pseudoisaac

I approached the bus stop and found a big fat guy smoking a cigar, stinking up the whole place, despite the clear signs saying no smoking in the bus shelter and the fact that other people have to stand there and breathe it in order to catch the bus. Maybe he had a family who would someday be mourning his death of lung cancer. Maybe he would soak up hundreds of thousands of dollars in taxpayer money or money from his fellow employees’ health premiums with many years of health problems. How could he? But he struck up a conversation with me, he began telling me his life story in fact. And he mentioned that when he was younger his house caught on fire and his sister died in it. So, his psychiatrist, a person in authority, prescribed smoking as a behavioral therapy. The psychiatrist thought that he needed to do something involving sparks and flame every day in order to overcome his post-traumatic symptoms. It was a decent idea, in line with standard treatment of phobias through systematic desensitization. But it doomed the man to a lifetime of smoking. It is just another mini-lesson in prejudice for me. Before I go thinking, "This asshole needs to stop breathing his smoke in my face, and quit," "We all pay the price" of tobacco use, and so on, I should think of the many ways in which a person is pushed and pulled around by forces and people they cannot control, some of them malevolent and some benign, and some people, like the psychiatrist, whose good intentions brought on consequences they did not foresee.

I bought a new (used) car. Fuck yeah. It is a 2008 Toyota Corolla. So basically a sex machine. I am going to be up to my NECK in pussy. It is a manual transmission, though, which means I can no longer eat burritos, update my Facebook status, and put on chap-stick while driving without putting other people at risk of serious physical harm. But after careful consideration, I have decided that is a risk I am willing to take. Originally the salesman said he had to drive the car off the lot for liability purposes for the test drive, but when he got in the car and realized it was a stick, he said, "Um, maybe you should drive it off." I guess he was not comfortable with it. The only problem is that I will have to pay monthly until I am 60 years old. But since I have been riding the 2 almost daily to get to class, I figure I will be slashed by a starving prostitute with a boxcutter before I get to that age. Between mothers hitting their infants, schizophrenic men shouting "bizz-bizz BEE-beeee!" again and again, and flat-out drunk people who apparently are running errands, I expect the daily nuthouse that is that bus to take my life somehow, eventually.

Also microbiology is going well. It is kind of easy actually. I think I have larn’t most of this stuff in other classes. The lab section is quite tedious though.

Also, ladies: stay away from me. You don’t want to get what I got. I was informed by my optometrist that I have meibomianitis, the worst kind. The prognosis is not good. Treatment involves hot towels.

In between classes today I realized I was hungry and sleepy so I stopped in the coffee shop near my next class. I ordered a cup of coffee and looked at the giant apple fritter and was somewhat grossed out by it because the last time I had a quarter-pound pastry of the like I felt sick, greasy and tired for the next hour. So I got a small bagel with cream cheese instead. And I think this is the sort of reaction I read about in an interview with a doctor in the paper recently. He spoke about how smoking used to be everywhere – restaurants, hospitals, homes. But now many people are annoyed or nauseated by smoking, and smokers are expected to confine their habit to someplace where it won’t irritate other people. The doctor said that in the future, people will have the same reaction to Double Downs and 1500 Calorie meals and 64 ounce sodas: they will no longer be socially or commercially acceptable. For instance if a restaurant puts a tub of fatty artichoke dip in front of you with a basket of chips, it will be considered strange. A "venti" Frappuccino will be off the menu because it is just 20 ounces of sugar slurry and leads to blood sugar spikes, even in non-diabetic people. Meals that are only fat and salt will be rejected as not really food. And a fast-food restaurant that makes its customers shit for the next two days will actually lose business, go figure. He said that this kind of visceral reaction to so-called "hyper-palatable" foods (i.e. baby food consistency) will make the reasonable portion size and fat/salt/sugar content the default.

Anyway the apple fritter was probably about 300 calories and while it looked appealing momentarily, I thought about how much it weighed and about the greasy fingers I would have afterward, and it seemed less desirable. I only had two hours before I could get home and prepare a lunch of actual food.

On the 17 going from the U to the library a woman boarded the bus with a crying infant of 2 and half to three and a half years. The mother got on and dragged the child to the back of the bus, far behind me. But I could still hear the mother clearly when she said, among other things, "Shut up!" "I’ll give you something to cry about" and "…trynna feed yo fat ass!"

A couple of things were odd about it. Why yell like that at a small child? Why call a small child fat? Why call a small child fat when you yourself are obese and can barely fit in the bus seat? Most importantly, why was I disinclined to say anything? Nobody said anything. And as I thought about it I realized I would have said something if it was a white woman who was verbally abusing her child like that. But because the mother was black, there was some kind of cultural allowance that made me and others keep quiet. A misguided respect for culture may have inhibited us, at the expense of the child’s welfare. Maybe if I or someone else had spoken up, the mother would think twice before berating her child like that in public in the future. We may have lower standards of conduct for black people, especially if they fit a certain description, as this mother did. Also I personally did not say anything because I feared being shouted at and lambasted like the kid was.

In any case, not speaking up does not benefit the small child.

In my abnormal psych class the professor asks students to speak to the class about any mental disorders we may have, which we possess in abundance. I talked to the class about depression, another about severe depression, and another two about generalized anxiety disorder.

But today was the most interesting one of all. We are in the middle of the unit on schizophrenia and related disorders, and at the beginning of class the professor said we were going to have a student speak but that he apparently wasn’t here today so it would have to wait. But sure enough, within a couple of minutes a student walked in, made his way to the front, and took a spot sitting on a desk facing the class. I could hardly see his face because of his long hair, but he was clearly under 20 years old and had sat unobtrusively at the back of class until I noticed him now. He wore jeans, skateboarding shoes, and a black t-shirt with a faint logo, and had thin, muscular, veiny arms. And he slouched.

The professor and he had obviously spoken in advance and agreed that the prof would ask the questions instead of the student speaking on his own for half an hour, which, it became clear, would be impossible. Over the next half an hour (and we could have spent much more time), we found out that our classmate was in the center of a conflict between two voices, one a female named Truth, who was often hilarious and pointed out the absurdities of life and made ironic commentary on other people; and a prodding, loud, harsh male voice who urges him to kill his father, burn the school down, and kill himself. We found out about his cumulative one year in a psychiatric hospital and his heavy history of LSD, ecstasy, "bath salt", and ketamine use. We found out he hardly sleeps because that only makes the auditory hallucinations worse, that he smokes two packs a day, and that when someone laughs hard, he sometimes sees their entire face morph into that of a demon. He knows a lot about the two voices that are vying to gratify themselves through his body. He knows they seem more persuasive when he has been drinking and that it is hard to ignore a voice that is inside your head, urging you to do something again and again.

He has been put on risperidone but couldn’t stand the side effects. While he was on the drug the hallucinations subsided, but he said he felt like a zombie. He said that in that state he was only sustaining the physical self but that he was not really living, and didn’t want to be that way for the rest of his life. In addition the drug made his whole body, especially his neck, stiff like a person with Parkinson disease. Who can blame him for feeling that way? He has never hurt anyone physically and is in post-secondary school, after all.

But who knows what his future holds? He said the first problems began in high school with major depression, which may have been the prodrome. They say schizophrenia in males generally begins in the late teens to early twenties, later in females. He obviously has some detachment about his disorder and some sophistication in dealing with it and talking about it. If he can get through the next five to ten years, maybe he will be fine.

I appreciate this kind of thing because it makes me think again about the people all around me. Any time I walk into a room, there are people there with all kinds of interesting stories to tell. Some of them have serious metal disorders and pain that are invisible to me. Two people came up to me and thanked me for talking about depression, but my own story seems small compared to that of this student with schizophrenia. You find out more and more each time you talk to someone. As Karl Menninger said, a fish that catches a hook on a line thrashes about violently trying to save itself. All that the world sees is the thrashing and tends to misunderstand it, because the free fish cannot understand the struggles of the hooked fish. This kind of discussion, where people share a little bit of themselves because they are interested in helping people and the rest of us are interested in helping people, is consciousness-expanding.

I am looking forward to the unit on eating disorders, and I expect at least five women in the class of 30 to come forward and talk about long struggles with eating. It is something I have always tried hard to understand.

4 Oct 2011

The Circumcision Debate: Is a Developmental Approach Useful?

Circumcision, or non-therapeutic excision of the foreskin in newborn males, is fraught with controversy. A recent effort in San Francisco to ban the practice brought the issue national attention but was defeated amid accusations of anti-Semitism and frivolity (Medina A20). Meanwhile, medical professional associations in the United States have taken a neutral stance (Christakis et al. 2000). Kathleen Stassen Berger states that good theories are meant to be practical (58). The goal of this paper is to see whether a life systems approach, taking into account the biosocial, cognitive, and psychosocial domains, can be helpful in resolving this emotional and charged debate. After mentioning how these three domains are relevant to the circumcision issue, I will relate my own personal experience and then offer a final thought on how useful the developmental approach is in the circumcision issue.

Biosocial

Berger describes birth as a traumatic process from which the infant nonetheless recovers quickly. She emphasizes the plasticity and resilience of newborns and mentions medical practices that have reduced the newborn mortality rate in the United States to less than one in 100 (98). An analysis of circumcision that appeared in the journal Pediatrics, while somewhat critical of the practice of routine circumcision, acknowledged that the rate of complications was only 0.2% and perhaps even lower (Christakis et al. 2000). With this emphasis on resilience, the circumcision procedure is unlikely to have a negative impact on most infants. However, some medical professionals have called for more attention to the rare but lifelong damage caused by botched circumcisions (Denniston 165). These complications can damage the person’s confidence, sex life, and feelings toward his parents later on in life.

Cognitive

At the time of circumcision, the baby boy is usually less than a week old (Christakis 2000). Berger emphasizes that during this time the infant is developing cognitively by exploring his world with his senses, with much of his behavior purely reflexive. Although she describes the newborn as an active explorer, she admits that “memory is fragile in early life” and that the earliest evidence of infant memory was demonstrated in 3-month olds (164). Thus even those who are vehemently opposed to circumcision cannot claim, based on the current evidence, that the infant has traumatic memories of the procedure.

Psychosocial

Berger states that the newborn baby begins with “reactive pain and pleasure” where either contentment or distress predominates at any one time (180). With this in mind it is easy to imagine the circumcision procedure causing distress to the infant, particularly if an anesthetic needle is used before the cutting itself or if religious practices forbid anesthesia. Increasingly, insurance plans and government payers are refusing to reimburse practitioners for non-therapeutic circumcision, which could conceivably lead to the procedure being performed by amateurs in order to satisfy religious or ethnic imperatives (Denniston 172). This may result in more botched procedures and more pain inflicted on the infant. In addition, an infant cannot express that he has soreness in his penis or monitor himself for infection. All these issues can bring pain and discomfort to the child during a time when he should be bonding with parents and learning to feel trust, security and contentment. On the other hand, the infant is not alone but is part of a family and culture. Circumcision may be a way of welcoming the child into the wider group through an ancient tradition, affording psychological and social benefits in its own right.

A personal experience

I was circumcised, without my consent, as an infant in accord with my parents’ religious beliefs. Later on as a teenager, a friend and I discovered that another friend was uncircumcised, and we found this to be a curiosity. Without thinking about it, we labeled him as somehow having a funny-looking penis or having parents who did not feel like handing over the extra twenty dollars to have the procedure done when he was born. Later still, I learned about female genital mutilation and recognized some similarities between the milder forms of female genital mutilation and male newborn circumcision as it is practiced today. This led me to oppose male newborn circumcision, and I believe I was fortunate to have had this realization before having children and imposing the procedure on them. But I realize now that for many parents, the first time they question the procedure is when they find out, on the day after delivery, that Medicaid or their insurance policy will not cover the procedure (Denniston 233). At this point the parents may be in no position to reflect properly on whether to go through with the circumcision or not, and end up feeling frustrated and confused.

A final thought

Circumcision will probably continue to be legal and widespread, but I believe it will decline in this country as more people undergo the change in thinking that I did and as potential legal challenges to the practice arise. The three developmental domains – biosocial, cognitive, and psychosocial – provide helpful input into how circumcision affects the developing person. The biosocial perspective points to harmful complications. The cognitive perspective is relatively neutral. The psychosocial perspective points to the pain of the procedure but also to the sense of belonging and satisfaction the procedure can bring. Reflecting on this through the developmental perspective has strengthened my conviction that I would not allow my own infants to be circumcised. And because it is indeed practical, I will bring the developmental perspective to bear on other issues that are important to me.

Works cited

Berger, Kathleen Stassen “The Developing Person Through the Life Span” Worth Publishers: New York, 2011

Christakis, Dimitri et al. “A Trade-off Analysis of Routine Newborn Circumcision.” Pediatrics Vol. 105 no. 1 January 2000.

Denniston, G.C. et al. (eds.) “Bodily Integrity and the Politics of Circumcision” 2006 Springer.

Medina, Jennifer “Efforts to Ban Circumcision Gain Traction in California” New York Times. 5 June 2011, page A20.

In reading the first few chapters in this class of mine I have already been struck by the sense that as a person I am not really of my own making. We have read about the influences of family, genes and culture and the interactions of these. We have read about the influence of technology, which is often under-emphasized in discussions of development. I am a healthy, educated person partly because I received life-saving vaccines at the right time and for a low cost. I never was infected with a virus that might have stunted my growth or impaired my cognition. All the necessities of life are provided for by the many companies competing for my money. I enjoy a varied diet thanks to a safe food supply and a global transport system that brings it to my city. (Outbreaks such as the current Listeria outbreak are in the news precisely because they are so rare.) I am not a smoker partly because of the triumphs of public health campaigns legislators and attorneys general who prevented me from ever getting hooked.

In reading I have thought about my love of birds and dinosaurs and deep time and my love of science generally. This, too, goes back to reading dinosaur picture books at bedtime with my parents. At regular check-ups, my pediatrician undoubtedly extolled the benefits of reading to children and encouraged my parents to do so. The doctor was supported in this by the most recent evidence and guidelines.

My love of nature is there because of family walks by the Minnehaha Creek. My fascination with biology and medicine is there because my parents had no qualms about letting me plunge my fingers into giant puffball mushrooms and into reeking bogs in search of frogs and insects. They even indulged me in my mold collection until it came time to throw some of it out for sanitary reasons. My series of pet rats was the same kind of thing.

I write this down because one has a tendency to imagine one is a piece of clay to be sculpted as one wishes. The Enlightenment ideals I admire would have it this way. But it is worthwhile to be reminded sometimes that one is so much the product of one’s connections and influences and of the many scientists and caregivers and industrialists who came before one, and so little one’s own creation.

Young people: get an education. Go as far as you can with your schooling while the subsidized loans are available and the family and social support is there. Going back to school has made me realize how important it all is.

I have had a glimpse over the past few years of the alternative to being an educated citizen: long years of repetitive, mindless work stretching on before you, with you having no role in advancing the field. With nothing to look forward to but the end of the shift, the end of the workweek, and the end of one’s working years. A situation where the place where one spends the majority of one’s time is nonetheless the least significant and most banal part of one’s life. Each day wears on you, each day feels like another eight hours that you will never get back. The only imperative in it is to keep the routine going, to go as long as you can before your health fails or you can take early retirement.

On the opposite side of life is school and education, where you make slow but inexorable progress and advancement. Where you make the important connections and can attain mastery with the necessary diligence. It is another world entirely. And once you do attain mastery in your field of study or your degree, you are ready to apply it to your career, where you can be an active participant in the field and a leader in life. You can nourish your child-like thirst for discovery and your inborn adventurousness.

This is not to say that everyone needs a college degree or more. Many people will be fine with a high school diploma and the satisfaction of physical work, the many roles necessary in the service industry, or the joys of a domestic life. A certificate is enough for a satisfying career in HVAC or plumbing or personal care-giving, for instance. And many of these jobs pay well. But I hold that for most people, the more education, the better.

– I just finished reading “The Reapers Are the Angels” and cried when I turned the last page. Yes, it was about zombies. But it was really good. The author is a high school teacher in New York City. The focus of the story is a fifteen-year old girl, born after the apocalypse, who moves about the wasteland with a special eye to the beauty in the world and a kind of survivor’s wisdom. They really need to make a movie out of this book. And they need to cast the chick from Winter’s Bone. Except she is too old now. But someone similar.

I am reading “The Walking Dead” comics series as well, and it too has a sense of people building back up after the catastrophe, which is something the author of Reapers mentioned in an interview. Although the apocalypse has happened, everyone is able to start over, becoming raiders or wasteland doctors or hunters where they were just office workers before. Come to think of it, “Fallout 3” had the same feel, only it was a nuclear war that led to that particular horror.

– Continuing with the night shift. It is going well. I sleep from 12 to 8 or 1 to 9pm. In the morning I get coffee at the new Urban Bean on Lyndale or just make it at home and enjoy the sun coming out. The mornings are really cold nowadays.

– My abnormal psych class is going well. It is very much based on the text and is pretty straightforward. I start my microbiology class with lab and my lifespan growth and development class next week, which will require more travel. Once again they are all classes I tried to take as an undergrad but could not because the sections were always full. I bought the textbooks, too. Only 400 bucks.

I had a dream that the monster from Frankenstein was hovering over my bed, watching me mutely with his ghoulish but knowing eyes. It was a nightmare actually. It coincided with my finishing the book by Mary Shelley, the first time I had read a book entirely in digital format, on my phone and on a computer at work. The fully text is very accessible because it is a public domain book and a classic.

My nightmare was the same horrible scene Shelley said she envisioned when she conceived of the book. She was trying to think of a ghost story to share with her friends while they were on vacation. She imagined a scientist who created a hideous being from dead bodies and other unholy means and materials. Horrified by what he had done, he aborted his work and went to sleep, hoping to put the whole thing behind him. But sure enough, as he slept, the creature made its way from the laboratory to his bedroom and sought answers from its creator, being, as it was, devoid of memory or belonging.

The description of the monster in the book is much scarier than the monster portrayed by Boris Karloff in the classic movie or by Robert DeNiro in the Kenneth Branaugh version. He was described as having long black hair, yellowish skin pulled taut over his muscles, and he was said to be very fast and was a very quick learner.

That was only a nightmare. Two days later I was awoken by an actual creature in my room. A bat was hopping around on the floor and squeaking. Those things can make a lot of noise. I threw a shirt on it and put it in a box, then let it out outside. It crawled up the side of the building. I think it may have injured itself on a wire in the window it entered through, where the squirrels have been chewing.