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Shelby Foote, The Civil War

Herman Melville, Moby-Dick, or the Whale

Michael Punke, The Revenant

Bill Bryson, Notes from a Small Island



The contents of this website are for contemplative purposes only. No medical advice will be given, and emails asking for medical advice will be ignored.

Although patient vignettes are based on my experiences with real individuals, I liberally change details to maintain patient confidentiality.

I also reserve the right to change old postings to correct errors, and to delete comments that include obscene language or that I deem abusive to me or other commentators.  If you are looking for a open mind, I suggest you consult a neurosurgeon.

Katrina Blog Project

Facebook No More.

Here are the circumstances surrounding my recent separation from social media:

I was friends with a woman I don’t know. In ordinary (analog) life that statement makes no sense, but in the strange logic of Facebook, it does. She was someone who occasionally posted on the same pages as I did, worked in my profession, and generally had opinions similar to mine (although she was a tad more liberally tinted than I).

That wasn’t abnormal. It also wasn’t abnormal that she posted a great deal of negative comments about Donald Trump. This was fine with me, since I am no fan.

But she had a troll. Some guy who would reply to every post critical of Trump with some kind of defense. Sometimes his comments seemed reasonable, but often they were annoying. He would reflexively defend Trump, every single time. He was so predictable and reliable a naysayer that I could practically write his answers for him. If Trump wanted Muslims out he was arguing that Muslims are behind most terrorism. If Trump wanted a wall he talked about Mexicans taking farm jobs. If Trump dumped on African countries, he argued that African countries were asking for it.  If Trump did it, it must be right.

It went on and on. I would refute him. He would try to refute me back. He wasn’t always nice. I guess I wasn’t always nice.

Then came the mothers and children being separated at the border. This, I thought, was such an obvious wrong that I couldn’t see him trolling about the issue. What could be more evil than taking an innocent child away from his or her parent? But I was wrong — he argued that the immigrants were breaking the law, and the law must be enforced, the age of the child punished be damned. He argued that if someone breaks the law, the government is justified in meting out whatever punishment it is in the mood to prescribe, no matter how heinous the punishment may be. Should the punishment fit the crime? Nope. The punishment should be so brutal that no one will ever think about repeating it again. The chopping-off-hands for stealing bread argument.

I was fed up. I wrote, “So how are you getting paid, in rubles or bitcoin? Just curious.”

It wasn’t the worst retort I ever made on Facebook. Nor was it the angriest. But I was angry. And after I posted it, I thought, why? Why am I angry? Who is this troll to me? Why do I care what an ignoramus thinks? What is the point in arguing with a fool?

So I deactivated my account.

I did it because I realize being angry is not entertainment. It is easy to make that mistake these days. While anger doesn’t entertain, it does stimulate, which is an antidote for boredom. For people who live dull, empty lives, devoid of love or compassion, anger is the antidote to boredom. It is easy to conjure up, and when anger arrives, it banishes fear and anxiety. Anger is an emotion that does not allow other emotions to co-exist with it, and so people who have no happiness in their lives tend to gravitate towards it, subconsciously preferring outrage is to fear, depression, emptiness, anxiety, or boredom.

This is what most social media clicking is about — not making people happier, but staving off that unpleasant feeling of boredom.  And anger is social media’s secret weapon — it makes boredom disappear. The average internet surfer is too mindless to realize that not being bored is not the same as being happy.

Happiness is a hard emotion to evoke. It requires art, intelligence, honesty, and the ability to generate empathy to make someone else happy. Anger, on the other hand, is easy. Just say something somebody else doesn’t want to hear. Be a troll. So if you want to attract eyeballs online, you can be artful, intelligent, and compassionate, or you can just piss people off. Either way generates clicks, and makes money. One is for the hardworking and concerned, the other for the ignorant and lazy. Anger is the perfect emotion for those too lazy to cultivate anything else.

Facebook and Twitter, and all their ilk, are designed to make people angry. To accomplish this, they deliver fast feedback — in Facebook, there is that little bell on the screen that shows a red number when somebody flames you back. You check the bell and find that some jackass answered you and it makes you want to answer back. This raises the temperature of your response, and your troll raises the temperature in return, and it spirals up from there.

Facebook and Twitter design their systems to promote fights. Just as reality TV producers figured out a long time ago that they could attract more viewers by encouraging people to argue with each other on camera, social media knows that it can get people coming back to a page if they can get people arguing with each other. And their algorithms encourage it —  If you get on a page and have a heated exchange with someone, the program offers you more feeds from that page or similar pages so you can get in more fights.

Social media companies will deny this, but the fact is, they make money from clicks. More clicks come from addictive behaviors. There isn’t a product on earth that its manufacturers wouldn’t want to be addictive if it could be, from Diet Coke to Call of Duty to Lucky Strikes to Game of Thrones. The holy grail of every marketing department is to create a product that is addictive, but can’t be proven to be addictive. Hook people without them knowing they are hooked. Think cigarettes in the 1950s.

For social media, the key to addiction is feedback. Social media sites provide immediate, continuous feedback, stimulating you to go back in, before you have had a chance to completely get out of the medium and depressurize. Most other products can’t do that. It is the feedback that makes you return and return.  Just when you think you are on your way out, it pulls you back in. Anger is the hook. Anger is addictive: it makes you feel self-righteous, feeds your fear of being publicly bested by someone else, encourages the impulse to get in the last word and therefore be recognized as having had the final say, and most of all, banishes anxiety and boredom, the scourges of our age.

I don’t like to be angry. I like to be in control of my emotions. I think happiness and compassion are out there to be found, and that they can’t be found in anonymous online encounters. Face to face time with real people is required. Avoiding anger is not always possible, but the least I can do is stop looking for opportunities to be obnoxious. Facebook tempts me to look for opportunities to be obnoxious, and so I shut it down.

Do I miss it? Sometimes. Sometimes I wish I could send friends far away pictures of what I am doing, or share my opinion about a book or movie, or political issue. But then I realize this has no effect on anybody. Lots of people sent me pictures of their kids or dogs and I ignored them, preferring instead to find out what the trolls were saying about the latest stupid thing Trump did

I don’t want to care about the latest stupid thing Trump did. That’s what Trump wants me to do, to be angry, and that’s what his legions of trolls want me to do. To be angry, and to be addicted to being angry.

So I’m out.

If my friends want to send me pictures of their dogs, cats, and kids, they can send me a Christmas card.


To the Graduate, Any Graduate, Who Might Happen Here

This year marks the twenty-first year since I received my medical doctorate. Since then, I have not for one day regretted my undergraduate major in English and American Literature. As the years have gone by, my knowledge of literature has given me a resource to hedge against the way medicine is practiced today — that is, data-driven dehumanization. A humanities degree offers me perspective, the ability to empathize with the plight of the ill, and most of all the ability to communicate the concepts of science in a way patients and other professionals can understand.

To any student who wants to major in the humanities, I say go for it. (Or if you already went for it, congratulations.) The world of technical knowledge will always be there for you. You may be a bit behind your more technically trained colleagues when you start your post-graduate career (I was), but while you can close that gap, most of your colleagues will never make up for the loss of wisdom and human understanding, of empathy for others, of the ability to discern the truth, and thus of the ability to sniff out a lie and render it harmless.

Knowledge of life and culture is knowledge, too. It doesn't fill the wallet directly, at least not at first, but over the years those who truly study and learn the humanities discover that others who lack that grounding often ask for advice, and usually respect the wisdom given. Insight and clarity of thinking is like being physically strong. It is something you can achieve when you are young, and if you care for it properly it can be with you always, but if you don't acquire it young you will find it much harder to learn when you are older. It is knowledge that lasts.

Practical knowledge, on the other hand, has the shelf-life of raw salmon.


ONE FINAL NOTE: Everyone thinks to get accepted to medical school that you have to major in biology or chemsitry. I have heard this one, and heard it, and heard it, and heard it. Every guidance counselor I have ever talked to will tell you the truth, that you can major in anything you want to and still go to medical school. Counselors and medical schools try, but nobody listens -- it is like the myth that cold weather gives you pneumonia; there is not an ounce of truth to it, never has been, but the belief cannot be stamped out.

But I tell you, as someone who majored in English and went to medical school -- medical schools don't care what you major in! And majoring in the humanities does not hinder your medical education. I swear it's true, and I am living proof.


Et Tu, Morgan Freeman?


Even now, probably even after the many more revelations of sexual harassement I expect to hear in the future, I will still refuse to believe that all men, or even the majority of men, sexually harass women.

But I am starting to believe that in a society where fame and money is valued more than anything else, that the famous and the wealthy are so free of normal social constraints that the temptation to abuse and dominate women who are socially or professionally beneath them is irresistible.

As Plato suggested in his myth of Gyges, if a man finds himself in a position where he will never be held accountable for anything he does, he will not be able to resist becoming a monster.

As someone who is neither rich nor famous, I think I am happy that I am so.



Regarding the firing of the Chaplain of the House of Representatives

It appears that Father Patrick Conroy, S.J., Chaplain of the House of Representatives, was fired this past week because in November, during a daily House morning prayer ceremony, he asked that God allow tax reform legislation to benefit the poor as well as the rich. This seems to be unacceptable to Paul Ryan.

It used to be the position of most politicians that the purpose of the U.S. government was to benefit all citizens, not just the rich. There now seems to be a feeling among some politicians (Paul Ryan included) that America’s prosperity depends on the social innovations of the rich, and that it is the purpose of the government not to fairly help all citizens, but to help those who are most able to help themselves.

The result of this policy, or so I gather, is that the Job Creators (note how Godlike the word "creator" is, instead of the old word "employer") will in turn reflect this beneficence to the poor, who otherwise would become addicted to government handouts.

I find this political viewpoint ridiculous, but that is beside the point. The point is that Christianity, going all the way back to the Gospels, has always been about the poor benefiting at least as much from God’s grace as the rich. A quick reading of the Beatitudes (“blessed are the poor in spirit,” “blessed are the meek,” “blessed are they who weep and mourn,” "blessed are they who hunger and thirst”) confirms this.

It is mainline Christian thinking, near Catholic dogma, that the poor and suffering are to be the primary benefactors of the good works of the Church. To expect a Catholic priest to say otherwise is to expect him to commit heresy.

What Fr. Conway said is normal for any priest to say from any pulpit. It is only political if you are of the opinion that God rewards the good with extreme wealth, and curses the poor with suffering because they are lazy.

I don’t know for certain that this is Mr. Ryan’s opinion, but if it is, he is definitely not a Catholic. The Church, for all the problems it has had in recent years, does not need the help of politicians who think it is appropriate to repurpose Church social teaching for personal and political gain.


The Rottweiler Effect

A friend of mine and critic of Donald Trump recently asked me why Trump’s supporters still support him, in spite of everything he has done. (And if you don’t think Trump has done anything reprehensible yet, please stop here. This article is not for you.)

My response was, “It’s simple. It’s the Rottweiler effect.” Let me explain. A person who owns a fierce, frightening, 120 pound attack dog thinks his dog is a good boy. He likes his dog because the dog protects him, loves him, and is prepared to rip the arm off anyone who tries to harm his master. The dog may growl at the neighbors and the mailman. The owner finds this funny. The dog is on his side, and the owner doesn’t trust the neighbors (or the U.S.Postal Service) anyway. Everything is right and good in the world.

Until the Rottweiler turns on him. When his 120 pound mauling machine decides he doesn’t love his owner anymore, all those bags of dog food and baths and petting and going out for walks lose their meaning.

A Rottweiler is a good as long as it is your Rottweiler and growls at the neighbors instead of you.

The Rottweiler efffect can be summed up this way: A Rottweiler is a good dog as long as it remains my dog. It becomes a bad dog when it answers to the neighbors.

The Rottweiler effect comes into play when people support a morally questionable person as long as that person benefits them, and cry foul when the same person turns against them later. It occurs because people prioritize results over good behavior. They want cheap gas, and don’t worry if we went to war to get it. They want free access to guns, and don’t worry what will happen if the wrong people get them, too. They want TV news they can agree with, truthful or not, and don’t care if the lack of truth in pleasant TV hurts anyone. They want a tax cut as long as it means somebody else's kids will have to go to a worse school, or somebody else's car is damaged by a pothole.

But to be like that is to play directly into the hands of evil. Satan never tempts anyone by saying, “Come on down to hell! You’ll love our eternal tormenting fires!” Instead, he says, “Let’s see if I can get you what you want first.” Once the tempted person gets what he wants, the devil gets his.

Put in more secular language, evil people first promise the world before they take it away.

The Rottweiler is easily identified. He promises you everything for no cost. He identifies the enemy and, after carefully assuring you that you are not one of them, brutally savages them. The owner/victim allows the dog to do what it wants, because it never occurs to him that the dog, once accustomed to savagery, might one day decide to turn its teeth on the hand that feeds it.

The Rottweiler effect is coming to a town near you. In fact, it has already been in your town for a long time. If you don’t want the Rottweiler turning on you, here’s some advice: Don’t feed him. No matter what he promises, don’t let someone who is unscrupulous be your protector or champion. Anything a bad person can do to your enemies, he can do to you.