Thursday, October 21, 2021

Adventures in Mind Management: Media Consumption

Sometime last year, I was discussing podcasts with a friend. I sent her a screenshot of my subscriptions, and she commented that everything was so heavy. 

At the time, I thought I had to listen to all the serious podcasts. But although it took me time, I finally realized that these were not making me happier (just the opposite) or better able to make the world a better place.

Since then, I've started skipping a lot of podcasts that would, to a first approximation, just make me angry. I've added in:

I still listen to things like Pod Save America and Lovett or Leave It, but have completely cut Bill Maher and most Sam Harris (the meditation ones are good).

I've done a similar analysis of TV / movie, although we are really liking Madam Secretary (so not all fun and games).

Wednesday, October 20, 2021

Adventures in Mind Management: Drugs Part 3, Anxiety and Pot

Mental Health Week continues....

While my depression episodes started more in my teen years, I was a "high-strung" kid well before that. However, being "uptight" hasn't generally been a huge problem since I met Anne in 1992. 

In late 2013, though, I was going through a bad patch that I eventually recognized as high anxiety. My doctor gave me clonazepam, and it was like a miracle for my mood (if not the underlying situation). 

As discussed in this series' other posts, antidepressants have been very hit-and-miss for me, with side effects and a delay in taking effect even when they have worked.

In contrast, the anti-anxiety medicine takes effect in several hours or less (sometimes as quick as an hour). It does not (at least for me) have any side effects, and it doesn't lead to any bad effects when it wears off. I have no urge to take it outside of periods of acute anxiety.

I also know people who are successfully on SSRI antidepressants who take an anti-anxiety medicine as needed.

 
I have not had good experiences with pot (smoked (only once) or edibles) over the years (apologies to Carl Sagan). I've tried gummies and tincture again this year to try to help with my pain, but I either feel nothing or I feel a nausea and unease. CBC-only tincture is hit-and-miss. Generally I feel nothing, although sometimes I feel like the edge has been taken off ala clonazepam. The effect is uncertain enough that it could be placebo. (Which is fine! People should not knock the placebo effect!)

Tuesday, October 19, 2021

Adventures in Pain / Mind Management: Drugs Part 2, 2021

I've been in pain before.

It has varied in cause and type. From surgery without anesthesia for my first two lung collapses to many acute Crohn's attacks, the pain has differed in kind and treatability, but generally not the treatment. I've had morphine, Dilaudid, and fentanyl. I've taken oxycodone to recover on a number of occasions. 

After my fall this year, however, things were different. I had smashed up my face enough to require reconstructive surgery. I broke bones in my spine such that I required spinal fusion. But the overriding pain, from the horrible moment I came to until this current moment has been pain in my hands, even though my hands were not injured. 

Needless to say, this is weird. 

In the hospital, normal opioid treatment covered my face and neck pain. But nothing short of sedation made my hand pain better. The nerve drug gabapentin helped a little, but the hands (especially the left) were still screamingly in pain.

At home, I stayed on the maximum dose of gaba, regular oxy, and some valium when my jaw was wired shut after facial reconstruction. (Especially at first, the jaw being wired shut felt like being trapped, even a little like drowning.) Things were bad, but trauma / crisis bad.

Being terminated without warning from what I thought was the last job I would ever have, well, that changed the nature of my situation. The stunning "betrayal" (to use the characterization by a colleague) by one of my best and oldest friends, combined with the end of that career, sent things deeply downward very quickly. 


It was like how dementor attacks are described in Harry Potter: all the joy is sucked out of you, and you feel you could never be happy again.  

Ever since I read Bob Wright's Why Buddhism Is True years ago, I have meditated and tried to be mindful. 

My default: monkey mind.

After the collapse this year, I knew I was depressed. I could often spot, and then stop, my doom loops of thought. I rationally knew that things would not always be this way. I was generally able to avoid catastrophizing. I did gratitude practice every evening after dinner and did a guided meditation before bed. 

Yet I was still depressed. 

As I mentioned, counseling didn't help. But given my ongoing pain, in early August, my doctors decided to switch around my drugs some. Part of the changes was adding in Cymbalta (Duloxetine), an antidepressant approved for neuropathic pain. 

This and the other changes seemed to help my hand pain a bit, although Cymbalta had a significant side effect that took some experimentation and finessing to accommodate. By September, I had weaned myself off Oxy, only taking it once since then for breakthrough pain. (I am still on the maximum does of nerve drug Pregabalin.)

And then by the end of September, I felt ... unexpectedly ... better. 


I realized that the antidepressant aspect of Cymbalta had kicked in. Although my hands still hurt, my mouth was still numb, and my neck sometimes hurt, I was no longer depressed. 

In addition to still feeling pain, I could still get upset and angry. I could still be sad and disappointed. But despite everything, I could, at times, see beauty in the world, and feel peace and joy. I can appreciate what's good in my life without forgetting (or forgiving) the people who have wronged and betrayed me and my family. (Loving kindness meditation is still a challenge.)

Again, 25+ years later, the antidepressant didn't change who I was or bliss me out. It lets me experience life unencumbered by the disease of depression. 

I still have chronic pain I'd very much like to reduce. I still have to figure out what to do with my professional life (in addition to One Step). But at least now I feel like there is at least hope. Not because of "hard work" or my "free will," but thanks to the drugs.

Monday, October 18, 2021

Adventures in Pain / Mind Management: Drugs Part 1, Backstory

Having read Michael Pollan's How To Change Your Mind and listened to many podcasters wax poetic about the effects of psychedelics, I decided to give them a try. Over several sessions, I eventually took enough mushrooms to have an impact. 

The visual effects were quite stunning. The Georgia O'Keefe and Vincent Van Gogh prints we have came alive (especially the two in Anne's office). But that was the only good thing. Overall, I very much did not like the trip. I felt nauseous and most importantly, not like myself.

This is not the case with antidepressants, at least for me, and at least when they work. 

When I was younger, I suffered from depression, which, in retrospect, was exacerbated by Seasonal Affective Disorder (but I didn't know that at the time). 

After my undergrad romance ended, I spiraled down pretty far. I went to a shrink who prescribed Prozac, which had only been approved by the FDA in 1987. Unfortunately, it made me worse. I didn't sleep for the three days I took it. I thought I was going to die. 

Eventually, I got out of town and had some new experiences. Then I met Anne and had the greatest year of my life (earning, between the two of us, about $20k that year). 

A year after we move to Pittsburgh for Anne to start her job at Carnegie Mellon, EK was born. For their first year, while they couldn't get around or communicate, EK was very unhappy. Additionally, Anne's job was not what they had promised, and my advisor turned on me. I also had undiagnosed Crohn's disease.

Since I had some idea how depressed I was, I started seeing a shrink. Having had such a bad experience with Prozac, I was quite nervous about any new drug, but willing to try anything. After one that didn't work, we eventually landed on the SSRI antidepressant Zoloft (Fluoxetine). 


The effect wasn't so much that I felt happy but that the depression was lifted, and I could see more clearly what the depression had been.

Many people have written eloquently and insightful about depression, so I won't go into it much here. But in short, it is as though there is a weight bearing down on you, especially in your chest. A fog and fatigue in the mind. A cloudy curtain that dulls the colors of things around you.


For me, a functioning antidepressant addresses all these things -- things that prevent you from being truly you. It doesn't change who you are, just lifts the illness preventing you from being you. In this sense, it is no different than an antibiotic clearing up a terrible bacterial head cold, or eventually getting over a very bad flu (or addressing Crohn's disease). 

No one would deny someone drugs for a disease outside the brain. It is irrational that we view diseases (literally: dis-ease) inside the brain any differently. Getting past this prejudice is one of the most important things we can do to reduce unnecessary suffering in the world.

Tomorrow: drugs and 2021.  

Sunday, October 17, 2021

Adventures in Pain Management: Counseling

Ever since my accident in January, I've been in chronic pain. As you might expect, this has had an impact on my mood (and what type of company I am).

In my younger days, I did not have much success with counseling (although there is one related point to be dealt with in a future post). The people I met with just didn't seem very smart, and they definitely weren't insightful or probing.

But a few months ago, I figured that I didn't really have much to lose. I didn't want to talk about my pain with Anne every day, and I was well past my maximum out-of-pocket insurance expenses for the year. So I went to Cigna's website and looked for someone who specialized in chronic pain.

However, my experience was really no better this time. The first session was OK as I laid out what had been going on. But after that, he talked much more than I did, but not about anything useful. (Below is what I wrote to him, although it is probably not useful for you to read.)

My next post on this topic, however, will more optimistic.

C'mon Siggy, Be Better!

I’m sad to write this, but our sessions aren’t working for me. 

You mentioned at the end of our third session that you had talked way more than me, and it hasn’t gotten any better. 

In this last session, I told you a short story about my accident, and then mentioned that I was in the anger phase of the stages of grief. You used the session to talk about the sex life of a patient and the plight of a rape victim, neither of which applies to my situation. You also talked extensively about your son and various of his projects. Also, you had forgotten that my firing was five months after my accident.

Of course, I don’t have anything against small talk and digressions. But those have become the vast majority of recent sessions.

Also, I’m not sure how the homework assignment – figuring out what it would mean to me if my hands were chopped off – is supposed to help me deal with chronic pain in my hands. Given that I face the choice of having my ulnar nerve cut, I’ve already thought about losing access to some function. Am I supposed to be glad that I only have pain, and at least my hands weren’t chopped off? I’m at a loss.

I do appreciate that in the first session I was able to tell you things on my mind. As I mentioned, I don't want to keep saying them to Anne. But I don’t feel that hearing you repeat, for example, what Freud would say about leg paralysis is worth either of our time. 


Saturday, October 16, 2021

Chiricahua National Monument

Another great place to go without crowds.








See the face?


Love how the passage frames the hoodoo at the end.







Saturday, October 9, 2021

Against Longtermism (Short): Again with the Nazis

Anne came across this post by Peter Singer. It reminded me that after I was suddenly terminated from my last job, a good friend suggested that I turn the anti-utilitarian / anti-summing thoughts in this post and this post into a book. But so far, I just can't come up with enough material for a book. (Although I'd love to see someone question the premise that the continuation of humanity is the ultimate good. This does not seem obvious to me.)

In short, I don't enjoy talk of "the only thing that matters are the possible future trillions of minds," for some of the reasons discussed here. I think is is also quite probably mathematically wrong for the reasons discussed here.

It strikes me along the lines of someone in 1938 who knows what is going on in Nazi Germany. They are in a position to influence public opinion and policy. And they say, "An asteroid might hit Earth someday. The numbers prove we must focus on that." 

Story of this photo here.

Monday, October 4, 2021

Things can be bad and still be better

Whenever someone like Pinker notes that in general, things get better (for humans), there are attacks by various people who are generally on our side of politics. They bring up various things* that are currently terrible. But both things can be true: there are things that are bad, and this is the best time (on average) to be alive (for humans). 


From page 429 of Andy Weir's excellent and fun Project Hail Mary

People nowadays ... they have no idea how good they have it. The past was unrelenting misery for most people. And the further back in time you go, the worse it was.


* There are plenty of terrible things in the world, but for some reason some people bring up inequality to argue against the idea that there has been progress. But it doesn't matter how much money Zuckerberg has. What matters is how much suffering people endure. I would definitely rather live in the unequal United States than Kazakhstan, even though the latter is vastly more "equal." 

Being Boring

More Pet Shop Boys!

Being Boring is both a funny and beautiful song. Maybe my favorite.


Rent just cracks me up.

When I had an undergrad romance, I listened to Heart a lot.



When it ended, I listened to What Have I Done to Deserve This.



Want just one song? Try this!  :-)

  

Sunday, October 3, 2021

Despite Everything

I get a lot of the criticisms of The West Wing, especially that it created unrealistic expectations for politics and that it is generally men men men men men. But as I've said, the first four seasons are just ... I can't get enough. And this scene, even as emotionally manipulative as it is, gets me every time.

Friday, October 1, 2021

Thursday, September 30, 2021

On Katie Porter's Takedown of Our Embarrassment of a Senator, Kyrsten Sinema

An honest question: Has anyone ever gone from liberal firebrand to corporate sell-out faster? 

Opinion: Katie Porter’s epic takedown of Kyrsten Sinema reveals an important truth

However the battle over President Biden’s agenda turns out, this ugly saga will accomplish something crucial: It will separate Democrats who take their role as public servants seriously from those who are operating with such epic levels of bad faith that they are essentially insulting the intelligence of their own constituents.

Rep. Katie Porter (D-Calif.) just delivered a sharp dressing down to Sen. Kyrsten Sinema (D-Ariz.) that neatly crystallizes this contrast. Many progressives are hammering Sinema, of course, but Porter’s broadside captures something essential about what we’re seeing from the senator, and by extension, about the crossroads that Democrats now face.

That essential point is this: Public servants should feel a basic obligation to level with the voters who granted them the privilege of being their representatives. While more may be happening in private talks than we know, all signs are that Sinema’s caginess is edging toward a level of deceptiveness that borders on betrayal of public duty.

Speaking on MSNBC, Porter lambasted Sinema for refusing to specify what she’ll accept in the multitrillion-dollar bill Democrats hope to pass through reconciliation. House progressives are threatening to vote down the smaller bipartisan infrastructure bill that already passed the Senate, to pressure centrists to negotiate the reconciliation bill in good faith.

Porter told host Lawrence O’Donnell that progressives would make good on that threat in the infrastructure vote set for Thursday, and added:

Until Senator Sinema and Senator Manchin are able to come up with what they want, to do for their constituents, to do for the American people — until Senator Sinema stops being cute, and starts doing her job and leading for the people of Arizona — we’re simply not going to be able to move the president’s agenda forward.

O’Donnell pointed out that if centrists get the infrastructure bill passed, they’ll be liberated from having to support a robust reconciliation bill later.

“I think that’s really irresponsible to their constituents and to the people of this country,” Porter replied. The reconciliation bill, Porter noted, will provide more home care to the elderly and child-care assistance that helps more women enter the workforce, and will expand health care to enable more workers to stay healthy and productive.

“I was elected to create a strong and stable and globally competitive economy,” Porter continued, adding that if Sinema and Manchin “really believe” the infrastructure bill alone will accomplish this, “they owe it to the American people to say that.”

Stressing that it’s impossible to negotiate until centrists say what they want, Porter added:

I was not elected to read the mind of Kyrsten Sinema. Thank goodness, because I have no idea what she’s thinking.

That last barb got a bit of buzz. But it’s more important that Porter brought this debate back to what it’s really all about: people.

The reconciliation bill is the heart of the Biden and Democratic Party agenda. It would invest in our people in all kinds of ways, providing social and economic infrastructure — child care, health care, education, paid leave — that would help and empower millions struggling to reach or remain in the middle class. As Jonathan Cohn puts it, all this would “alter everyday life in the same way that the core pieces of the New Deal and Great Society did.”

What’s more, the bill is central to the Democratic Party’s vision for realizing our decarbonized future and rebalancing our political economy, which has been badly skewed for decades toward the wealthiest and most powerful.

Sinema and Manchin object to the $3.5 trillion spending target and appear to have reservations about its tax hikes on the rich and corporations. But we don’t know much more than this. As the Times reports, Sinema and Manchin still won’t “enumerate the contours of a bill they could support.”

Which of those provisions designed to provide a lift to millions, secure a more habitable planet, and make the tax code fairer to working people and less prone to elite chicanery — which would they throw out? We don’t have a remotely clear enough picture of this yet.

In his new statement, Manchin does suggest support for undoing some of the 2017 GOP tax cuts, which the reconciliation bill would do. But his bizarre diatribe against “vengeful” taxation and his vague demand for global tax competitiveness suggest he’ll resist taxing wealth and cracking down on multinational corporate tax avoidance, weakening hopes for a more balanced political economy.

And Manchin’s pieties about spending and “brutal fiscal reality” suggest he sees deficits and inflation as far greater threats than that posed by the warming of the planet. This, even as scientists warn that we have a short window to avert catastrophe on a global scale.

But ultimately, all of this remains as vague as it is distressing. And Sinema, if anything, has been even vaguer.

At the end of the day, what’s at issue is whether Democrats will rise to all of these monumental challenges. So Porter is right: If Sinema and Manchin truly believe the infrastructure bill alone — or that bill paired with a reconciliation bill that’s been effectively gutted — is enough to meet those challenges, then they should damn well tell their voters and the American people that they think this.

And then they should feel compelled to justify it.

Wednesday, September 29, 2021

Rationality

"Bertrand Russell famously said, “It is undesirable to believe a proposition when there is no ground whatsoever for supposing it is true.” The key to understanding rampant irrationality is to recognize that Russell’s statement is not a truism but a revolutionary manifesto. For most of human history and prehistory, there were no grounds for supposing that propositions about remote worlds were true. But beliefs about them could be empowering or inspirational, and that made them desirable enough."

From Steven Pinker's Rationality, quoted in this LessWrong review.