The inflection point occurred a couple months ago.
First, just a bit of background. My wife works at two hospitals, Stone County Hospital and Mills County Medical Center. She was hired primarily to work at Mills, but because there were three people doing a job that could (theoretically) be done by two, that meant that she had some hours to make up working at Stone. Also, when I refer to “hours” that’s not “hours worked” but rather “coverage hours” which means hours that the service is taking in patients. So if she is working 16 hours for patients that come in within a 12 hour span, she gets 12 hours. Also, she is expected to take phone consultation call on the evenings of the days that she works, so if she’s working 12 hours, she also has another 12 of phone consultation (or 14 if the shift is 10).
One of the three doctors at Mills County Medical Center resigned, which left Clancy and one colleague having to do the entire job. This is possible, but it also leaves no room for somebody getting sick or going on vacation. The problem for Clancy was that in addition to her duties at Mills, they were still giving her hours at Stone. This was in addition to the above-mentioned phone consultation and one night a week of full call (where she is expected to go in). So Clancy asked the person responsible for scheduling if she really needed to be working those hours at Stone.
In response, she got a really terse, somewhat condescending letter from a higher up outlining what he thought the hours were. She was expected to work 144 hours per four-week period (that’s 36 hours a week, the remaining four being sick/vacation/holiday), and she had 12 shifts of 8 hours at Mills and so needed to work three shifts of 12 hours at Stone to make 144. He went on to explain about how people who want their job have to work a minimum number of hours yadda yadda.
The problem was that his math was wrong. The shifts at Mills were 10 hours instead of 8 and there were 14 of them instead of 12. And on top of that, they were giving her four days at Stone rather than three. The result was 140 hours at Mills, plus another 48 at Stone, for a total of 188 hours that wasn’t including phone consultation or on-call. The latter of which being a particular sticking point because most doctors don’t have to do it because they can’t deliver babies. They did a whole thing of “Do you really want to be the kind of employee who is sitting there counting hours?” but at the end of the day her argument was pretty bulletproof.
So they stopped scheduling her at Stone. However, to “make up for it” they expanded the coverage hours at Mills from 10 to 12. That meant that she was back at 168 hours, plus phone consultation plus obstetrical call with no vacation, sick time, or holidays. Clancy agreed to it because she mostly just wanted to (a) stop working at Stone and (b) stop having 10 day work stretches.
Unfortunately, it simply proved to be too much for her. She got several consecutive weeks of above-average patient loads. On top of all that, her employer worked out something with another service that Clancy and her colleague would start taking some of their patients, too. Clancy has never been the fastest worker, and she just got overwhelmed with it. Last month we racked up $850 a month in hotel expenses because she would work until she was too tired to drive. Attempts on her part to streamline her efficiency were thwarted by the constant level of reaction that she was in. Being away from her daughter and living in hotels ate away at her, and she was still getting yelled at by her superiors for not having her paperwork done in a timely manner.
So this week, she submitted her resignation. Her contract is up for renewal in June and she will stay on until then. We’re not sure what comes after this. We probably won’t be relocating for a new job immediately. She will likely do some temp work to keep us afloat and work on trying to become more efficient at her next job, to work smarter instead of so long and so hard. And beyond that, to take the time to find the right job, instead of doing what we’ve been doing, which is kind of falling into the jobs she’s taken.
It is unlikely we will be staying in the area for more than a year or two. I’m going to miss some of the conveniences of living so close to the city, and I’m really going to miss this house. But fortunately we won’t have to uproot in the immediate future.
I had tried to vaguely “eat less” and eat more of the high-fiber cereal in the morning, but it really wasn’t working. What I decided instead was simply to start counting calories and see where I stood. I never got an accurate measure, however, due to the Hawthorn Effect. Once I knew it was being counted, I modified my behavior almost immediately. According to the calculator I basically need to stay under 2500 calories a day, but every day but one (out of ten or so) I’ve come in under 2000. Despite the fact that my rules explicitly state I can eat whatever I want.
What I’ve learned most immediately is when I was mindlessly eating. Like I’d get a piece of cheese of Lain and then I’d get one for myself since I was right there. I also managed to, without much effort, figure out where I could scale back when preparing a sandwich for example. I also found out which foods are good at filling me up without taking up much in the way of calories. That last one could backfire because eggs are one of the good filler foods, but progress is progress.
What I find most noteworthy about this is how consistent I’ve been. In all but a couple of days, I’ve eaten between 1800 and 1900 calories. That’s a pretty range, made more interesting by the fact that I had no target in that range. To the extent that I had a goal, it was going to be 2500. Now I am for below 2000 – but no rules – and I not getting all the way up to 1990 or anything. My body apparently needs 1800-1900 to function and to stave off hunger.
It actually makes me wonder if my pre-monitoring calculations were similarly reliable. If I was eating between 2800-3000 calories, somewhat reliably, day-after-day.
Dr. X, a friend of Hitcoffee, has warned against what some mental health professionals call the Dark Triad. This triad is, to quote Dr. X, a “personality organization that comprises three psychological traits: psychopathy, narcissism and Machiavellianism.” People with that personality organization are dangerous. They are a problem that needs to be dealt with, especially if they are a coworker or in a position of responsibility.
What do we do with such people? In the comment thread to that post, Dr. X suggests that we fire them. To me, the obligation to fire implies that we shouldn’t hire in the first place. If the dark triadic person is not independently wealthy and yet can’t or shouldn’t be hired, how should he or she fend for themselves? Perhaps once properly identified–either through that person’s actions or through some sort of deep analysis–then we ought to consider civil commitment, or prison if justified. Or you can do the Philip K. Dick option: hunt down the androids and eliminate them. I reject that “solution” as does Dr. X and most (all?) others I”ve heard speak on it. But the terms of the discussion are consistent with certain conclusions.
Absent in the discussion on that thread and in the material Dr. X cites (or at least in the quoted portions of that material…I didn’t read the linked-to articles), is a discussion of whether this personality organization is just how or what someone is, or if it has a (personal) history. If people develop into that organization or develop out of it. Not to call this an illness–it’s not clear to me that the language of “personality organization” is a language about illness–but…is there a cure? Or are people just like that?
I’m obviously uncomfortable with the idea. Maybe it’s naivete or wishful thinking. If such people exist, then they exist whether I like it or not. If almost by definition such people don’t seek to change or improve or grow, then they don’t. Sometimes survival and defense of the common good are important. My wish that such people who would imperil either don’t exist doesn’t mean that they don’t.
These discussions remind me of the “mark of Cain” from Genesis. I thought it would be cool to incorporate an allusion to that story when talking about such people. But then I actually read the story, probably for the first time since I was a child. The story starts out as I remember. Cain kills Abel out of jealousy or envy or whatever. The Lord punishes him: “When you till the ground, it shall no longer yield its strength to you. A fugitive and a vagabond you shall be on the earth”
But it doesn’t end there. Cain complains that it “will happen that anyone who finds me will kill me.” To that the Lord commands that “whoever kills Cain, vengeance shall be taken on him sevenfold.” And he sets a “mark” on Cain to warn people not to harm him.
I’m no expert in Biblical interpretations, and I imagine that that passage has been interpreted and reinterpreted through the ages. There’s also a point of unclarity. The referent “him” on whom vengeance is to be meted sevenfold strikes me as amphibolous, at least in the version I’m quoting: I assume the vengeance is to be meted against the one who would harm Cain, but perhaps Cain is the recipient of the vengeance?
Still, the “mark” of Cain seems on my uninformed reading to be the opposite of what I had thought. It strikes me as a mark of mercy, or perhaps mercy tempered by a warning. People are not expressly forbidden to be wary of him or to stop him from further crimes, but they are forbidden to harm him.
Again, there may be other ways to interpret that story, and one might legitimately question whether that story ought to be a guide to anything. But that story exists and I can’t shake it, just like I can’t shake the possibility that dark triadic persons exist.
I have been listening to the works of Harlan Coben lately. On the whole, he’s a great storyteller and his novels are very gripping. My main complaint is that at the end of each standalone novel, he has one last twist that makes things worse rather than better. In two of the three cases, it’s a left-field “you were never going to guess that” sort of thing, which is fine… but one of the reasons you never would have guessed it is that the behavior of the characters prior to the revelation makes less rather than more sense. In one case, it turns out throughout the entire novel the narrator had very pertinent information to the case never affected his thinking throughout. In all three cases, the story would have been better if they’d gone with the penultimate theory of crime (or equivalent).
Rabbi Michael Lerner warns against psychoanalyzing/diagnosing Mr. Trump (or any political leader, for that matter), especially when such psychoanalysis is intended as a tool for opposition. He points out that it’s questionable to diagnose people without working with them for a long time in a therapeutic setting. Rather, he says, one should focus on actions instead of on the internal demons of one’s opponent. (Mr. Lerner lists other reasons as well. Read the whole thing.)
I’m inclined to agree. I get very uneasy when I read of a psychotherapist or other mental health professional diagnose a politician with a disorder.
Occam’s Razor can do some good here. If Mr. Trump is unstable, erratic, or unpredictable, his actions by themselves speak to how much we can trust him or how competent he is. Whether the diagnosis is right or wrong, we don’t need it.
Or mostly we don’t. Mr. Lerner’s warning is an “editorial note” to another piece, “Trump as Narcissist,” by Michael Brenner, also found at the above link.* Brenner makes several arguments that stand or fall on their own. But his key point is that Mr. Trump is a narcissist and we cannot expect the demands and incentives of the presidency to tame his narcissism.
That argument is marginally informed by whether Mr. Trump really and truly suffers from narcissism. If he does, there’s less hope that he’ll mature and grow into the presidency. If he doesn’t, there’s slightly more hope. And if a 25th amendment solution is at all in the offing, then maybe psychological unfitness is a way to invoke that process. (At the same time, I’m not sure we really want to invoke that process, and I am especially wary of admitting to that end testimony from mental health professionals who have not even met with Mr. Trump personally.) So…maybe diagnoses of the sort Mr. Brenner offers do some good after all.
But the argument that Mr. Trump will grow into the presidency doesn’t rely only on the proposition that he’ll become a better person. It also relies on the claim that our system of checks and balances might actually work and that the federal bureaucracy will do what bureaucracies do and somehow condition what Mr. Trump can accomplish. We may of course doubt whether any of this will happen or if it does, whether we’ll welcome what the country would look like afterward. (For example, I’m glad that Michael Flynn has quit the National Security Agency, but I also share Noah Millman’s concerns about the intelligence leaks that seem to have prompted his ouster.)
And for the record, I don’t believe there’s something epistemologically magical about the “months, or sometimes years” of working with a client that Mr. Lerner says is necessary to determine if a person suffers from a disorder. I acknowledge that the the diagnoser probably has to always base his or her decision on incomplete information. So maybe it’s not entirely fair for me to claim the public diagnoses lack sufficient information.
That acknowledgement, however, doesn’t change my mind that such health professionals are acting unprofessionally and to a certain extent dangerously in their public diagnoses. They’re contributing to a discourse in which mental illness is seen as something shameful or to be feared. To my mind they’re weaponizing techniques that originally were meant to help or at least understand people.
Such is not their intention, and it’s not everything that they’re doing. Some mental disorders and perhaps even “personality organizations” ought to disqualify a person from certain positions of responsibility, among them the presidency. When an apt case presents itself, then maybe these mental health professionals are doing a service in highlighting it. And as even Mr. Lerner notes, there is something to be said for noting certain “styles” of politics and cultural expression. He cites Christopher Lasch’s study of the American “culture of narcissism, and I could cite Richard Hofstadter’s essay on the “paranoid style” of American politics.
Maybe there’s no “pure” approach. Maybe some harm has to be done for a greater good. I will probably not convince these mental health professionals otherwise. But I urge them to at least acknowledge and more forthrightly address the dangers of what they’re doing.
*If you read Tikkun Olam a lot, you’ll find that Mr. Lerner often attaches editorial comments to essays he publishes but disagrees with.
For Linky Friday, I had an item about the c-section rate and whether it may promote evolution towards big heads. In the comments, Kristin Devine linked to this article, about c-section rates:
Experts say that even total C-section rates—which include cesareans for all births, not just the low-risk ones we focused on—should rarely be high. “Once cesarean rates get well above the 20s and into the 30s, there’s probably a lot of non-medically indicated cesareans being done,” says Aaron B. Caughey, M.D., chair of the Department of Obstetrics and Gynecology at Oregon Health & Science University School of Medicine in Portland and a lead author of the new ACOG/SMFM recommendations. “That’s not good medicine,” he says.
When asked to explain their high C-section rates, hospitals offered several responses.
Mark Rabson, corporate director of public affairs at Jersey City Medical Center, described how his hospital, which serves “a diverse metropolitan area with many socio-economic issues,” was working to lower C-section rates by, for example, reviewing the care of all providers whose cesarean rates are above 30 percent and offering them assistance in how they manage patients during labor. In addition, he says the hospital is now using midwives, healthcare professionals trained to avoid intervening in childbirth unless medically necessary, and people fluent in multiple languages to educate patients about cesareans.
Patricia Villa, a spokeswoman for Hialeah Hospital, told us “while there are many factors that impact a woman’s decision to have a cesarean section, we are focused on driving improvement in this area.” She also noted that the hospital had been recognized by the March of Dimes for it’s efforts to prevent elective early deliveries before 39 weeks.
Photo by koadmunkee 
My wife is the type of person to hold the line. I’m frankly not sure that I wouldn’t find some sort of way to rationalize interventions.
But while people know about that aspect of it, and probably know that a lot of women pressure their obstetricians for c-sections, that’s really only a part of the equation. The other part involves decisions that the OB makes well prior to the c-section decision. Intervention begets intervention. If a woman gets an appointment for induced labor, a future c-section becomes more likely. If she gets an epidural, a c-section becomes more likely. If labor is sped along through other interventions, c-sections become more likely. Why? Well, as best as I can figure, the more that a hospital intervenes, the less control the body has over the process. So even if two physicians have the exact same philosophy towards c-sections specifically, their philosophy on earlier interventions may lead to different c-section rates. And a woman’s chances of getting a c-section may depend not just on the obstetrician or the hospital, but the specific anesthesiologist on duty and how aggressive their philosophy is.
In the map on Kristin’s article, you notice that a lot of rural states have lower c-section rates. That’s at least part of why. Clancy’s employer in Arapaho didn’t even offer epidurals. The less resources, the less earlier intervention. The less earlier intervention, the less likely a c-section is to become necessary in the first place. My wife’s c-section rate isn’t just low because she views it as the Option of Last Resort, but because she’s not an interventionist generally (in obstetrics and elsewhere).
So it’s not just a question of whether a c-section is medically necessary, but also whether it becomes medically necessary along the way. Both of these things are going to depend on a lot of things like obstetrician philosophy, hospital policy, resources, other personnel, and (as important as anything else) patient philosophy. Whether they want an epidural has a cultural context, and that’s going to vary from place to place. Whether a woman will be the only person she knows that had a c-section, or whether she’s been told that’s the way to go. Whether she lives in a place where people read Mother Jones, or Newsweek.
Right now we live in a culture where, in addition to all sorts of other incentives, c-sections are normal and giving birth on hands and knees or underwater is considered weird and unnatural. Because intervention begets intervention (both psychologically and medically), and our health care system is an interventionist one from top to bottom, I am skeptical that we’re going to see change any time soon.
Daughter Explains Brutal Obituary She Wrote For Her Father | GOOD
At a young age, Leslie quickly became a model example of bad parenting combined with mental illness and a complete commitment to drinking, drugs, womanizing and being generally offensive. Leslie enlisted to serve in the Navy, but not so much in a brave & patriotic way but more as part of a plea deal to escape sentencing on criminal charges. While enlisted, Leslie was the Navy boxing champion and went on to sufficiently embarrass his family and country by spending the remainder of his service in the Balboa Mental Health Hospital receiving much needed mental healthcare services.
Sir Humphrey: Unfortunately, although the answer was indeed clear, simple, and straightforward, there is some difficulty in justifiably assigning to it the fourth of the epithets you applied to the statement, inasmuch as the precise correlation between the information you communicated and the facts, insofar as they can be determined and demonstrated, is such as to cause epistemological problems, of sufficient magnitude as to lay upon the logical and semantic resources of the English language a heavier burden than they can reasonably be expected to bear.
Hacker: Epistemological — what are you talking about?
Sir Humphrey: You told a lie.
Hacker: A lie?
Sir Humphrey: A lie.
Hacker: What do you mean, a lie?
Sir Humphrey: I mean you… lied. Yes, I know this is a difficult concept to get across to a politician. You… ah yes, you did not tell the truth.
Hacker: You mean we are bugging Hugh Halifax’s telephones?
Sir Humphrey: We were.
Hacker: We were? When did we stop?
Sir Humphrey: [checks his watch] Seventeen minutes ago.
Please ignore anything below this, there is experimentation in progress