Fool Me Once...

"Sir, I have found you an argument; but I am not obliged to find you an understanding."

Samuel Johnson

"Be wise with speed;

A fool at forty is a fool indeed."

Edward Young

A few brief reflections today:

1. Errol Morris has begun an interesting series on anosognosia, which is a lack of knowledge of a deficit or disability (in psychiatry we speak of "lack of insight," or lack of awareness that one has a mental illness). It pertains to a number of specialized neurological syndromes (which may include certain varieties of hysteria), but in a far broader sense it seems to me that it pertains to foolhardiness--the fool is precisely he who is smugly confident that he has all the relevant information or skills that he needs, when he doesn't. Folly is the self-assured ignorance of one's own ignorance. Conversely, an ignorant person could be considered wise if he is aware of his ignorance (the first lesson of Socrates). All organisms have imperfect knowledge and therefore may be considered ignorant, but only human beings can be foolish or wise. This must finally be neurobiological, but with an inescapable moral component.

2. According to a review, in his biography of Marcus Aurelius, Frank McLynn considers the Roman emperor's stoic philosophy monstrous and inhuman inasmuch as it prizes individual virtue and peace of mind over vulnerable care for the external world. I have often thought the same about the Zen attitude of non-attachment, but it occurs to me that these philosophies are meant to be bracing tonics, not to be imbibed in excess. It is said that the only difference between a medicine and a poison is the dose; the same could be said of ideologies.

3. The latest entry in the New York Times's delightful philosophy blog looks at existentialism's subject/object distinction in the context of the pop phenomenon that is Lady Gaga. The point seems to be that Ms. Gaga (?) embraces the objectification of the female form, exaggerates it to an absurd degree, and then flaunts it like a weapon, exulting in her power. Arguably this has gone on for millenia, but never apparently with such gusto or in such over-exposed fashion. Inasmuch as one consciously and authentically objectifies oneself, one also operates more deeply as a controlling subject, but at the price of becoming more broadly an object. It is the plastic surgery conundrum again--does one ultimately do it for oneself or for others? Both, of course, but in each individual case--and presumably cumulatively as well--one effect must prevail.

4. One can run a psychiatric clinic without benzodiazepines or stimulants just as one can run a pain clinic without opiates or an office without air conditioning. That is, one can--human beings lived without these things for most of history and continue to do so in much of the world--but for better or worse this is what we call civilization.

5. I am always warily curious about the patient who was dissatisfied with his last doctor, and not because there aren't plenty of lame doctors around. But when I hear "All he wanted to do was dope me up on medicines," I am tempted to reply, "Sort of like you're trying to get me to do now?" and when I hear "He kept changing my medicine every month," I think, "Sort of like you'll ask me to do next visit?"