wrong about the future in fields that they have extensively studied.
His work is compelling and interesting; my only worry is that the metaphor he borrows to explain the world can overtake him. The theory of the hedgehog and the fox may become his fox so that whatever he sees reinforces his thesis. I may be wrong. I have tried to become a hedgehog from the fox I was once. I can only hope I don't fall in the same traps.
That is not to say that David Bowie was actually born in Wisconsin, but that I was sure that he was. In Gardner's terms, I was fox. My previous self wasn't to be trusted. I understand. That kid who was me was often wrong. The problem was that he was too sure of himself, which often led him to be wrong.
It is far better, in the context of this book, to be the proverbial hedgehog. While the fox knows one big thing and focuses all his or her explanations in the context of that big thing, the hedgehog...hedges. There are multiple layers which lead to complexity in forecasting the future events.
The problem, in Gardner's view and as a society, is that the fox is more often wrong. But the fox is often more often of one note, allowing his predictions to be strong and easily explainable. He is often more likely to be spectacularly wrong. But that appears what we want. Sometimes someone who will examine everything is locked out as a pundit because it takes more than a minute and a half or 500 words to make a cogent and balanced point. Hedgehogs have no voice.
Gardner brings in example after example to show western society's [reference for foxes, and their objective lack of ability in predicting the future from past events. He shows that "Experts" are most likely to be wrong about the future in fields that they have extensively studied.
His work is compelling and interesting; my only worry is that the metaphor he borrows to explain the world can overtake him. The theory of the hedgehog and the fox may become his fox so that whatever he sees reinforces his thesis. I may be wrong. I have tried to become a hedgehog from the fox I was once. I can only hope I don't fall in the same traps.
September 28, 2011
In Cheap We Trust
The book shouts from the cover the word in big letters: CHEAP.
But that's only half the story. If I remember correctly, she states somewhere that the real thesis of the book is not about cheapness, but about thriftiness and frugality. The problem is, would you pick up a book that shouted from the cover in big letters: FRUGALITY?
I probably wouldn't, but that is why we have marketers. When I have to think of the central word, I think not of a consumer too hard to part from their money; I instead think of a bargain that doesn't last, the dime-store clown shoes whose vinyl cracks on the first wear. Only in passing do I think of a tightwad.
What this book is is a history of that characteristic that we have so many words for; the dead opposite of a fool and his money. What Weber reviews is the history of the popularity of thriftiness, and not surprisingly it follows the business and political cycles. One day everyone is eating sawdust and the next people are lighting cigars with currency, as long as it isn't German. What she does very well is dispel the notion that Thrift is some bedrock American value that we are forever getting away from. (It is part of "Kids these days" syndrome, where everything was better back then). It is a fashion that cycles with the times.
She transitions from the history and looks at the current state of thriftiness. The most interesting for me is her extended look at people that consider themselves Freegans or are honest with themselves and call themselves dumpster divers. This is a group of people who have tried to remove themselves as far as possible from the consumptive society. While these people are interesting, I was missing one thing. The biggest critique of such a movement to me, is that they are parasitical in a way I don't mean to be derogatory. They opt out of buying things, but their lifestyle depends on others buying and discarding the consumer goods and foods that they then can appropriate. It works as a fringe movement, but it doesn't scale up.
For me, that seems to reflect my ultimate issue with Cheapness as a movement, even the 'Ethical Cheapness" Weber calls for. It feels like a first world issue that we can wear at our choosing and still splurge. It hides the real effects of poverty and the degradation of the planet that capitalism imposes to all of the riders. As long as cheapness and thrift are choices we can look at them as idiosyncrasies. The problem is that thrift is a necessity for billions, but that we can ignore in the first world. I enjoyed the book, and I kept wanting more, I just wish that issue would have been looked at more in depth, especially as she moved from history and into personalizing the experience later in the book.
But that's only half the story. If I remember correctly, she states somewhere that the real thesis of the book is not about cheapness, but about thriftiness and frugality. The problem is, would you pick up a book that shouted from the cover in big letters: FRUGALITY?
I probably wouldn't, but that is why we have marketers. When I have to think of the central word, I think not of a consumer too hard to part from their money; I instead think of a bargain that doesn't last, the dime-store clown shoes whose vinyl cracks on the first wear. Only in passing do I think of a tightwad.
What this book is is a history of that characteristic that we have so many words for; the dead opposite of a fool and his money. What Weber reviews is the history of the popularity of thriftiness, and not surprisingly it follows the business and political cycles. One day everyone is eating sawdust and the next people are lighting cigars with currency, as long as it isn't German. What she does very well is dispel the notion that Thrift is some bedrock American value that we are forever getting away from. (It is part of "Kids these days" syndrome, where everything was better back then). It is a fashion that cycles with the times.
She transitions from the history and looks at the current state of thriftiness. The most interesting for me is her extended look at people that consider themselves Freegans or are honest with themselves and call themselves dumpster divers. This is a group of people who have tried to remove themselves as far as possible from the consumptive society. While these people are interesting, I was missing one thing. The biggest critique of such a movement to me, is that they are parasitical in a way I don't mean to be derogatory. They opt out of buying things, but their lifestyle depends on others buying and discarding the consumer goods and foods that they then can appropriate. It works as a fringe movement, but it doesn't scale up.
For me, that seems to reflect my ultimate issue with Cheapness as a movement, even the 'Ethical Cheapness" Weber calls for. It feels like a first world issue that we can wear at our choosing and still splurge. It hides the real effects of poverty and the degradation of the planet that capitalism imposes to all of the riders. As long as cheapness and thrift are choices we can look at them as idiosyncrasies. The problem is that thrift is a necessity for billions, but that we can ignore in the first world. I enjoyed the book, and I kept wanting more, I just wish that issue would have been looked at more in depth, especially as she moved from history and into personalizing the experience later in the book.
August 23, 2011
Writing
Writing
As Plato knew, has holes. The Poets
Were not allowed refuge in his ideal republic;
A place
Where philosophers were kings
And vice-versa. I have a different idea
About
words, words, words. They can
Say so much though so much is left
Unsaid.
And in the silence between those holes
The space is filled: a gesture, a look,
A universe of meaning. The turn of the lip
And the crinkle of the eye
Show and make and tell
A love that is not just know
But felt, in galaxies unknown to
Astronomers, and organs unfamiliar
To
The anatomist and words unavailable
To mere philosophers.
As Plato knew, has holes. The Poets
Were not allowed refuge in his ideal republic;
A place
Where philosophers were kings
And vice-versa. I have a different idea
About
words, words, words. They can
Say so much though so much is left
Unsaid.
And in the silence between those holes
The space is filled: a gesture, a look,
A universe of meaning. The turn of the lip
And the crinkle of the eye
Show and make and tell
A love that is not just know
But felt, in galaxies unknown to
Astronomers, and organs unfamiliar
To
The anatomist and words unavailable
To mere philosophers.
April 20, 2011
Lethe Shore
Each night
I drink the waters
from Lethe shore
Not to forget
but
to see each new
day
with wonder.
I drink the waters
from Lethe shore
Not to forget
but
to see each new
day
with wonder.
April 6, 2011
John Edgar Mihelic: Works and Deeds.
JOHN EDGAR MIHELIC
South Avers Avenue, Chicago, Illinois 60632
jedgar.mihelic (at sign) gmail.com
SUMMARY
A dynamic and talented individual with experience and success in various fields. Has been a diligent manager, motivating employees to work hard, and is willing to step in and help. Vast communication skills; has covered with intelligence and verve both civics and the arts for several newspapers. A leader in the classroom, bringing students of various ages into new knowledge and higher skill levels. Now ready to help grow your business.
WORK HISTORY
CHICAGO CAREER TECH, Chicago, Illinois
Health Information Technology Specialist 2010-2011
Course of Study: DeVry University, Health Information Technology Certificate. Learned the fundamentals of medical coding, including extensive background in biology, anatomy, and physiology. Prepared to work with health data, application systems, and electronic health information databases. Prepared for involvement in regulatory compliance and quality assessment activities designed to ensure that health information systems support patient care and safety. Able to perform clinical coding tasks, support healthcare data analysis using application software, and analyze and manage healthcare data.
City of Chicago, Division of Innovation and Technology
• Worked with the Department of Health and Human Services to aid in the installation of MacAfee encryption software to protect sensitive data
• Entered data in Cerner PowerWorks and PowerCharts
• Audited Medicaid and Medicare billing logs and recouped $142,000 for the city in two months
Community Support Services, Brookfield, Illinois
• Entered and audited data to maximize payments for services rendered by CSS, which provided services for the developmentally disabled
• Interacted with clients and employees in administrative capacity, working the front desk to ensure efficient running of the office
ADVANTAGE CHEVROLET, Hodgkins, Illinois
Sales and Leasing Consultant 2008
• Developed rapport with varied customers in order to find and fill needs for the mutual benefit of the customer and the company
• Worked on developing strategic relationships with customers who walked on the lot, established dealership customers, and through personal network of contacts
ST. RITA OF CASCIA HIGH SCHOOL, Chicago, Illinois
Chemistry Teacher 2007-2008
• Wrote and implemented lesson plans to enlighten students on the finer points of chemistry. Developed own method of evaluation for students of various levels. Learned to diffuse disciplinary issues and effectively resolve conflicts
• Served as Assistant Track Coach and aided in the development of a conditioning program for student athletes
• Trained beginning athletes in the skills of throwing the shot put and the discus; one student qualified for the IHSA state tournament in his first year competing
KANSAS STATE UNIVERSITY ENGLISH DEPARTMENT, Manhattan, Kansas
Graduate Teaching Assistant 2005/2007
• Taught elementary and intermediate rhetoric and composition. The over-all structure of the class was set, but developed specialized lesson plans to fit student learning styles. 99.2% of students passed department-wide evaluations
• Served as a writing tutor, facilitating remedial learning and English as a second language for students improving writing skills
• On a one–on-one basis, guided students through the writing process, from brainstorming to final copy editing
THE MANHATTAN MERCURY, Manhattan, Kansas
Staff Writer 2006
• Covered local government for Manhattan’s largest newspaper
• Learned to formulate questions to receive the most precise answers from often reticent sources
• Wrote articles in genre-specific format
CASA D’AMICI, Morgantown, West Virginia
Shift Manager / Cook 2002-2005
• Cooked according to restaurant-standardized recipes and maintained clean and sanitary cooking area
• As a manager, supervised the busiest shifts of the week, working at high volume with efficient labor. Average labor ran at 8% of sales
• Reconciled receipts at the end of the shift
• Maximized customer experience for food quality and service quality
WEST VIRGINIA UNIVERSITY DEPARTMENT OF CHEMISTRY, Morgantown, West Virginia
Teaching Assistant 2001-2002
• Supervised students as they performed their required lab work for elementary introductory chemistry classes
• Aided students when misunderstandings of course material arose
• In two years, had a 100% safety record in the lab
ADDITIONAL EXPERIENCE
OPEN BOOKS, Chicago, Illinois, Volunteer, 2010. Aided running of annual literature festival.
THE DAILY ATHENAEUM, Morgantown, West Virginia, Staff Writer, 2003. Covered arts and entertainment for the student paper.
THE MUSKET, Morgantown, West Virginia, Staff Writer, 2002-2003. Covered politics and scholastic issues for local paper.
EDUCATION
KANSAS STATE UNIVERSITY, Manhattan, Kansas, Graduate Coursework in English, 2005-2007
WEST VIRGINIA UNIVERSITY, Morgantown, West Virginia, B.A., English, 2000-2004
FAIRMONT STATE UNIVERSITY, Fairmount, West Virginia, General Studies, 1999-2000
TRAINING
DEVRY UNIVERSITY, Chicago, Illinois, Health Information Technology, 2010-2011
South Avers Avenue, Chicago, Illinois 60632
jedgar.mihelic (at sign) gmail.com
SUMMARY
A dynamic and talented individual with experience and success in various fields. Has been a diligent manager, motivating employees to work hard, and is willing to step in and help. Vast communication skills; has covered with intelligence and verve both civics and the arts for several newspapers. A leader in the classroom, bringing students of various ages into new knowledge and higher skill levels. Now ready to help grow your business.
WORK HISTORY
CHICAGO CAREER TECH, Chicago, Illinois
Health Information Technology Specialist 2010-2011
Course of Study: DeVry University, Health Information Technology Certificate. Learned the fundamentals of medical coding, including extensive background in biology, anatomy, and physiology. Prepared to work with health data, application systems, and electronic health information databases. Prepared for involvement in regulatory compliance and quality assessment activities designed to ensure that health information systems support patient care and safety. Able to perform clinical coding tasks, support healthcare data analysis using application software, and analyze and manage healthcare data.
City of Chicago, Division of Innovation and Technology
• Worked with the Department of Health and Human Services to aid in the installation of MacAfee encryption software to protect sensitive data
• Entered data in Cerner PowerWorks and PowerCharts
• Audited Medicaid and Medicare billing logs and recouped $142,000 for the city in two months
Community Support Services, Brookfield, Illinois
• Entered and audited data to maximize payments for services rendered by CSS, which provided services for the developmentally disabled
• Interacted with clients and employees in administrative capacity, working the front desk to ensure efficient running of the office
ADVANTAGE CHEVROLET, Hodgkins, Illinois
Sales and Leasing Consultant 2008
• Developed rapport with varied customers in order to find and fill needs for the mutual benefit of the customer and the company
• Worked on developing strategic relationships with customers who walked on the lot, established dealership customers, and through personal network of contacts
ST. RITA OF CASCIA HIGH SCHOOL, Chicago, Illinois
Chemistry Teacher 2007-2008
• Wrote and implemented lesson plans to enlighten students on the finer points of chemistry. Developed own method of evaluation for students of various levels. Learned to diffuse disciplinary issues and effectively resolve conflicts
• Served as Assistant Track Coach and aided in the development of a conditioning program for student athletes
• Trained beginning athletes in the skills of throwing the shot put and the discus; one student qualified for the IHSA state tournament in his first year competing
KANSAS STATE UNIVERSITY ENGLISH DEPARTMENT, Manhattan, Kansas
Graduate Teaching Assistant 2005/2007
• Taught elementary and intermediate rhetoric and composition. The over-all structure of the class was set, but developed specialized lesson plans to fit student learning styles. 99.2% of students passed department-wide evaluations
• Served as a writing tutor, facilitating remedial learning and English as a second language for students improving writing skills
• On a one–on-one basis, guided students through the writing process, from brainstorming to final copy editing
THE MANHATTAN MERCURY, Manhattan, Kansas
Staff Writer 2006
• Covered local government for Manhattan’s largest newspaper
• Learned to formulate questions to receive the most precise answers from often reticent sources
• Wrote articles in genre-specific format
CASA D’AMICI, Morgantown, West Virginia
Shift Manager / Cook 2002-2005
• Cooked according to restaurant-standardized recipes and maintained clean and sanitary cooking area
• As a manager, supervised the busiest shifts of the week, working at high volume with efficient labor. Average labor ran at 8% of sales
• Reconciled receipts at the end of the shift
• Maximized customer experience for food quality and service quality
WEST VIRGINIA UNIVERSITY DEPARTMENT OF CHEMISTRY, Morgantown, West Virginia
Teaching Assistant 2001-2002
• Supervised students as they performed their required lab work for elementary introductory chemistry classes
• Aided students when misunderstandings of course material arose
• In two years, had a 100% safety record in the lab
ADDITIONAL EXPERIENCE
OPEN BOOKS, Chicago, Illinois, Volunteer, 2010. Aided running of annual literature festival.
THE DAILY ATHENAEUM, Morgantown, West Virginia, Staff Writer, 2003. Covered arts and entertainment for the student paper.
THE MUSKET, Morgantown, West Virginia, Staff Writer, 2002-2003. Covered politics and scholastic issues for local paper.
EDUCATION
KANSAS STATE UNIVERSITY, Manhattan, Kansas, Graduate Coursework in English, 2005-2007
WEST VIRGINIA UNIVERSITY, Morgantown, West Virginia, B.A., English, 2000-2004
FAIRMONT STATE UNIVERSITY, Fairmount, West Virginia, General Studies, 1999-2000
TRAINING
DEVRY UNIVERSITY, Chicago, Illinois, Health Information Technology, 2010-2011
February 23, 2011
Civics Lesson
A bunch of Godly white men, many of them slaveholders, met in various eastern cities. They made this document after a constitutional convention or two. They said, "Il sera!" and then l'etais. The law has always followed their intent ...or not
The elementary civics lesson is that the government is like paper-rock-scissors, with each branch having some control over the others. The dual chambers in the legislative branch make the rules, but the executive branch has to say it is ok. Then, if someone thinks they were wrong, they can bring it to the judicial branch, which is like climbing steep stairs. If you can appeal to the Supreme court and they agree with you, the law is overturned. If they don't agree with you, or don't bother to listen to you, you are essentially wrong. And you remain wrong unless someone in the future has a similar problem and takes the same steps and this time there's a different make-up of the court. Then you can be right where you were once wrong.
For example, black people were once property even though they counted in the census (native Americans were 'untaxed people' and didn't count at all!). A black who was not property sued, asking "Can I be a citizen?" And the infinitely wise court told Dredd Scott "I don't think so." That's case law.
A dozen years and a war later we passed through legislation saying, "Sorry about that. You can be a citizen if you were born in the country."
And fifty years later we let ladies vote too.
The elementary civics lesson is that the government is like paper-rock-scissors, with each branch having some control over the others. The dual chambers in the legislative branch make the rules, but the executive branch has to say it is ok. Then, if someone thinks they were wrong, they can bring it to the judicial branch, which is like climbing steep stairs. If you can appeal to the Supreme court and they agree with you, the law is overturned. If they don't agree with you, or don't bother to listen to you, you are essentially wrong. And you remain wrong unless someone in the future has a similar problem and takes the same steps and this time there's a different make-up of the court. Then you can be right where you were once wrong.
For example, black people were once property even though they counted in the census (native Americans were 'untaxed people' and didn't count at all!). A black who was not property sued, asking "Can I be a citizen?" And the infinitely wise court told Dredd Scott "I don't think so." That's case law.
A dozen years and a war later we passed through legislation saying, "Sorry about that. You can be a citizen if you were born in the country."
And fifty years later we let ladies vote too.
All questions are the wrong questions
Of course, he will recommend a transition. That's his job. I bet he makes extra on the transition also.
We know that we would ultimately benefit from making the transition too, but I retire in three years. I have zero interest in learning a new system when I'm comfortable with the old way and highly proficient with the paper records. I know all the patients and their kids. Dr. Johnson delivered all of them. Now some big shot from the city will come in and tell me that we're doing it all wrong. We may not be doing it your way, Mr. Big Shot, but we're doing just fine, thank you.
How much is this going to cost anyway? Is it worth it? To tell you the truth, Dr. Johnson's been slipping lately. He didn't retake his boards. Anything more difficult than a cold we refer to the county seat and their fancy hospital. They have electronic records there. They also have buildings that are three and four stories tall. Is that the way we do it here? Of course not, but it works just fine.
Oh, we'll do it. It's just ... you ever feel like you've been left behind? That's how I feel every day now. I'm just another milk cow that will be put out to pasture.
I think Doc is retiring soon. And this...this will close up. We haven't found anyone to take over the practice. It’s the whole town. The only ones here are the elderly, the kids, and the sad cases who wanted nothing more than to get out...they never did. You see them down at the Sports Page more than you see them at any church. My kids made it. All three went to the university. They don't come back....
My kids never call me, and you ask me about medical records? At least I have my cats.
We know that we would ultimately benefit from making the transition too, but I retire in three years. I have zero interest in learning a new system when I'm comfortable with the old way and highly proficient with the paper records. I know all the patients and their kids. Dr. Johnson delivered all of them. Now some big shot from the city will come in and tell me that we're doing it all wrong. We may not be doing it your way, Mr. Big Shot, but we're doing just fine, thank you.
How much is this going to cost anyway? Is it worth it? To tell you the truth, Dr. Johnson's been slipping lately. He didn't retake his boards. Anything more difficult than a cold we refer to the county seat and their fancy hospital. They have electronic records there. They also have buildings that are three and four stories tall. Is that the way we do it here? Of course not, but it works just fine.
Oh, we'll do it. It's just ... you ever feel like you've been left behind? That's how I feel every day now. I'm just another milk cow that will be put out to pasture.
I think Doc is retiring soon. And this...this will close up. We haven't found anyone to take over the practice. It’s the whole town. The only ones here are the elderly, the kids, and the sad cases who wanted nothing more than to get out...they never did. You see them down at the Sports Page more than you see them at any church. My kids made it. All three went to the university. They don't come back....
My kids never call me, and you ask me about medical records? At least I have my cats.
February 17, 2011
Advance Healthcare Directives: Power of Attorney for Healthcare and Living Wills
Introduction
In an episode of the sit-com “Seinfeld,” the character of Kramer rents the movie The Other Side of Darkness, a fictional straight-to-video movie that deals with a woman in a coma. Frightened by the movie, he has a living will drawn up. At first, he considers making Jerry his executor, but decides that he is too sentimental after Jerry refuses to throw away his old tennis racquet. Kramer decides Elaine should be his executor instead and they meet with a lawyer After Kramer finishes watching the movie, when the woman miraculously comes out of the coma, he decides he needs to get his living will annulled, but he misses his appointment because he drives so slowly for fear of getting in an accident (‘The Jerk Store”).
The height of the plot is revealed when Kramer talks to Jerry and reveals his own ignorance on the topic. Kramer says, "I finished watching The Other Side of Darkness and the coma woman wakes up. I didn't know it was possible to come out of a coma."
Jerry surprised at Kramer’s ignorance, retorts, "I didn't know it was possible not to know that."
In this episode, the character’s past history as a lovable bumbling fool are played for laughs, but in reality the issues surrounding Kramer’s fears are very real. In our society talking about death can be a touchy and tricky subject, but death and near-death situations are things that will happen to everyone so it is best that we shed our shame and fear and talk about the extinguishing of our candle in a responsible manner. I talk not to coming to terms with your God, but at looking at the necessities we have in this world. A responsible adult will have pre-defined both power of attorney and a living will.
Power of Attorney for Healthcare and Living Wills Defined
Before we delve too much further into the examination of why these tools are important, we should have a look at just what they are. A living will is defined as a written, legal document that spells out the types of medical treatments and life-sustaining measures you do and don't want, such as mechanical breathing (respiration and ventilation), tube feeding or resuscitation. In some states, living wills may be called health care declarations or health care directives (“Living wills and advance directives for medical decisions”). An important thing to notice here is that a living will does not necessitate any procedure be done or not done. The treatments you wish to have done to you as you look at the possible terminal issues are drawn up in advance with a lawyer who specializes in end-of-life care. Drawing up a living will allows you as a future patient to make some of the hard decisions beforehand so that some of the most meaningful decisions you will ever make are not made in a rushed panic. Having a living will allows you to set the terms at which you live.
The situations covered in a Living Will are not exhaustive. Situations may arise when what is covered in the Living Will does not happen and what is happening was completely unforeseen. If this happens, and you are not capable of making a decision, you need someone who will act in your best interests. In this case, going hand-in-hand with the Living Will is the Power of Attorney. The Medical Power of Attorney is defined as “a legal document that designates an individual — referred to as your health care agent or proxy — to make medical decisions for you in the event that you're unable to do so. A medical POA is sometimes called a durable power of attorney for health care. However, it is different from a power of attorney authorizing someone to make financial transactions for you” (“Living wills and advance directives for medical decisions”). Both the Power of Attorney and Living Wills are called advance directives (along with a Do Not Rusticate order). Advance directives ensure that you care will be along the lines of your wishes. You can make sure that no expense is spared, or you can make sure you go gently into that good night. The key is that you give yourself agency beforehand so you live and die as you please.
Advance Directives in the real World
Kramer’s fictional situation may have been played for laughs, but in the real world a lack of advance planning for end-of-life situations can be very tragic. The most notable situation in recent memory where such issues came up was in the case of Terry Schiavo. In the spring of 2005, Ms. Schiavo came to the national attention but her struggle and the struggle between her loved ones persisted for years prior to the media frenzy. “Schiavo suffered severe brain damage in 1990 after her heart stopped because of a chemical imbalance that was believed to have been brought on by an eating disorder. Court-appointed doctors ruled she was in a persistent vegetative state, with no real consciousness or chance of recovery” (Terri Schiavo dies, but battle continues). The struggle over her life was born out between her husband and her parents. Her husband, Michael long maintained that Terry had specifically stated that she would never wish to live in a condition like the one she had deteriorated to. Her parents fought Michael at each step of the process, involving the state supreme court and even in the end the United States Congress before it went to the federal courts. A judge eventually sided with the husband – her feeding tube was removed – and she was allowed to pass on as the Supreme Court declined to hear the case.
Conclusion
The Schiavo case became a circus. The media engulfed the small town the hospice was located in, it made the dedicated workers feel like prisoners as media and various hangers-on of wide-ranging interests made the Schiavo bed a proxy for so many other issues raging in the ongoing culture wars. The Schiavo case was a circus that did not have to be. The only reason it was a circus was because of the lack of legal documentation prior to the 1990 incident that endangered Ms. Schiavo’s health. Had she planned ahead, like Kramer, then the ensuing circus would never have taken place. The acrimony between the two warring parties would have been avoided because the true intent of the patient would have been known and the person she would have wanted to speak for her would be allowed to speak. Unfortunately, episodes like this need to happen in our society before people are willing to talk about such a sensitive topic. A 2006 study, taken a year after the Schiavo case brought the need for advance directives into the public consciousness, showed that only about a quarter of adults in the United States had living wills (“A year after Schiavo's death, 'living will' quandary remains”). A quarter is far too low a rate for a country that will not talk about death. Please, make sure you have your advance directives in place now and not later. Later may be too late. Do not do it for your loved ones. Do it for yourself.
Works Cited
Mayoclinic.com. “Living wills and advance directives for medical decisions” http://www.mayoclinic.com/health/living-wills/HA00014 Accessed February 2, 2011.
MSNBC. “Terri Schiavo dies, but battle continues” http://www.msnbc.msn.com/id/7293186/.Accessed February 2, 2011.
USAToday. “A year after Schiavo's death, 'living will' quandary remains” http://www.usatoday.com/news/health/yourhealth/2006-04-02-your-health_x.htm. Accessed February 2, 2011
Wikipedia, “Jerkstore” http://en.wikipedia.org/wiki/Jerkstore Accessed February 2, 2011.
Youtube. “Seinfeld The Comeback: Coma” http://www.youtube.com/watch?v=c0snC9_E_no Accessed February 2, 2011.
In an episode of the sit-com “Seinfeld,” the character of Kramer rents the movie The Other Side of Darkness, a fictional straight-to-video movie that deals with a woman in a coma. Frightened by the movie, he has a living will drawn up. At first, he considers making Jerry his executor, but decides that he is too sentimental after Jerry refuses to throw away his old tennis racquet. Kramer decides Elaine should be his executor instead and they meet with a lawyer After Kramer finishes watching the movie, when the woman miraculously comes out of the coma, he decides he needs to get his living will annulled, but he misses his appointment because he drives so slowly for fear of getting in an accident (‘The Jerk Store”).
The height of the plot is revealed when Kramer talks to Jerry and reveals his own ignorance on the topic. Kramer says, "I finished watching The Other Side of Darkness and the coma woman wakes up. I didn't know it was possible to come out of a coma."
Jerry surprised at Kramer’s ignorance, retorts, "I didn't know it was possible not to know that."
In this episode, the character’s past history as a lovable bumbling fool are played for laughs, but in reality the issues surrounding Kramer’s fears are very real. In our society talking about death can be a touchy and tricky subject, but death and near-death situations are things that will happen to everyone so it is best that we shed our shame and fear and talk about the extinguishing of our candle in a responsible manner. I talk not to coming to terms with your God, but at looking at the necessities we have in this world. A responsible adult will have pre-defined both power of attorney and a living will.
Power of Attorney for Healthcare and Living Wills Defined
Before we delve too much further into the examination of why these tools are important, we should have a look at just what they are. A living will is defined as a written, legal document that spells out the types of medical treatments and life-sustaining measures you do and don't want, such as mechanical breathing (respiration and ventilation), tube feeding or resuscitation. In some states, living wills may be called health care declarations or health care directives (“Living wills and advance directives for medical decisions”). An important thing to notice here is that a living will does not necessitate any procedure be done or not done. The treatments you wish to have done to you as you look at the possible terminal issues are drawn up in advance with a lawyer who specializes in end-of-life care. Drawing up a living will allows you as a future patient to make some of the hard decisions beforehand so that some of the most meaningful decisions you will ever make are not made in a rushed panic. Having a living will allows you to set the terms at which you live.
The situations covered in a Living Will are not exhaustive. Situations may arise when what is covered in the Living Will does not happen and what is happening was completely unforeseen. If this happens, and you are not capable of making a decision, you need someone who will act in your best interests. In this case, going hand-in-hand with the Living Will is the Power of Attorney. The Medical Power of Attorney is defined as “a legal document that designates an individual — referred to as your health care agent or proxy — to make medical decisions for you in the event that you're unable to do so. A medical POA is sometimes called a durable power of attorney for health care. However, it is different from a power of attorney authorizing someone to make financial transactions for you” (“Living wills and advance directives for medical decisions”). Both the Power of Attorney and Living Wills are called advance directives (along with a Do Not Rusticate order). Advance directives ensure that you care will be along the lines of your wishes. You can make sure that no expense is spared, or you can make sure you go gently into that good night. The key is that you give yourself agency beforehand so you live and die as you please.
Advance Directives in the real World
Kramer’s fictional situation may have been played for laughs, but in the real world a lack of advance planning for end-of-life situations can be very tragic. The most notable situation in recent memory where such issues came up was in the case of Terry Schiavo. In the spring of 2005, Ms. Schiavo came to the national attention but her struggle and the struggle between her loved ones persisted for years prior to the media frenzy. “Schiavo suffered severe brain damage in 1990 after her heart stopped because of a chemical imbalance that was believed to have been brought on by an eating disorder. Court-appointed doctors ruled she was in a persistent vegetative state, with no real consciousness or chance of recovery” (Terri Schiavo dies, but battle continues). The struggle over her life was born out between her husband and her parents. Her husband, Michael long maintained that Terry had specifically stated that she would never wish to live in a condition like the one she had deteriorated to. Her parents fought Michael at each step of the process, involving the state supreme court and even in the end the United States Congress before it went to the federal courts. A judge eventually sided with the husband – her feeding tube was removed – and she was allowed to pass on as the Supreme Court declined to hear the case.
Conclusion
The Schiavo case became a circus. The media engulfed the small town the hospice was located in, it made the dedicated workers feel like prisoners as media and various hangers-on of wide-ranging interests made the Schiavo bed a proxy for so many other issues raging in the ongoing culture wars. The Schiavo case was a circus that did not have to be. The only reason it was a circus was because of the lack of legal documentation prior to the 1990 incident that endangered Ms. Schiavo’s health. Had she planned ahead, like Kramer, then the ensuing circus would never have taken place. The acrimony between the two warring parties would have been avoided because the true intent of the patient would have been known and the person she would have wanted to speak for her would be allowed to speak. Unfortunately, episodes like this need to happen in our society before people are willing to talk about such a sensitive topic. A 2006 study, taken a year after the Schiavo case brought the need for advance directives into the public consciousness, showed that only about a quarter of adults in the United States had living wills (“A year after Schiavo's death, 'living will' quandary remains”). A quarter is far too low a rate for a country that will not talk about death. Please, make sure you have your advance directives in place now and not later. Later may be too late. Do not do it for your loved ones. Do it for yourself.
Works Cited
Mayoclinic.com. “Living wills and advance directives for medical decisions” http://www.mayoclinic.com/health/living-wills/HA00014 Accessed February 2, 2011.
MSNBC. “Terri Schiavo dies, but battle continues” http://www.msnbc.msn.com/id/7293186/.Accessed February 2, 2011.
USAToday. “A year after Schiavo's death, 'living will' quandary remains” http://www.usatoday.com/news/health/yourhealth/2006-04-02-your-health_x.htm. Accessed February 2, 2011
Wikipedia, “Jerkstore” http://en.wikipedia.org/wiki/Jerkstore Accessed February 2, 2011.
Youtube. “Seinfeld The Comeback: Coma” http://www.youtube.com/watch?v=c0snC9_E_no Accessed February 2, 2011.
Schizophrenia: Causes and Consequences
Introduction
In our country, diseases of the mind are often stigmatized. To have any sort of mental defect is a character flaw that one should be able to work away through an effort of the will. If you cannot work through this, you are less of a person and are often left on the outside of normal working society. This bias seeps into the apparatus of medical care in America also. Until very recently, it was common for medical insurance plans to lack compensation for mental disorders at the level they compensated for physical ‘organic’ illnesses and accidents. The irony in such an unbalanced healthcare system is that mental disorders themselves are organic diseases. People who suffer from conditions as varying as bi-polar disorder, anxiety attacks, and anorexia nervosa do not just suffer; they often suffer in silence and suffer alone.
Figure 1: Mental Illness is often suffered alone
A personal connection
I write this because I do not want those who suffer to have to suffer in silence. We as a society have begun to normalize conditions such as depression and ADHD. I personally feel that this is because pharmaceutical companies have found particular chemicals that are able to treat those conditions and on some level ‘normalize’ the victims so that they can participate in society and not be defined by their disease.
I write this because I have been touched and my own life has been affected by mental illness. I have been fortunate in that I personally have not suffered but I have been affected. I have had friends, colleagues, coworkers, and family members suffer. I would not know though if those people had not been comfortable enough to discuss with me their situations. Everyone is in the same boat whether he or she is aware of it or not. In fact, the only things more shocking than the prevalence of mental illness are the silence that surrounds those who suffer and the stigma of having a disease.
I write this for my friend Steve . Steve was diagnosed in 2005 with schizophrenia. He is an honest and loving man, but as long as I have known him both before and after his diagnosis, he has been in a continual process of piecing his life together after his disease broke it apart. He has lost friends, jobs, and even access to his own children due to his disease. His diagnosis helped explained and give reasons for his behavior. His diagnosis also helped to show a path to recovery and treatment that was not there for him before. He has had his vicissitudes; his disease is now largely controlled through medication and therapy. Steve’s self-awareness helps both him and everyone around him. When he was first diagnosed, I taught myself as much as I could about his condition so I could understand him better. I hope that I can do the same for my readers here, so we can help the process of walking mental illness from the shadows.
What is Schizophrenia?
As a result of the too-common silence on mental disorders, many are poorly understood. They are often depicted in the media in a poor or untrue light, to be demonized when someone acts poorly as a result of the condition. This is not to excuse people of their acts, such as the shooters at Virginia Tech, Northern Illinois University and the recent tragedy in Arizona. People are ultimately responsible for their actions, but lack of treatment and silence on the issues creates situations where tragedies happen when early intervention would have helped. Before we can come to an understanding of any disease, we have to look at the broad definition what the disease is. Schizophrenia is defined as: “Schizophrenia is a group of severe brain disorders in which people interpret reality abnormally. Schizophrenia may result in some combination of hallucinations, delusions and disordered thinking and behavior. The ability of people with schizophrenia to function normally and to care for themselves tends to deteriorate over time.
“Contrary to some popular belief, schizophrenia isn't split personality or multiple personality. The word "schizophrenia" does mean "split mind," but it refers to a disruption of the usual balance of emotions and thinking
“Schizophrenia is a chronic condition, requiring lifelong treatment” (Definition). The important thing to note here is that there is no one schizophrenia but we see that it is a cluster of related disorders that are often defined through the symptoms that occur.
Symptoms
The symptoms that characterize schizophrenia are varied. They include the stereotypical ‘voices in the head’ but such auditory hallucinations are not always present. WebMD describes the symptoms well: “Typically with schizophrenia, the victim’s inner world and behavior change notably. Behavior changes might include the following: social withdrawal, depersonalization (intense anxiety and a feeling of being unreal), loss of appetite, loss of hygiene, delusions, hallucinations (hearing or seeing things that aren't there), and the sense of being controlled by outside forces.
“Oftentimes, a person with schizophrenia may not have any outward appearance of being ill. In other cases, it may be more apparent, causing bizarre behaviors. For example, a person with schizophrenia may wear aluminum foil in the belief that it will stop one's thoughts from being broadcast and protect against malicious waves entering the brain.
“People with schizophrenia vary widely in their behavior as they struggle with an illness beyond their control. In active stages, those affected may ramble in illogical sentences or react with uncontrolled anger or violence to a perceived threat. People with schizophrenia may also experience relatively passive phases of the illness in which they seem to lack personality, movement, and emotion (also called a flat affect). People with schizophrenia may alternate in these extremes. Their behavior may or may not be predictable” (Types and Symptoms).Schizophrenia touches every aspect of the victim’s life. The symptoms are not just delusions and hallucinations, but all the symptoms negatively affect the potential for living a ‘normal’ life.
Types
The symptoms of schizophrenia cluster around different elements of a sufferer’s personality. This aspect of the disease has led to the development and diagnosis of several different types of schizophrenia, including aspects of behavior that would surprise most people as being lumped under schizophrenia. The various types of schizophrenia are defined here and on WebMD as: “Paranoid-type schizophrenia is characterized by delusions and auditory hallucinations but relatively normal intellectual functioning and expression of affect. The delusions can often be about being persecuted unfairly or being some other person who is famous. People with paranoid-type schizophrenia can exhibit anger, aloofness, anxiety, and argumentativeness.
“Disorganized-type schizophrenia is characterized by speech and behavior that are disorganized or difficult to understand, and flattening or inappropriate emotions. People with disorganized-type schizophrenia may laugh at the changing color of a traffic light or at something not closely related to what they are saying or doing. Their disorganized behavior may disrupt normal activities, such as showering, dressing, and preparing meals.
“Catatonic-type schizophrenia is characterized by disturbances of movement. People with catatonic-type schizophrenia may keep themselves completely immobile or move all over the place. They may not say anything for hours, or they may repeat anything you say or do senselessly. Either way, the behavior is putting these people at high risk because it impairs their ability to take care of themselves.
“Undifferentiated-type schizophrenia is characterized by some symptoms seen in all of the above types but not enough of any one of them to define it as another particular type of schizophrenia.
“Residual-type schizophrenia is characterized by a past history of at least one episode of schizophrenia, but the person currently has no positive symptoms (delusions, hallucinations, disorganized speech or behavior). It may represent a transition between a full-blown episode and complete remission, or it may continue for years without any further psychotic episodes” (Types and Symptoms). As you see, there is a surprisingly wide range and a very open definition of just what it means to be schizophrenic. The intensity of the disease varies and how people cope with their symptoms vary. You can learn to live with it or you can try to drown it out with alcohol, but ultimately the need is for victims to seek treatment.
Causes
Before we can treat a disease though, we have to know what causes a disease. That way we can disrupt the disease’s pathway and short-circuit the disease before it can act out. This is as true for bacterial infections as it is for mental disorders. When looking for an organic cause of schizophrenia though you will be disappointed: “It's not known what causes schizophrenia, but researchers believe that a combination of genetics and environment contributes to development of the disease.
“Problems with certain naturally occurring brain chemicals, including the neurotransmitters dopamine and glutamate, also may contribute to schizophrenia. Neuroimaging studies show differences in the brain structure and central nervous system of people with schizophrenia. While researchers aren't certain about the significance of these changes, they support evidence that schizophrenia is a brain disease (Causes).
Unfortunately, mental disorders are poorly understood, even though progress is being made every day. The national institute of mental health notes its obscure cause, but notes the genetic aspect of the disease: “Scientists have long known that schizophrenia runs in families. The illness occurs in 1 percent of the general population, but it occurs in 10 percent of people who have a first-degree relative with the disorder, such as a parent, brother, or sister. People who have second-degree relatives (aunts, uncles, grandparents, or cousins) with the disease also develop schizophrenia more often than the general population. The risk is highest for an identical twin of a person with schizophrenia. He or she has a 40 to 65 percent chance of developing the disorder” (What causes schizophrenia?).
Treatment
Luckily, for the sufferers of the disease, there are treatments for schizophrenia, even though the cause is unknown. In treating schizophrenia, the attack is like that of treating the common cold. You cannot fully treat the disease, but you can treat the symptoms. There is a variety of medicines available to treat the symptoms. For example, “Antipsychotic medications have been available since the mid-1950's. The older types are called conventional or "typical" antipsychotics. Some of the more commonly used typical medications include: Chlorpromazine (Thorazine); Haloperidol (Haldol), Perphenazine (Etrafon, Trilafon); Fluphenazine (Prolixin)” (How is schizophrenia treated?). There have been advances in the chemicals used to treat the disease, but they all exist to limit the psychotic symptoms, hallucinations, and breaks with reality that characterize the disease.
Unfortunately, the medicines used to treat schizophrenia have side effects that may make the victim discontinue use of the medicine, or perhaps they need a different drug or dosage for their medicine to be effective. For this reason, it is necessary that effective treatment of schizophrenia must include a trusting relationship between the doctor and the patient. Once psychotic episodes are controlled then the patient can move on to psychosocial treatments, which “can help people with schizophrenia who are already stabilized on antipsychotic medication. Psychosocial treatments help these patients deal with the everyday challenges of the illness, such as difficulty with communication, self-care, work, and forming and keeping relationships. Learning and using coping mechanisms to address these problems allow people with schizophrenia to socialize and attend school and work” (How is schizophrenia treated?).
Conclusion
By understanding and being aware about mental diseases, we as a culture can move past the stigmatization of those who suffer from the disease. Although the disease, such as schizophrenia, may be hard to define and poorly understood, we can at least make an attempt to understand that one percent that suffers with it. We can stop pointing fingers at the failings of those around us and instead point them towards a place of treatment so that they can steady their symptoms and rejoin society as productive members. My friend Steve did and we need to help everyone who suffers to be able to take the same path.
Works Cited
“Causes”. MayoClinic.com http://www.mayoclinic.com/health/schizophrenia/DS00196/DSECTION=causes Accessed February 13, 2011.
“Definition”. MayoClinic.com http://www.mayoclinic.com/health/schizophrenia/DS00196 accessed February 13, 2011.
“How is schizophrenia treated?” National Institute of Mental Health http://www.nimh.nih.gov/health/publications/schizophrenia/how-is-schizophrenia-treated.shtml Accessed February 13, 2011.
“Photograph”. Prison Advice and Care Trust http://www.prisonadvice.org.uk/?q=volunteerstory Accessed February 13, 2011.
“Schizophrenia Types and Symptoms”. WebMD.com. http://www.webmd.com/schizophrenia/guide/schizophrenia-symptoms Accessed February 13, 2011
“What causes schizophrenia”? National Institute of Mental Health. http://www.nimh.nih.gov/health/publications/schizophrenia/what-causes-schizophrenia.shtml Accessed February 13, 2011.
In our country, diseases of the mind are often stigmatized. To have any sort of mental defect is a character flaw that one should be able to work away through an effort of the will. If you cannot work through this, you are less of a person and are often left on the outside of normal working society. This bias seeps into the apparatus of medical care in America also. Until very recently, it was common for medical insurance plans to lack compensation for mental disorders at the level they compensated for physical ‘organic’ illnesses and accidents. The irony in such an unbalanced healthcare system is that mental disorders themselves are organic diseases. People who suffer from conditions as varying as bi-polar disorder, anxiety attacks, and anorexia nervosa do not just suffer; they often suffer in silence and suffer alone.
Figure 1: Mental Illness is often suffered alone
A personal connection
I write this because I do not want those who suffer to have to suffer in silence. We as a society have begun to normalize conditions such as depression and ADHD. I personally feel that this is because pharmaceutical companies have found particular chemicals that are able to treat those conditions and on some level ‘normalize’ the victims so that they can participate in society and not be defined by their disease.
I write this because I have been touched and my own life has been affected by mental illness. I have been fortunate in that I personally have not suffered but I have been affected. I have had friends, colleagues, coworkers, and family members suffer. I would not know though if those people had not been comfortable enough to discuss with me their situations. Everyone is in the same boat whether he or she is aware of it or not. In fact, the only things more shocking than the prevalence of mental illness are the silence that surrounds those who suffer and the stigma of having a disease.
I write this for my friend Steve . Steve was diagnosed in 2005 with schizophrenia. He is an honest and loving man, but as long as I have known him both before and after his diagnosis, he has been in a continual process of piecing his life together after his disease broke it apart. He has lost friends, jobs, and even access to his own children due to his disease. His diagnosis helped explained and give reasons for his behavior. His diagnosis also helped to show a path to recovery and treatment that was not there for him before. He has had his vicissitudes; his disease is now largely controlled through medication and therapy. Steve’s self-awareness helps both him and everyone around him. When he was first diagnosed, I taught myself as much as I could about his condition so I could understand him better. I hope that I can do the same for my readers here, so we can help the process of walking mental illness from the shadows.
What is Schizophrenia?
As a result of the too-common silence on mental disorders, many are poorly understood. They are often depicted in the media in a poor or untrue light, to be demonized when someone acts poorly as a result of the condition. This is not to excuse people of their acts, such as the shooters at Virginia Tech, Northern Illinois University and the recent tragedy in Arizona. People are ultimately responsible for their actions, but lack of treatment and silence on the issues creates situations where tragedies happen when early intervention would have helped. Before we can come to an understanding of any disease, we have to look at the broad definition what the disease is. Schizophrenia is defined as: “Schizophrenia is a group of severe brain disorders in which people interpret reality abnormally. Schizophrenia may result in some combination of hallucinations, delusions and disordered thinking and behavior. The ability of people with schizophrenia to function normally and to care for themselves tends to deteriorate over time.
“Contrary to some popular belief, schizophrenia isn't split personality or multiple personality. The word "schizophrenia" does mean "split mind," but it refers to a disruption of the usual balance of emotions and thinking
“Schizophrenia is a chronic condition, requiring lifelong treatment” (Definition). The important thing to note here is that there is no one schizophrenia but we see that it is a cluster of related disorders that are often defined through the symptoms that occur.
Symptoms
The symptoms that characterize schizophrenia are varied. They include the stereotypical ‘voices in the head’ but such auditory hallucinations are not always present. WebMD describes the symptoms well: “Typically with schizophrenia, the victim’s inner world and behavior change notably. Behavior changes might include the following: social withdrawal, depersonalization (intense anxiety and a feeling of being unreal), loss of appetite, loss of hygiene, delusions, hallucinations (hearing or seeing things that aren't there), and the sense of being controlled by outside forces.
“Oftentimes, a person with schizophrenia may not have any outward appearance of being ill. In other cases, it may be more apparent, causing bizarre behaviors. For example, a person with schizophrenia may wear aluminum foil in the belief that it will stop one's thoughts from being broadcast and protect against malicious waves entering the brain.
“People with schizophrenia vary widely in their behavior as they struggle with an illness beyond their control. In active stages, those affected may ramble in illogical sentences or react with uncontrolled anger or violence to a perceived threat. People with schizophrenia may also experience relatively passive phases of the illness in which they seem to lack personality, movement, and emotion (also called a flat affect). People with schizophrenia may alternate in these extremes. Their behavior may or may not be predictable” (Types and Symptoms).Schizophrenia touches every aspect of the victim’s life. The symptoms are not just delusions and hallucinations, but all the symptoms negatively affect the potential for living a ‘normal’ life.
Types
The symptoms of schizophrenia cluster around different elements of a sufferer’s personality. This aspect of the disease has led to the development and diagnosis of several different types of schizophrenia, including aspects of behavior that would surprise most people as being lumped under schizophrenia. The various types of schizophrenia are defined here and on WebMD as: “Paranoid-type schizophrenia is characterized by delusions and auditory hallucinations but relatively normal intellectual functioning and expression of affect. The delusions can often be about being persecuted unfairly or being some other person who is famous. People with paranoid-type schizophrenia can exhibit anger, aloofness, anxiety, and argumentativeness.
“Disorganized-type schizophrenia is characterized by speech and behavior that are disorganized or difficult to understand, and flattening or inappropriate emotions. People with disorganized-type schizophrenia may laugh at the changing color of a traffic light or at something not closely related to what they are saying or doing. Their disorganized behavior may disrupt normal activities, such as showering, dressing, and preparing meals.
“Catatonic-type schizophrenia is characterized by disturbances of movement. People with catatonic-type schizophrenia may keep themselves completely immobile or move all over the place. They may not say anything for hours, or they may repeat anything you say or do senselessly. Either way, the behavior is putting these people at high risk because it impairs their ability to take care of themselves.
“Undifferentiated-type schizophrenia is characterized by some symptoms seen in all of the above types but not enough of any one of them to define it as another particular type of schizophrenia.
“Residual-type schizophrenia is characterized by a past history of at least one episode of schizophrenia, but the person currently has no positive symptoms (delusions, hallucinations, disorganized speech or behavior). It may represent a transition between a full-blown episode and complete remission, or it may continue for years without any further psychotic episodes” (Types and Symptoms). As you see, there is a surprisingly wide range and a very open definition of just what it means to be schizophrenic. The intensity of the disease varies and how people cope with their symptoms vary. You can learn to live with it or you can try to drown it out with alcohol, but ultimately the need is for victims to seek treatment.
Causes
Before we can treat a disease though, we have to know what causes a disease. That way we can disrupt the disease’s pathway and short-circuit the disease before it can act out. This is as true for bacterial infections as it is for mental disorders. When looking for an organic cause of schizophrenia though you will be disappointed: “It's not known what causes schizophrenia, but researchers believe that a combination of genetics and environment contributes to development of the disease.
“Problems with certain naturally occurring brain chemicals, including the neurotransmitters dopamine and glutamate, also may contribute to schizophrenia. Neuroimaging studies show differences in the brain structure and central nervous system of people with schizophrenia. While researchers aren't certain about the significance of these changes, they support evidence that schizophrenia is a brain disease (Causes).
Unfortunately, mental disorders are poorly understood, even though progress is being made every day. The national institute of mental health notes its obscure cause, but notes the genetic aspect of the disease: “Scientists have long known that schizophrenia runs in families. The illness occurs in 1 percent of the general population, but it occurs in 10 percent of people who have a first-degree relative with the disorder, such as a parent, brother, or sister. People who have second-degree relatives (aunts, uncles, grandparents, or cousins) with the disease also develop schizophrenia more often than the general population. The risk is highest for an identical twin of a person with schizophrenia. He or she has a 40 to 65 percent chance of developing the disorder” (What causes schizophrenia?).
Treatment
Luckily, for the sufferers of the disease, there are treatments for schizophrenia, even though the cause is unknown. In treating schizophrenia, the attack is like that of treating the common cold. You cannot fully treat the disease, but you can treat the symptoms. There is a variety of medicines available to treat the symptoms. For example, “Antipsychotic medications have been available since the mid-1950's. The older types are called conventional or "typical" antipsychotics. Some of the more commonly used typical medications include: Chlorpromazine (Thorazine); Haloperidol (Haldol), Perphenazine (Etrafon, Trilafon); Fluphenazine (Prolixin)” (How is schizophrenia treated?). There have been advances in the chemicals used to treat the disease, but they all exist to limit the psychotic symptoms, hallucinations, and breaks with reality that characterize the disease.
Unfortunately, the medicines used to treat schizophrenia have side effects that may make the victim discontinue use of the medicine, or perhaps they need a different drug or dosage for their medicine to be effective. For this reason, it is necessary that effective treatment of schizophrenia must include a trusting relationship between the doctor and the patient. Once psychotic episodes are controlled then the patient can move on to psychosocial treatments, which “can help people with schizophrenia who are already stabilized on antipsychotic medication. Psychosocial treatments help these patients deal with the everyday challenges of the illness, such as difficulty with communication, self-care, work, and forming and keeping relationships. Learning and using coping mechanisms to address these problems allow people with schizophrenia to socialize and attend school and work” (How is schizophrenia treated?).
Conclusion
By understanding and being aware about mental diseases, we as a culture can move past the stigmatization of those who suffer from the disease. Although the disease, such as schizophrenia, may be hard to define and poorly understood, we can at least make an attempt to understand that one percent that suffers with it. We can stop pointing fingers at the failings of those around us and instead point them towards a place of treatment so that they can steady their symptoms and rejoin society as productive members. My friend Steve did and we need to help everyone who suffers to be able to take the same path.
Works Cited
“Causes”. MayoClinic.com http://www.mayoclinic.com/health/schizophrenia/DS00196/DSECTION=causes Accessed February 13, 2011.
“Definition”. MayoClinic.com http://www.mayoclinic.com/health/schizophrenia/DS00196 accessed February 13, 2011.
“How is schizophrenia treated?” National Institute of Mental Health http://www.nimh.nih.gov/health/publications/schizophrenia/how-is-schizophrenia-treated.shtml Accessed February 13, 2011.
“Photograph”. Prison Advice and Care Trust http://www.prisonadvice.org.uk/?q=volunteerstory Accessed February 13, 2011.
“Schizophrenia Types and Symptoms”. WebMD.com. http://www.webmd.com/schizophrenia/guide/schizophrenia-symptoms Accessed February 13, 2011
“What causes schizophrenia”? National Institute of Mental Health. http://www.nimh.nih.gov/health/publications/schizophrenia/what-causes-schizophrenia.shtml Accessed February 13, 2011.
February 9, 2011
Depressions are not Acts of God: on the Lords of Finance
Ahamed, in this book, lays out just what happened in the time period covering the run-up to the First World War to the run-up of the second. The subtitle of the work speaks of the bankers who broke the world, and I can imagine it felt something like that, both for the workers, the reinters and the capitalists. There’s a good bit of economic history here but a paucity of the political history – you need to know that for context. What you get here is the economic driver of that context that happened (If you believe in economic determinism).
Anyway:
Late in the book, the author quotes the newly-sworn-in president, Franklin Roosevelt in context of temporarily unpegging the dollar from the gold standard. He supposedly joked that reporters can ask all they want about the gold standard because no one in the public knows what the gold standard is. (Broadly, it is keeping a fixed exchange rate between a currency and gold. Naturally it becomes more complicated in practice.) The gold standard is the center of this book. In this book, it is the devil – once the central banks allow for floating exchange rates economic prosperity starts to work out. In fact, where at one point the French central bank’s gold holding made it the strongest developed country economically and politically, once everyone started going off the gold standard the holdings became a liability and the Franc was too strong.
I may be a little reductive here (because thick book > short review) but the author’s insistence is that the central banks were too stuck on the gold hoarding orthodoxy and too slow to listen to the genius that was J. M. Keynes (and even Irving Fischer). Ahamed even draws the parallels to contemporary situations. It’s an imperfect parallel – there’s no large economy suffering under the yoke of reparations. However, we may be able to learn from past history and correct our policies even at this late date in our generation’s depression. Central Banks are not a Panacea, but our Federal Reserve System is not a monster from Jekyll Island either. It could use some more oversight, but it can be a powerful tool in policy. Those who love the idea of hard money should read this, at least for a little context – especially since the global population and economic growth have boomed in the last 80 years and the gold supply has not. Inelastic supply stays that way.
Anyway:
Late in the book, the author quotes the newly-sworn-in president, Franklin Roosevelt in context of temporarily unpegging the dollar from the gold standard. He supposedly joked that reporters can ask all they want about the gold standard because no one in the public knows what the gold standard is. (Broadly, it is keeping a fixed exchange rate between a currency and gold. Naturally it becomes more complicated in practice.) The gold standard is the center of this book. In this book, it is the devil – once the central banks allow for floating exchange rates economic prosperity starts to work out. In fact, where at one point the French central bank’s gold holding made it the strongest developed country economically and politically, once everyone started going off the gold standard the holdings became a liability and the Franc was too strong.
I may be a little reductive here (because thick book > short review) but the author’s insistence is that the central banks were too stuck on the gold hoarding orthodoxy and too slow to listen to the genius that was J. M. Keynes (and even Irving Fischer). Ahamed even draws the parallels to contemporary situations. It’s an imperfect parallel – there’s no large economy suffering under the yoke of reparations. However, we may be able to learn from past history and correct our policies even at this late date in our generation’s depression. Central Banks are not a Panacea, but our Federal Reserve System is not a monster from Jekyll Island either. It could use some more oversight, but it can be a powerful tool in policy. Those who love the idea of hard money should read this, at least for a little context – especially since the global population and economic growth have boomed in the last 80 years and the gold supply has not. Inelastic supply stays that way.
January 29, 2011
an ounce of prevention is a pound of cure.
I’ve been trying to do some preventative maintenance on the automobile, so that we can avoid having some big hits on auto bills. In December, I got an estimate of different things that need to be done with the car. There was enough stuff that just the preventative stuff was going to be almost seven hundred dollars. This is smart, as the car was my wife’s before we were married and she wasn’t that good at keeping up on the regular stuff. When we had the brakes done at about 65,000 miles she had to admit that she had never had the brakes looked at. Then recently, the precipitating incident for the recent car-consciousness, the battery was dying and she want to ignore it. The old battery died on the day we bought the new battery (but before we were able to get it through a painful install).
So- doing some basic things on the car, like alignment and tire rotation and an oil change and nothing should be the problem. I wanted to get the cheap and easy stuff done. However, one tire had been having trouble holding air. Nothing easy here; the problem was bigger than I though. My rim was bent.
My mechanic said we should be able to have the thing fixed, so we took the wheel off. Unthankfully, the wheel is a special kind of aluminum. Aluminum is hard to work with because it is not as flexible as steel, but this wheel is covered in a special kind of plastic glaze that gives it a chrome look. The downside is that you can’t tool the metal without a chance of it breaking and the machine shop must have some sort of insurance reason not to do the work.
Even the fixing of the wheel would have been expensive. It was estimated for about two hundred at first for the fix. But without being fixed I have to buy a replacement wheel. I could buy one from the junkyard, an aftermarket place, or a dealership. Each choice was about a hundred-dollar step up. I’m waiting on a junkyard to call be back so that I can pay three hundred on top of hundred I paid for the earlier stuff. The lesson: sometimes an ounce of prevention is a pound of cure.
So- doing some basic things on the car, like alignment and tire rotation and an oil change and nothing should be the problem. I wanted to get the cheap and easy stuff done. However, one tire had been having trouble holding air. Nothing easy here; the problem was bigger than I though. My rim was bent.
My mechanic said we should be able to have the thing fixed, so we took the wheel off. Unthankfully, the wheel is a special kind of aluminum. Aluminum is hard to work with because it is not as flexible as steel, but this wheel is covered in a special kind of plastic glaze that gives it a chrome look. The downside is that you can’t tool the metal without a chance of it breaking and the machine shop must have some sort of insurance reason not to do the work.
Even the fixing of the wheel would have been expensive. It was estimated for about two hundred at first for the fix. But without being fixed I have to buy a replacement wheel. I could buy one from the junkyard, an aftermarket place, or a dealership. Each choice was about a hundred-dollar step up. I’m waiting on a junkyard to call be back so that I can pay three hundred on top of hundred I paid for the earlier stuff. The lesson: sometimes an ounce of prevention is a pound of cure.
January 20, 2011
My Biography
One day early in the year the first space shuttle reached orbit, a singular sperm reached a human egg and fertilized and grew. I was born crying into this world on October 17, 1981. In the course of the years, many things happened. I enjoyed most of them, and most of them were solitary. I liked to build models and read books. When I did thing socially, I liked to be in charge unless I didn’t know the power relations between the individual members of the group then I was quite and reserved.
I went to school. I did well.
I moved around and made new friends. I moved more and lost touch with them. I learned early how to lose friends. I learned to not make friends too closely.
I got a job. I did well. I got more and did well at times and worse in other aspects.
I went back to school. I fell in love. I got a job. I got married. I got another job.
I lost a job.
I continue to read a lot. I have stopped reading fiction and instead read nonfiction and worry about the world. I am now learning and happy to be in a professional situation with adults .
I went to school. I did well.
I moved around and made new friends. I moved more and lost touch with them. I learned early how to lose friends. I learned to not make friends too closely.
I got a job. I did well. I got more and did well at times and worse in other aspects.
I went back to school. I fell in love. I got a job. I got married. I got another job.
I lost a job.
I continue to read a lot. I have stopped reading fiction and instead read nonfiction and worry about the world. I am now learning and happy to be in a professional situation with adults .
January 15, 2011
Malthus Overlord Inc.
Malthus overlord is in the business of contraception to avoid the overpopulation of the planet and to be sage stewards of the world we live in. We focus on both genders starting at the age of ten. We believe our approach is the most moral and ethical approach to the elimination of suffering the world over. We do the majority of our work in developing countries where the population growth is over the replacement rate of 2.1 live births for every female of reproductive age. MOI is also developing groundbreaking technology to increase the incidence of homosexuality in the human population. We know the world does not necessarily want our services; but remember Malthus Overlord Incorporated, because the world needs us.
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