Willpower

"During these last decades the interest in professional fasting has markedly diminished. It used to pay very well to stage such great performances under one's own management, but today that is quite impossible. We live in a different world now."

Kafka, "A Hunger Artist"

Of all issues perhaps obesity best embodies the complex, perhaps unfathomable relations between the "willing spirit" and the "weak flesh," as the saying goes; this is all the more true now as obesity, as compared to drug or even alcohol problems, has affected a large fraction of the population. This week's New England Journal of Medicine features a telling large-scale diet study, with an accompanying editorial (the latter is brief and particularly worth reading for general interest).

The study, conducted by Frank M. Sacks, M.D. et al, followed 811 adults over two years and looked at the weight loss resulting from diets containing varying ratios of protein, fat, and carbohydrates. It was an intensive program involving relatively affluent and enthusiastic adults as participants and experienced nutritionists and other weight-loss experts who provided counseling and support.

Unsurprisingly, subjects did not uniformly comply with the dietary ratios and caloric guidelines, but even so the study concluded that the protein/fat/carbohydrate breakdown was not a significant predictor of weight loss (a result that in a rational world would end a thousand fads, but in the real world will have little effect on the weight loss industry). Among the impressive 80% who completed the study, average weight loss at six months was 6 kg (7% of starting body weight), but the weight crept back slightly such that average loss at two years was 4 kg (about 9 pounds of course). The most significant predictor of success? Attendance at counseling and support meetings; in other words, motivation matters.

While 9 pounds is better than nothing, the discouraging overall conclusion (corroborated by many previous weight loss studies) is that on average, diets do not work. Indeed, in the editorial Martijn B. Katan, Ph. D. writes, "Evidently, individual treatment is powerless against an environment that offers so many high-calorie foods and labor-saving devices," and he goes on to emphasize community prevention initiatives that may, barring bariatric surgery, be the only viable intervention. However, "on average" is important, because if one considers that many subjects lost no weight at all, a number of them lost a substantial amount and did keep it off for two years.

As a general philosophical point, it seems reasonable to conclude that those suffering from obesity, somewhat like those in thrall to substances of various kinds, are not (yet) sufficiently motivated to change their behavior. This to me seems like a statement of psychological fact, and is not meant to be remotely disparaging. It is not to say that they are "weak," that they are "happy" about their obesity or that they don't want (at all) to change their dietary and exercise patters; it is merely to say that these motivations are not sufficiently vigorous to change behavior, or they conflict with other motivations. The biochemistry of weight loss is not hard--reduction of caloric intake and increase of caloric expenditure beyond a certain point will result in weight loss, as surely as an apple falls from a tree; it is the psychology of weight loss that is hard.

We increasingly know from evolutionary psychology that the biological hurdles are high for dieters--we are wired to find fats and carbohydrates highly reinforcing, and they are abundantly available in contemporary environments. We are similarly wired to conserve energy and avoid unnecessary exertion. Versus these factors, the disincentives of obesity, except in its most morbid forms, are somewhat abstract and distant; the health effects are often years off, and the social stigma of obesity is often surmountable and may even be decreasing as obesity becomes less uncommon. And while I don't mean to psychopathologize obesity or to make blanket statements, in some cases that problems with self-esteem may curtail the emotional reward of successful weight loss.

Also, we know that diets are much easier in the short term than in the long term. The improvements in physical well-being and appearance that accompany dieting tend to be subtle and incremental. Someone who can stop abusing alcohol or cocaine may feel remarkably better within days, whereas a dieter may not feel or look significantly different for months.

As mentioned, the editorial concludes that once we talk about the treatment of obesity, as opposed to its prevention in the first place, the battle is already mostly lost. At this point that may be true in a general epidemiological sense, but I keep thinking about those few who do get it off and keep it off. The point is not at all that they are "better" or "stronger" than anyone else; rather, in the context of their life narratives their resolve exceeded a critical point because the payoff somehow became worth it to them.

I don't know that there is a simple recipe (so to speak) for getting to that point, although a recent local news story I saw floated the idea of higher insurance premiums for obese state employees (as well as smokers). It would be a bit disheartening if that made the difference, but that's because I'm more of an existentialist than a behaviorist by nature. The means shouldn't matter.

Old Wine, New Bottles

Human nature, essentially changeable, unstable as the dust, can endure no restraint; if it binds itself it soon beings to tear madly at its bonds, until it rends everything asunder, the wall, the bonds and its very self.

Franz Kafka, "The Great Wall of China" (trans. Edwin and Willa Muir)

"I have a new antidepressant for you...Seroquel XR." These encouraging drug rep's words were directed at a colleague in the office next door (happily I escaped). How did medications initially indicated for schizophrenia successfully migrate to bipolar disorder and now depression? The answer involves both the very porous psychiatric diagnostic system and the slack standards for FDA approval.

Last year, when Abilify was approved for "adjunctive" treatment of depression, patients who saw some commercials started asking for it. The advent of direct-to-consumer advertising on television a few years back allowed pharmaceutical companies to go around physicians at will, and this affected psychiatry more than other specialties due to diagnostic ambiguities. Now that Seroquel XR is indicated for acute treatment of bipolar depression, a number of patients will overlook the bipolar part and will start asking for Seroquel for depression, and a certain fraction of doctors will comply. In fact, Seroquel is widely used "off-label" for both anxiety and insomnia; the maker could probably obtain those indications too if it were worth the company's while.

I think the atypical-antipsychotics-for-bipolar-disorder-and-depression phenomenon represents the confluence of no fewer than five factors. The least interesting is the perennial and understandable drive of pharmaceutical companies to make as much money as possible by accumulating indications. Second, the drug companies are not required to conduct head-to-head trials of prospective drugs with drugs already known to be effective; they need only to demonstrate superiority over placebo. The result is that "new" treatments are not necessarily advances over already available treatments; they are merely different (the "me too" drug).

Third, in recent years the profession has undergone a crisis of confidence in both the safety and the effectiveness of standard antidepressants, particularly for bipolar depression, which is often resistant even to standard mood stabilizers like lithium and valproic acid. Fourth, and related to this, treatment-resistant depression remains a huge problem in general; depression is increasingly recognized as a major source of disability worldwide, and the bad news is that a significant number of patients do not get better even with aggressive treatment.

Why else has a treatment like electroconvulsive therapy, marred as it by stigma and side effects, remained a quite viable treatment for seventy years now? Severe depression can be grim indeed, and ECT still treats it better than anything else. So in the treatment of depression there is very much an effectiveness vacuum; patients urgently want help, and psychiatrists urgently want to help them, so anything at hand that can be shown to be better than sugar pills for depression is likely to be used, even if side effects--such as the high cost, weight gain, and other metabolic issues of atypical antipsychotics--can be alarming. Neither patient nor psychiatrist wants to hear, or to say, "There is nothing more I can do."

Fifth, atypical antipsychotics are both more convenient and, in a purely subjective sense, better tolerated than many alternatives. The standard mood stabilizers--lithium and the anticonvulsants--require monitoring of blood levels other laboratory tests, whereas atypical antipsychotics (unless one counts the lipid profiles that ought to be done to monitor metabolic side effects) do not. This can be an issue of compliance as well as convenience. And while the objective side effects can be dismaying, many patients are subjectively surprisingly tolerant of substantial weight gain (which only adds to the problem of course).

So while I'm thoroughly tired of the phrase "perfect storm," we have one here: a high potential for profit, malleable diagnostic boundaries, and a widespread eagerness to help and be helped with respect to a prevalent illness scourge. Helpful interventions might include ending televised direct-to-consumer drug advertising, requiring higher standards for FDA approval, devising antidepressants that are actually better than the ones we have now (I'm told people are working on that, but breath-holding is not advised), and when it comes to prescribing decisions, knowing when enough is enough.

Great. Just Great.

The Sunday Times had an interesting article by David Orr on the subject of greatness in poetry, or rather, the apparent lack thereof in recent decades. It suggests that Elizabeth Bishop may have been the most recent Great One. Hmm.

As Orr notes, poetry is one genre whose whole reason for being would seem to be to swing for the fences. Sure, there's light verse, limericks, doggerel, etc. but who would care really if these vanished from the earth? What we crave from poetry, if we crave anything, is something that will blow us away, change everything if only for a moment. Yes, this is a highly Romantic conception. But where are the classicists who actually read the likes of John Dryden or Alexander Pope? Poetry is the Romantic genre.

What separates the Great from the Merely Very Good? No more perhaps than separates the Tall from the Of Above Average Height. The Great--in anything--is just a repository of cultural value, beyond a threshold established by social consensus. Of course, look around these days--who's around to assemble a consensus? After all, when I just reflected on the cultural valence of greatness a few moments ago, one of the first things that came to mind was "They're Grrreat!" courtesy of Frosted Flakes. The offspring of advertising and poetry are sterile.

At any rate, here's a poem that I found to be striking, if not Great (it's already publicly available at http://www.tnr.com/):

Hardy's Sky

A sky out of Thomas Hardy: bleak, cloud-broken, swollen with

wind-shiver, grey-gold with touches of crucifixion and apocalypse,

everything a flight, a fugue, so the small voices of these slate juncos

make music a huddle of refugees might make--bedraggled, bent

under tattered loads, feeling the weather change, the air harden,

the taste of things grow harsh and crude on their forced march

towards haggard light, towards some poor haven, this endless trek

against weather, firest blossoming from the sky ceiling, the ferocious

thump of air waves pushing them, staggering ear drums, pure dread

bursting in scatterflash and stuttercrack, these terminal fireworks

at odds with all past knowledge. So the beat goes on, no end to it,

and in this Thomas Hardy sky you'd see, had you eyes for it, words

like numb and wasting inscribed, and sad or dim, drearisome, wan,

and everything tucked in like a heart in its beating chest of bone

so the whole body thrums with it, beaten through and through by it.

Eamon Grennan

(Thomas Hardy--he was great; I didn't know junco--it is apparently a kind of finch).

Odds and Ends

I've been busy looking over page proofs for an epically wrangled-over article ("Evolution, Human Enhancement, and the Narrative Self," available by email request) for Literature and Medicine. Blog posting takes two minutes; academic print publishing can take two years (maybe if a blog is wine by the box, the academic journal is something more sophisticated). But there is something to the knowledge that one's work is occupying physical space in libraries (I take my pleasures where I can get them).

At any rate, this blog reflects my liking for quotes, which are like grains of sand that get lodged in my oyster of a brain until, one hopes, they are transmuted into something else. So as I was looking over that manuscript I came across a few quotes that, to switch metaphors, serve as the survey stakes for what I was trying to get across. To reverse metaphors, I should allow the possibility that these great quotes are themselves pearls that I merely manage to grind back down into my sandy prose.

But philosophy has no direct influence on the great mass of mankind; it is of interest to only a small number even of the top layer of intellectuals and is scarcely intelligible to anyone else. On the other hand, religion is an immense power which has the strongest emotions of human beings at its service. (Freud, "The Question of a Weltanschauung").

Perhaps the tragedy of classical psychoanalysis was its inability to accept that what most human beings most need is not insight, but something else entirely (which is only partially supplied by religion). Freud hoped that the treatment would change the allegedly neurotic need. But would we still recognize Homo sapiens without this need?

This is Socrates' legacy, and it is precisely this challenge that Freud takes up: to figure out a form of conversation in which one can succeed in genuinely taking oneself into account. (Jonathan Lear, Freud).

By bringing psychology into philosophy, Freud was trying to make the latter more philosophical. But his psychology wasn't yet psychological enough.

If I were having a philosophical talk with a man I was going to have hanged (or electrocuted) I should say, "I don't doubt that your act was inevitable for you, but to make it more avoidable by others we propose to sacrifice you to the common good. You may regard yourself as a soldier dying for your country if you like. But the law must keep its promises. (Oliver Wendell Holmes, quoted by Steven Pinker).

This is a spot-on summary of the necessary compatibility of free will and determinism. All is determined, but human society (and specific persons) can only function by presupposing that individuals can modify their behavior.

Yes, we were natural for eons before we were cultural--before we were human, even--but so what? We are cultural now. (Robert Scholes, quoted by Harold Fromm).

In a way this mind-bender, conjoined with evolutionary psychology, motivated my whole paper. How much does our escalating knowledge of our own contingent human nature grant us real freedom to alter our own individual and species identity?

One of the good things psychotherapy can do, like the arts, is show us the limits of what science can do for our welfare. The scientific method alone is never going to be enough, especially when we are working out how to live and who we can be. (Adam Phillips).

Amen.

Mood-Stabilizers All Around

I was much further out than you thought
And not waving but drowning.

Stevie Smith


Who could object to a "mood-stabilizer?" It sounds as gentle and as appealing as a spring rain. Indeed, when I mention it to patients they often seem to like the sound of it (if not quite so much as "nerve pill," which is really hard to turn down). "Antidepressant," by contrast, has sort of a grim ring to it, perhaps because "anti-" sounds, well, oppositional, and "-depressant" like, well, a downer. Names matter.

Ah, that vexed bipolar subject again. When DSM-V finally emerges (or to paraphrase David Hume, falls stillborn from the printing press) in the next few years, probably the single greatest impact upon everyday clinical practice will involve the evolving classification of bipolar disorder (the classification of Axis II/personality disorders may run a close second).

In the current American Journal of Psychiatry Christopher D. Schneck, M.D. joins the growing chorus supporting a broader bipolar definition, one that includes so-called "mixed depression," or depression associated with "subsyndromal" manic symptoms (which may include mood lability, irritability, agitation, or "racing thoughts" that fall short of a manic episode). In the current classification the only possible "mixed episode" is the simultaneous occurrence of a full major depressive episode and a full-blown manic episode for one week (these states can be clinically impressive and personally appalling, but are uncommon).

What is driving this reconsideration is the disappointingly poor performance of antidepressants not only in general, but particularly in bipolar depression. Run-of-the-mill antidepressants haven't had a good few years, frankly. First came concerns about medication-induced suicidality, then scandals involving research publication bias, and now this, the possibility that wide swaths of the clinical territory previously thought suited for antidepressants will at some point shift to bipolar states calling for mood-stabilizers. Is anyone "just" depressed any more? And I won't even get into the potential overlap with borderline personality and other characterologic and cultural issues.

A diagnostic shift may well be called for, but the potential problem is bipolarity as "the night in which all cows are black," that is, the bipolar concept is so elastic as to include a large segment of the psychiatric population. For instance, it is very rare for me to see a depressed or anxious patient who does not, when specifically asked, endorse "mood swings." Depression and anxiety in themselves make people more sensitive to everyday stressors, which can generate mood instability. Similarly, insomnia is nearly ubiquitous in depressed and anxious states. When people lie awake at night they tend to focus on their (inevitably fretful) thoughts more, which--again, when specifically asked--is highly likely to be confirmed as "racing thoughts."

Another problem is the treatment implications of sending a patient down the bipolar diagnostic road. Clinical inertia being what it is, there is often no turning back, at least for a long time. Antidepressants, while not without their problems, tend on average now to be relatively cheap, well-tolerated, and straightforward to take. Mood-stabilizers, by contrast, are often very expensive, can cause weight gain and other troubling side effects, and may require periodic blood tests for monitoring. Easier-to-take mood-stabilizers have been sought in Neurontin and Topamax, but these haven't turned out to be effective for this indication. Many clinicians now--granted, somewhat lazily--reach for atypical antipsychotics for bipolar disorder, but those are fraught with risk and expense as well.

I don't recommend a reactionary, strictly by-the-DSM-IV, approach to bipolar disorder, and I've treated plenty of ambiguous cases with mood-stabilizers, but it is never a straightforward process. Often folks in this gray area end up taking several antidepressants and mood-stabilizers from different doctors over multiple years, and one has to try to figure out what seemed to work best; the name for what is going on is often quite conjectural. In this business we ultimately have only one tool in the box: pragmatism.

Pleistocene Pleasures

"My business is to sing."

Emily Dickinson

I recommend Denis Dutton's The Art Instinct, a concise, accessible, and compelling overview of evolutionary psychology as it applies to the origins of the arts (the NYT review is here). The basic argument is that artistic interests and pursuits are universal to human experience (although with obvious temporal and geographic diversity) and are grounded in dispositions formed over a million years of hominid evolution.

Dutton's approach is nuanced and respectful of the gaps in our knowledge (theories of evolutionary psychology are far harder to demonstrate than are general evolutionary theories because, for one thing, brains don't fossilize). We do not, obviously, explicitly approach the arts in evolutionary ways any more than we consciously seek out a high-fat diet because it protected our ancestors from famine; the motivations in each case are quite literally unconscious.

In addition to general theories he handles the major arts individually. He maintains that all else being equal, people prefer depictions of landscapes that have basic features--a slightly elevated view of juxtapositions of open space and vegetation, signs of water, and small groups of animals and figures--of the African savanna in which humanity evolved. Narratives of all kinds (from Shakespeare to soap operas), Dutton claims, are natural ways of navigating the extreme complexities of human social life in a way that doesn't risk real-life consequences. Linguistic aptitude also can attract potential mates, although less so perhaps than impressive upper body strength (not all of us were blessed with both).

Music is clearly important to Dutton personally, and he acknowledges that it poses the greatest challenge to evolutionary theory inasmuch as such an abstract art does not, compared to other arts, seem as relevant to past survival advantage over evolutionary time. He ends up concluding that even more than the other arts, music is much like the peacock's tail, that is, a very contingent concoction designed to woo potential mates (witness the predominance of love as a perennial musical theme).

He also points out that compared to other arts, we tolerate and even invite an astonishing amount of repetition (albeit with variation), both of tonal ideas within musical works and of musical works themselves (over a period of years one might listen to a favorite album a hundred times, which we're not likely to do even with a poem). Let's see, what other human behavior involves the appreciation of extreme repetition with variation? Well, nothing comes to mind here, I'll think of it later.

Dutton takes clear aim at modernism in the arts (particularly atonal music and some avant-garde follies of the visual arts) as a misguided notion that taste can be culturally contorted to an infinite degree; rather, evolution suggests that our interests, while quite manifold, are finally finite. Indeed, avant-gardism over the past century has arguably been a massive expression of cultural hipsterism, in which mere exclusivity (manifested in the sheer cost of works of art as well as the smug satisfaction of being counted among the cognoscenti) has carried some sectors of the arts well into the realm of sophisticated kitsch.

The most hilarious example of this is best captured in Dutton's words:

The imitations reached rock bottom in 1961 with Merda d'artista, a series of works produced, in every sense of the word, by the Italian conceptual artist Piero Manzoni. In fact, in 2002 the Tate Gallery paid $61,000 to add to its collection Can 004 from Manzoni's series of ninety cans of his own feces...In Manzoni's case the only humor to be found is in the messy fate of many who acquired works in the Merda d'artista series: quietly, but knowing exactly what he was up to, Manzoni had improperly autoclaved the cans. At least half of those bought by museums and collectors eventually exploded.

In the closing pages of his book Dutton argues that great art relies on authentic individuality against a cultural background of stable values and the sense that some things do ultimately matter. This may be why the ironic age has found contemporary masterpieces to be hard to come by.

I find these kinds of evolutionary accounts to be fascinating and, really, deeply spiritual inasmuch as the fact of consciousness (and the necessary supposition of free will that comes with it) shields us from reductionism. Sure, one can say that Beethoven manipulates merely primitive urges just as one can say that tones are merely compression waves conveyed through air, but to do so is to miss the point. So much is both given and contingent, but the question in the arts, as in life, is: where do we go from here?

Full Partners

What is it men in women do require?

The lineaments of Gratified desire.

What is it women in men do require?

The lineaments of Gratified desire.

William Blake

Psychotherapy is, famously, not about giving advice. So it's interesting to browse the blog posts at Psychology Today which are, of course, stuffed with advice, much of it pretty good. What else are they supposed to do? One can manage only so many posts on empathic listening. Maybe opining spontaneously and at length into the Internet vacuum makes it easier to stay mum and receptive in session.

For obvious reasons, though, particularly as none of their therapist bloggers is anonymous, the approach is fairly general even when not theory-driven. So I was curious to find two well-written posts that offer diametrically opposed marital advice.

Michael J. Formica advocates authenticity in relationships by cautioning against general enabling. Usually I think of an enabler as someone who looks the other way or otherwise tacitly approves of a partner's substance abuse, but he uses it for anyone who, to the detriment of his or her own vital interests, enables a partner's own personal script, whatever it may be. Of course, we immediately recognize this as the submissive, self-abnegating type who, Formica warns, risks giving him/herself away in a relationship.

As if in rebuttal, John R. Buri marvels at how many people, having married "for love," at some point stop being even minimally engaging, civil, and affectionate toward a partner. In his view "authenticity" is taken by many as license to be callous and indifferent in a relationship if that seems to "come naturally." His recommendation is to let go of the self, at least enough to express a certain level of affection even if it doesn't feel "natural."

Of course, these two needn't be seen as disagreeing at all; indeed, we can envision them working with the two partners in the same dominant-submissive relationship. The joke goes that dermatology therapeutics consists of: drying it out if it's moist and moistening it if it's dry. I suppose the corresponding couples counseling approach is: if it's rigid and unyielding, soften it up, and if it's passive and squishy, firm it up.

But there are all kinds of judgment calls here. How do we decide which "interests" are vital enough to qualify for "authenticity?" That is, what do we merely want from a relationship as opposed to truly need? And selfless affection for the partner sounds wonderful--until it crosses into inauthenticity. No answers here--I guess that's why therapy pays the bills and blogging doesn't.

The glorious early stages in a relationship are like being in a fine sailboat with the wind at your backs; everything trends in one direction. Over time, the wind shifts to the side and then eventually to the front. Unable to sail directly into the wind, you tack between self/authenticity on the right and other/affection on the left. Nobody manages it well enough to actually reach a destination--the goal is merely to stay afloat, even if going in wide circles.

And then there are the beachcombers...

The Green Night

"O beware, my lord, of jealousy! It is the green-eyed monster, which doth mock the meat it feeds on."

Othello


As Natalie Angier points out in her interesting NYT article on the neurobiology of vice, envy and jealousy are distinct emotions, the latter referring chiefly to possessions potentially lost, the former pertaining to either goods or broader states of being never attained. But we easily recognize them as stemming from the common root of a resentful scarcity of the self. For anyone who has experienced them--and I presume we all have at one time or another--it is hard to say which is more unpleasant, forever gazing up at a desired peak--or falling from it once there. Most of us experience envy or jealousy trivially or transiently; some unfortunate folks make them into a pastime.

Envy apparently has an ancient association with green, perhaps because it was recognized as a kind of moral malady (yellow or greenish skin has long and rightfully been seen as a marker of illness). As Angier notes, envy is a peculiarly ungratifying sort of vice, except when it can be "successfully" discharged as schadenfreude. I think we tend to view the deeply envious as more pathetic than vicious, but all the same it is not a state of mind--advertising as it does the envier's incapacity and ingratitude--that inspires admiration. Envy seems a distinctly spiritual and existential sort of ailment.

The article's least illuminating aspect, actually, is its description of neuroimaging experiments (eventually to be assembled in the Annals of Tautology) designed to show that schadenfreude relates to an area of the brain (the ventral striatum) associated with dopamine and pleasurable experience. We need scanners to tell us this? Do they mean to say that envy, like every other experience, comes from the brain and not from an ethereal soul?

In the psychotherapy literature, envy is advanced as one reason why narcissism is so hard to treat. The narcissist has trouble being healed by a therapist because he envies what the therapist presumably has, i.e. relative well-being and peace of mind. Envy and resentment threaten to undercut the very person trying to help him. This is a distortion of the healthy "idealizing transference" (admiration, basically) that tends to occur in therapy. One admires someone who is seen to occupy a high position that one might conceivably reach as well; one envies the high position that seems unattainable. I suppose the challenge of psychotherapy is to make the unattainable seem attainable, but by constructive self-development rather than by resentful attacks on others. And some find it helpful to regularly practice gratitude as an antidote to envy.

Sociologically we would seem to be the envious species par excellence. The resentment of the technologically and economically backward Muslim world has been blamed, rightly or wrongly, for 9/11 and Al Qaeda. And as capitalism has threaten to careen out of control in recent decades, our keeping-up-with-the-Joneses status anxiety, i.e. envy, has been widely cited. Buying the McMansion, the late model car, the newest Ipod: all are preventive measures for envy, but like a colonoscopy (how's that for a metaphor?) these acts buy tranquillity only for a while. Envy is an evolutionary treadmill of the mind; at some point one just has to jump off.

Late Romantic

Out on the winding, windy moors

We'd roll and fall in green.

You had a temper like my jealousy

Too hot, too greedy.

How could you leave me,

When I needed to possess you?

I hated you, but I loved you too.

Kate Bush

Had I not endured a most lame lapse in Internet connectivity over the weekend (I guess it's a good thing I'm married and was not mid-sentence on Match.com), I would have written about that least romantic of Romantic texts, Emily Bronte's Wuthering Heights (no, I can't seem to generate the diaeresis in her name here). A recent rereading of it reminded me that it makes "love" of the Hallmark-card-variety seem mild indeed.

The Irish Anglican curate Patrick Bronte (1777-1861) lived long enough to bury his wife and all six of his children, but not before Emily (1818-1848), Charlotte (1816-1855), and to a lesser degree, Anne (1820-1849), became acclaimed novelists. In conjunction with their ill-fated brother Branwell, the girls had famously devised the childhood fantasy worlds of Angria and Gondal--their upbringing was austere and isolating, of the kind that a television in the background effectively dispels today. It was the perfect English Romantic family, with equal parts genius and tuberculosis.

Emily Bronte was an enigmatic figure who left few unpublished writings behind. Charlotte later recalled her sister as follows: In Emily's nature the extremes of vigour and simplicity seemed to meet. Under an unsophisticated culture, inartificial tastes, and an unpretending outside, lay a secret power and fire that might have informed the brain and kindled the veins of a hero; but she had no worldly wisdom; her powers were unadapted to the practical business of life: she would fail to defend her most manifest rights, to consult her most legitimate advantage. An interpreter ought always to have stood between her and the world. Her will was not very flexible, and it generally opposed her interest. Her temper was magnanimous, but warm and sudden; her spirit altogether unbending.

If claustrophobia and agoraphobia can ever be said to coexist, they would seem to do so in Wuthering Heights; it is like a game of violent chess played in a closet set down on an endless plain. Interpersonally the book is minimalistic and constricting, comprising two families four miles apart who seem to despise each other but who can't stop having encounters, presumably because the rest of the human race is nowhere in evidence. If here, as for Sartre, hell is other people, it is still far preferable to the lack thereof. If anyone doubts that the opposite of love is not hate, but indifference, read this book.

Here is a tidy vignette on love: The intimacy thus commenced grew rapidly; though it encountered temporary interruptions. Earnshaw was not to be civilised with a wish, and my young lady was no philosopher, and no paragon of patience; but both their minds tending to the same point--one loving and desiring to esteem, and the other loving and desiring to be esteemed--they contrived in the end to reach it.

Heathcliff is of course the dark conundrum of the novel. Even as a child he is described as having a kind of native churlishness about him, what in that century may have been termed "spleen." But he had been a homeless child, and was treated cruelly and resentfully at times after his adoption, so as always we cannot separate inheritance from environment. His exceeding cruelty supposedly scandalized critics of the day, but his extreme attachment to Catherine Earnshaw, however perverse and extending, in classic gothic fashion, beyond the grave, rules out psychopathy. His is not the "motiveless malignity" of Iago. Malignant narcissism, perhaps: he does have a monomaniacal need for control combined with real sadism. And yet his great strength and firmness of character are granted grudging admiration, particularly beside the mild and weak characters of Edgar and Linton.

Emily Bronte wrote a few great poems as well, which Charlotte "happened upon," as would occur to another poetic Emily on the other side of the Atlantic years later (Emily Dickinson was eighteen years old when Wuthering Heights appeared and Emily Bronte died). Not having revisited the novel for twenty years, I had forgotten how many affinities exist between the two Emilys: inscrutable intensity, to the point of morbidness at times; otherworldliness, yet compounded with exquisite sensitivity to natural and spiritual realities; the stern and distant fathers; the supportive sister; and both way before their time.

The book may be ideal for both romances and break-ups, a particularly barbed reminder that if we think we're done with love, it may not be done with us (and Cupid's arrows are not rubber-tipped). Red is for romance--and for blood.

(We had a fine weekend, really, don't get the wrong idea).

The Bicentennial

Like everyone in the blogosphere I note the two-hundredth birthdays of Abraham Lincoln and Charles Darwin today. Between them they represent rarely dreamed of heights of moral and scientific heroism. It is interesting that both have enjoyed increased attention recently for unrelated reasons, one because of a black President from Illinois and the other because of growing mainstream acceptance of evolutionary psychology. Why do these two grip the imagination so?

Lincoln's life was so unlikely and so symbolic as to be mere fancy, had it not all really happened. It had every element of the perfect story: the by-the-bootstraps education, the political longshot, the puzzling marriage, the enigma of the melancholic jokester, the epic national crisis, the elimination of an unequivocal evil, the appalling assassination occurring poignantly in the wake of victory, the reverential afterlife. Riven though it was by tragedy, it was in many ways the perfect life of action.

Darwin's life, by contrast, was outwardly placid and unruffled: the perfect life of knowledge. Many have described evolution as the single greatest scientific insight in history, and that seems true, for it changes profoundly our view of who we are and how we got to be that way. Pressure from Alfred Russell Wallace may have spurred him at the last, but Darwin sprang his theory upon a 19th-century world not eager for its religious implications. If many still repudiate his theory today, it is willful disbelief; they close their eyes against the clear light of day.

Being human, these two men had their imperfections, but they were titans of the modern age because in their complementary but equally magnificent ways, each undertook a supreme test and got it right. Lincoln said that "If slavery isn't wrong, nothing is wrong." If these two were not great, then the word has no meaning.

Wide Open Spaces

"I have traveled much in Concord."

Thoreau

Something a little lighter for post #150. I happened to see the 2009 Forbes list of the "10 most miserable cities" in the U.S. based on composite scores reflecting climate, taxes, unemployment, crime, etc. Here's the rundown:

1. Stockton, CA

2. Memphis, TN

3. Chicago, IL

4. Cleveland, OH

5. Modesto, CA

6. Flint, MI

7. Detroit, MI

8. Buffalo, NY

9. Miami, FL

10. St. Louis, MO

I noted this not because any of these is particularly surprising (well, Chicago maybe a little), but because I've always been interested in people's sense of place and the kinds of locales they seek out or seem surprisingly content with. For some people blood is thick enough to deter wandering, whereas others manage to escape from economically, sociologically, and psychologically depressed areas, such as the town I commute a half hour to for work.

Geography also probably played some role in my becoming a physician. As one would hope, my main motivation for psychiatry was a fascination for subjectivity and mental experience. The income, comfortable but not stratospheric, was less of a factor than was job flexibility. If medicine and/or psychology had been unavailable for some reason, my next choice probably would have been liberal arts academia in some capacity.

But a major issue with university-level, tenure-track academia is the fact that, unless you are a rare superstar professor able to sell one's talents to the highest bidder, you pretty much have to settle where you can find a viable job, and once there you might stay there a long time. I liked the idea that, as a physician, I could go pretty much anywhere I wanted and at least make a decent living. Of course, far fewer physicians have their own practices than used to be the case, but when a physician does have a boss, he is at more liberty to leave and find a different boss than some other professionals are.

Ironically, I haven't (yet) used this freedom to work all over the place; while I have done my fair share of traveling, I have lived only in or near medium-sized cities in the Midwest and Southeast. But I know that if I suddenly did want to roam, my profession would not prevent me. I enjoy places like Chicago or Manhattan for a few days, but I have never felt a serious urge to live there. Psychiatrists are infamous for preferring the big city and its sophisticated cultural goodies, leaving wide swaths of rural population unserved. But people need to be where they'll feel at home. Culturally I would probably be most at home in the Pacific Northwest, but I don't think I could deal with the weather. If I made a dramatic geographic move it would probably be to the desert Southwest (I have a cousin in Tucson who, I'm sure, keeps a room waiting for me).

A few months ago a large survey-based study made news by suggesting distinct trends in psychological profiles of U.S. regions and states. The methodology was questionable, of course, and obviously one finds all sorts of folks in all sorts of places, but it does seem to corroborate a sense one has that, despite the homogenizing effects of popular culture, different parts of the country have differing broad "personalities." Supposedly North Carolina tends to be highly agreeable and dutiful. Hmmm.

Also a few months ago Stanley Fish bravely wrote a New York Times piece (with the aptly Thoreauvian title "Travel Narrows") confessing his firm distaste for travel, including the logistical discomforts and the gawking at famous, and of course "touristy," sights. It seems to me that travel is one of those things, like dining out or going to the movies perhaps, that is widely held to be a great good that nobody in his right mind could object to. I wouldn't go as far as Fish, but I can relate to his protests. As we slide toward economic apocalypse, perhaps the thrifty homebody will get come into his own...

The Sky's the Limit

Falstaff: Now, Hal, what time of day is it, lad?

Prince Henry: Thou art so fat-witted with drinking of old sack, and unbuttoning thee after supper, and sleeping upon benches after noon, that thou hast forgotten to demand that truly which thou wouldst truly know. What a devil hast thou to do with the time of the day? Unless hours were cups of sack, and minutes capons, and clocks the tongues of bawds, and dials the signs of leaping-houses, and the blessed sun herself a fair hot wench in flame-coloured taffeta, I see no reason why thou shouldst be so superfluous to demand the time of the day.

Henry IV

Courtesy of Arts & Letters Daily (again), I see Mary Eberstadt's review of the curious cultural trajectories of food and sex over the past few decades. For the first time in human history, Western societies have offered virtually unlimited access to those two primal goods to most of their populations. Her review is lengthy but interesting (I was going to write fascinating or even titillating, but I don't want to wax immoderate here). Think of it as an edgily romantic runup to Valentine's Day.

As she notes, throughout most of human history food consumption was limited by natural scarcity (and by harsh social punishments of theft), while sex was constrained by biological deterrents (like kids, and syphilis) and social sanctions. Beginning around the 1960's, thanks to technological advances and liberalizing attitudes, all of these barriers started to give way. How have we handled this unprecedented access?

Gluttony was of course one of the seven cardinal sins, but post-medieval societies didn't get too worked up about obesity, which was rare and, if anything, a sign of economic prosperity (the reverse is true now, as obesity is inversely correlated with rising socioeconomic status, not least because the relatively poor are more likely to consume cheap and concentrated calories and less likely to have access to safe and convenient exercise options).

As many have noted, the obesity epidemic is the classic disease of civilization, in which cheap and abundant food meets evolutionary tendencies to store fat for next year's famine. What is surprising, as Eberstadt notes, is the advent of remarkably puritanical attitudes about food choice and body weight over the past few decades. I would suppose this represents a confluence of three factors (in addition to the status factor just mentioned): the mainstreaming of animal rights concerns, an increasing awareness of environmental impacts of food production, and the ever more apparent price tag of food and other behavioral choices (since the health care system is always shifting costs in some way, my neighbor's Big Mac could wind up being my insurance premium).

Eberstadt has an alternative and intriguing notion, although I'm not sure I buy it. As food has acquired more moralistic connotations, sex as we all know has generally done precisely the opposite over the past half century. Eberstadt seems to suggest that as the sexual revolution has continued to careen widely, most recently into an explosion of Internet pornography, we may be transferring some of our (currently politically incorrect) anxieties about sex onto food. That is, we feel a "natural" need to rein in our impulses, and in the current cultural climate it is easiest to do this with diet. It's an intriguing idea, even if just speculative psychobabble on her part; perhaps some kind of hard-wired self-restraint can be culturally bypassed only for a while or only at a price.

Eberstadt also cites a body of research showing the allegedly deleterious effects of pornography and more lenient sexual habits in general. Some of it seems questionable; for instance, when she argues that married folks have better financial and health outcomes than singles, this obviously doesn't show that marriage was the causative factor rather than mere correlate. She is more convincing when discussing the effects of the sexual revolution upon children, mediated not least by the predominance of divorce. So go sow some wild oats, then procreate--in that order (just as stereotypes are often true, cliches became cliches for a reason).

Bloggo, ergo sum

I'm nobody! Who are you?

Are you nobody too?

Then there's a pair of us--don't tell!

They'd banish us, you know.

How dreary to be somebody!

How public, like a frog

To tell your name the livelong day

To an admiring bog!

Emily Dickinson

Bloggers out there are brooding again, about...blogging. Andrew Seal at Blographia Literaria weighs the relative virtues of serendipity and focus in literature blogs, while Cheryl Fuller at Jung at Heart ponders the overlapping of clinical and personal material in psych blogs. Bloggers are out wandering in a wilderness of words and feel the need, every now and then, to pause and wonder, "Where the heck am I?" or "Where did everybody go?"

Depending on the blog, one might occasionally visit a site for news or information, but more commonly I would say that one goes there (and much more important, returns at least once) because the sensibility and the perspective are worthwhile. Similarly, I read, say, The New Republic not because I agree with everything therein or find all of the articles noteworthy, but because I know that I'm likely to find something compelling in any given issue.

As I've written before, the narrow subject blog is not for me--I could write about nothing here beyond psychopharmacology or psychotherapy, but that would bore both me and potential readers. So I write about whatever bee is in my bonnet on a given day; in that sense, my idiosyncratic interests motivate me more in this blog than psychiatry does. But my bonnet attracts only certain varieties of bees, and I can think of any number of subjects that never will be refracted through this eccentric sensibility: cooking, ballet, pro wrestling, ice hockey, big game hunting, etc.

I started this blog at a time when I had moved to a practice that is in some ways relatively anonymous. I work with public patients over a limited period of time. Nothing prevents patients from hunting down a computer (at a public library if need be) and looking me up, but because of the nature of their problems and of our interaction, that is much less likely to happen than if I worked in a private or psychotherapy setting.

I may at some point in the future add on a part-time private practice, which probably would be psychotherapy-focused, and I've wondered what that would mean for the blog and vice versa. Perhaps I would alter the content significantly, or perhaps it would remain the same and merely be "grist for the mill" as the cliche goes. But inasmuch as the site would have the potential to be a recruiting tool (or, regrettably, a deterrence tool), I would probably feel obliged to upgrade the professional content a bit. But I'm not sure I'm motivated at present (I'll have to come back and edit that out though if I do get motivated...).

The Funny Book

"And yet you are sad. I had rather have a fool to make me merry than experience to make me sad; and to travel for it too!"


Rosalind



When I splurged on the luxuriant two-volume Complete Far Side five years ago, my then five-year old took an interest for some reason. She was accustomed to seeing me reading (a lot), but the sight of my laughing out loud at a tome nearly as large as her was irresistible I suppose. So we developed a regular habit of reading "the funny book," as she always called it. We enjoyed it on two levels--I enjoyed her company and Gary Larson's sublime sense of the absurd, while she enjoyed all of the funny-looking animals and people. She always tried to get me to explain the joke, and it was a good reminder of all the cultural foundation beneath a simple witticism.


The other night we retrieved the book for the first time in a long while. She is ten now, but dry wit, like puberty I guess, is still (fortunately) for her a ways off. Analysis of humor is notoriously unfunny, and none of my explanations leads to hilarity--I'm sure Larson could have done a great panel on some solemn-looking kid cramming to become a comedian or a cartoonist (and it probably would have involved a duck somehow).


The sight of any Far Side cartoon takes me instantly back a quarter century. Larson's strip ran from 1980 to 1995, but it was pre-eminently a creature of the 1980's; tellingly, he took a year-long sabbatical in 1989, and the last five years of the series seemed tired and plodding in comparison to its heyday. Even genius runs its course. To me The Far Side is one of the very few great cultural products from that benighted time; before Seinfeld was the "show about nothing" in the following decade, Larson's work was the cartoon strip about nothing--except raw wit and the unabashed depiction of ludicrous but pitiable humanity.


I like my humor in lightning flashes: the devastating turn of phrase or sight gag. The best visual humor, whether in the old-fashioned pen and paper cartoon or in a digital concoction on The Daily Show, bursts upon us in an instant. I always liked Larson's style because it was so simple, even archaic; its visual directness contrasted with its extreme semantic shrewdness.


Far Side kids were always chubby, naive, and incredibly dorky--they were wide-eyed in a crazy world. The men tended to be of two types, either nerdy and vulnerable (and therefore paired with a strong-minded woman), or oafish and slovenly, but in a complacent, bachelor, devil-may-care sort of way. The women were matronly and, it must be said, homely in the extreme.


Of course the strip was dominated by animals, but they, like all the clowns, scientists, aliens, and cavemen, were really ways of accentuating our own very peculiar propensities in an unfamiliar host (witness the praying mantis kids having breakfast: "Mom, Edgar's making that clicking sound again!"). I have no idea what Larson's views on animals is, but his cartoons often implied the mayhem that humans are continually creating in the natural world (one of my favorites shows a suburban dude's consternation as some bears direct their sewage pipeline into his living room).


Looking back now, nuclear holocaust was a surprisingly frequent theme (it's not easy explaining to a ten-year old how that's funny), as are scientists shown as careless and as clueless as the rest of us. Compared to, say, New Yorker cartoons, shrinks were a rare subject (although one of his best shows a hapless "Mr. Fenton" perching in the office coatrack); Larson was writing for a less thoroughly therapized readership. But I can't imagine any cartoonist having more fun with hell (nerds in hell ("Hot enough for ya?"), distributing accordions in hell, video racks full of nothing but Ishtar in hell, pizzas being delivered to hell).


Far Side humor is frequently satirical of course, but never witheringly so. The animals were counterpoised to people as if to remind us that we, too, are animals, with our own limited needs, visions and repertoires. People are more often greedy, selfish, and short-sighted than truly malicious (yes, that's a compliment). And if Larson took aim at the most self-important among us (as groups, that is, and without naming names), that is as it should be. An artist in the deepest sense, he delighted and instructed, showing us how contingent, ridiculous, and yes, cruel and unjust human and non-human worlds can be, and doing so while being, well, funny as hell.

Psycho-Logical

M. C. Escher: "Night and Day"

You start a conversation you can't even finish it

You're talking a lot, but you're not saying anything

When I have nothing to say, my lips are sealed

Say something once, why say it again?

Talking Heads

1. Where has Anonymous gone? For weeks, months maybe, a comment (acerbic, incendiary, ingenious as the case may be) for virtually every lowly post, but suddenly nothing, and with no explanation. Is this just a camping trip, off the grid? Should I be concerned? Was it something I wrote? Sure, there are lots of other bloggers--and commenters--in the Internet sea, but I just don't understand...

2. In the era of increasingly mechanized, rapid-fire medicine, no refrain is heard so often as the deep need of patients (that is, all of us, eventually) to have their stories listened to, at length if need be. I'm a big believer in this, as it is usually therapeutic--except when it isn't. Another artifact of our medical non-system is massive redundancy, as folks are shuffled between various providers across disciplines and up and down hierarchies.

Every now and then I have significant past records on a new patient before the first appointment. I like to get the story au naturel from the source, but I do always skim through any records I have beforehand in case any glaring discrepancies come up. Sometimes it happens that once a patient learns I have records, he becomes disinclined to go through a story that has obviously been rehashed many times. "Don't you have it there?" he says, pointing to the chart. (Where I work now he may be there under pressure, not entirely by choice).

Well, in a way I have the story, and in a way I don't at all. Obviously I have ways--not always effective--of trying to get someone talking. But just as one has a right to waive informed consent, one has a right not to cough up a life story upon request.

3. Many people seem fascinated by forensic matters, but I never have been, whether in life, popular culture, or psychiatry. Abstractly, the problem of evil is compelling, but in practical terms I find wrongdoing and mayhem to be merely sordid and sad. So the dimension of psychiatry that involves trying to figure out whether someone is lying or "gaming the system" is not my favorite.

Some clinicians are surprisingly jaded about disability status. Once someone has obtained disability status, they believe, they are beyond the pale, that is, consciously or unconsciously motivated not to get better, and condemned to a life of wanton passivity. I'm probably just naive, but I find it easier to unambiguously identify those who cannot work than those who definitely could and merely won't.

Disability payments are not large in the overall scheme of things (i.e. in middle class terms), and seemingly shouldn't offer so much temptation. But many of the people seeking it aren't in the game for middle class stakes anyway. No, their options are closer to minimum wage, which may not pay a great deal more than disability would. And it's odd how persistent unemployment starts to make people feel a lot more disabled, when logically of course they should feel merely unemployed. And a criminal history can make it a lot harder to find a job. As one repeat felon memorably told me the other day, "I need a bailout."

Of course it's good for one's self-respect and dignity to work, or even to keep trying to find something. It's also good for the waistline to exercise regularly and eat more vegetables. Wisdom cries out in the streets...

President Parker

(Courtesy Marvel Comics--hope they don't mind)

Highbrow, lowbrow, highbrow, lowbrow...I guess it averages out in the end. It's a good thing the Internet is bottomless--in all the Obamamania I had managed to overlook our new President's appearance in, of all things, a Spider-Man comic book. Supposedly Obama is a Spidey collector--he is both more meticulous and better-funded than I am, so I'm guessing he has my modest stash beaten easily.

So many parallels between Obama and Peter Parker. Just as Spidey (who burst on the scene in 1962 in the issue pictured above) was an introspective and complicated hero compared to the unflappable but stiff heroes of the 1940's, so Obama aspires to a new direction after World War II and baby boomer presidents. Does that make John McCain The Vulture? Mitch McConnell the Sandman? Sarah Palin resembles the Scarlet Witch a bit, but she was a good guy. Oh that's right, we're postpartisan, it's all good now...

Wallace for Wednesday

Jean Baptise Camille Corot: "The Cow at the Watering Place"

Just because.

The Well Dressed Man with a Beard

After the final no there comes a yes

And on that yes the future world depends.

No was the night. Yes is this present sun.

If the rejected things, the things denied,

Slid over the western cataract, yet one,

One only, one thing that was firm, even

No greater than a cricket's horn, no more

Than a thought to be rehearsed all day, a speech

Of the self that must sustain itself on speech,

One thing remaining, infallible, would be

Enough. Ah! douce campagna of that thing!

Ah! douce campagna, honey in the heart,

Green in the body, out of a petty phrase,

Out of a thing believed, a thing affirmed:

The form on the pillow humming while one sleeps,

The aureole above the humming house...

It can never be satisfied, the mind, never.

Wallace Stevens

The House of Woe

"A sad tale's best for winter."

Mamillius

Sometimes I buy Library of America editions just to prod myself into reading someone I wouldn't usually seek out, and so it turned out with Edith Wharton. American prose fiction roughly between Twain and Faulkner has never been a favorite, and I can't abide Wharton's literary stablemate Henry James apart from his short stories (which limit his gratuitous and vague prolixity, something I might be said to know something about), but I decided to undertake The House of Mirth (I remember enjoying Ethan Frome in High School and The Age of Innocence when I read it some years ago).

It's not a prepossessing title (has "mirth" ever been in regular use, even in 1905?), and I find Wharton's style to be fastidious at best and precious at worst. And her metier, like James's, seemed to be writing about the superrich gallivanting around on permanent vacation; these characters had either to generate some drama or die of a cosseted boredom. But Mirth turned out to be worth it, largely of course thanks to protagonist Lily Bart.

Bart is intelligent, sensitive, and, we are repeatedly told, beautiful, but her tragic flaws appear to include a certain vagueness and passivity in her character, and an inability to go after or even fully recognize what she wants; she seems to float through the book, buffeted by her own occasional impulses and beckoned by rewards that finally provoke only distaste. She craves luxury and admiration, yet cannot enjoy them with a compliant conscience; she also craves respect (from herself and, for some reason, from the aloof and censorious Lawrence Selden), yet is unwilling to take the road not taken that might lead there. As she drifts and dreams, riches, esteem, and dignity all end up eluding her. As Wharton writes in this grimly diagnostic passage:

And as she looked back she saw that there had never been a time when she had had any real relation to life. Her parents too had been rootless, blown hither and thither on every wind of fashion, without any personal existence to shelter them from its shifting gusts. She herself had grown up without any one spot of earth being dearer to her than another: there was no centre of early pieties, of grave endearing traditions, to which her heart could revert and from which it could draw strength for itself and tenderness for others. In whatever form a slowly-accumulated past lives in the blood--whether in the concrete image of the old house stored with visual memories, or in the conception of the house not built with hands, but made up of inherited passions and loyalties--it has the same power of broadening and deepening the individual existence, of attaching it by mysterious links of kinship to all the mighty sum of human striving. Such a vision of the solidarity of life had never before come to Lily.

It occurs to me that what are now often spoken of as the sins of our time--self-indulgence, superficiality, triviality, rootlessness, relativism--have always been among us, but mainly in the persons of the rich. Our contemporary ills may be primarily those of prosperity: too much free time, too many diversions, and too much latitude for self-creation--or self-destruction. This manifests itself in bodies as well--Wharton repeatedly notes (and not in a good way) the corpulence of the rich, never quite concealed beneath the finery.

The book is also an interesting reminder that the problems of prescribed psychotropics long antedate benzodiazepines in the 1960's. Lily overdoses on what is described as "chloral," and I assume that means chloral hydrate, which is a very old hypnotic drug (synthesized in 1832), but one that we were still prescribing when I was a resident a dozen years ago. Misery and self-medication go back a long way, unfortunately.

Overall I commend The House of Mirth as a fitting midwinter read. Something to put aside for the next ice storm (results may vary, use as directed, and do not combine with Jude the Obscure--or chloral hydrate).

Political Animals

"Conservative: a statesman who is enamoured of existing evils, as distinguished from the Liberal, who wishes to replace them with others."

Ambrose Bierce

Mooching as I often do from the Arts & Letters Daily website, I see an intriguing article on the genetic influences upon political attitudes. As James Q. Wilson describes, with recognition of the logistical limitations and theoretical nuances involved in such inquiry, identical twins (who share 100% of the same genes) are significantly more similar (40% in the research cited) in their liberal vs. conservative attitudes than are fraternal twins (who share 50% of their genes as do any siblings). Genetic influence is always about probability and not destiny, so it is not impossible, merely less likely, for twins to differ remarkably in political outlook (or in any number of other attributes).

As Wilson notes, liberalism and conservativism are complex constructs, can apply differently to social, cultural, and economic domains, and do not always match up neatly with Democratic or Republican parties at any given time. He points out the interesting fact that for the past century or so of American history, when people have been more or less free to express their political views, there has been a remarkable 40/40/20 balance of liberals, conservatives, and independents going either way depending on circumstances.

It is tempting to speculate from this that even in remote evolutionary time, human social groups may have benefited from some equilibrium between genes that may promote innovation, mobility, and cultural fluidity and those that my incline toward stability, order, and traditional authority. Too much of one or the other could have predisposed groups throughout history to either fragmentation or rigidity. Just speculation though.

When I think of liberals vs. conservatives, the following values come naturally to my mind; this is simplistic and certainly not black and white, as I find myself identifying with both lists depending on contexts. Liberalism: equality, fairness, freedom to (empowerment), creativity, secularism, idealism, novelty. Conservatism: merit, responsibility, authority, order, realism, religiosity, freedom from.

These are just off-the-cuff associations, and I realize there are overlaps and exceptions. I don't know how well they match up with recent incarnations of Democrats or Republicans; but common sense tells me, as it does many others, that too far either way lies madness.

The Realist

Polonius: What do you read, my lord?

Hamlet: Words, words, words.


I am a few days late in noting the passing of John Updike, but there is a good reason for it--as many have noted, it doesn't really seem possible that he's gone. As will be the case when Dylan passes into memory some day, it seemed that Updike--like the poor, with whom he had nothing else in common--would always be with us.

In recent years I have mostly encountered Updike through his New Yorker criticism, which always seemed very much at home in that urbane and perspicuous publication; his fiction, I confess, I generally found to be pleasant, but in a vague and uncompelling sort of way (he wrote prolifically, and I also confess I haven't read more than a small fraction of his output). He wasn't to my preferred literary taste, but that probably reflects more on my not unlimited reading range than upon his worth.

Frankly, I have trouble enjoying and really being moved by contemporary American realism, which for me is typified by Updike, Cheever, and to a lesser degree Raymond Carver. Its very ordinariness feels journalistic to me; in prose fiction I have always been drawn more to fabulism, broadly considered, than realism.

To my mind the prose writer's eye cannot merely be a contemporary camera; it must imbue its subject with an illuminating oddity, whether owing to temperamental exoticism (Hawthorne), metaphysical depth (Melville), a deranged but transfiguring style (Faulkner), an exquisite taste for absurdity (Nathanael West), a specific and powerful point of view (Flannery O'Connor), or sheer exuberance that carries all before it (Bellow and Roth).

To me Updike was none of these things. In the stories and novels upon which his reputation will rest, he casts a finely perceptive and appreciative eye upon the rituals of suburbia and American culture. Many have cited, with either admiration or contempt, his prettifying prose, and indeed, he could make a trip to Wal-Mart sound eternally glorious. But there seemed to be something facile and glib in this project.

I do not mean to speak ill of the dead, or to pick a fight with anyone who deeply loves his work. Again, my preferences have as much to do with my own particular needs in literature than with any serious foray into literary criticism. But Kafka wrote somewhere that literature must crack up the frozen sea within us; Updike's work felt less like an axe than like a massage. Some people love massages; I don't. (Axes I love only in a literary sort of way).