The .Plan

Using simple caffeine to raise alertness in conjunction with naps during a trip is a winning strategy, Dr. Rosekind said. Caffeine takes 15 to 30 minutes to work, and an effective nap should be less than 45 minutes, to avoid going into the kind of deep sleep that leaves people groggy. So drinking a cup of coffee just before a nap, he said, can ensure that you will awaken with a little extra zip. The caffeine and nap working together “can actually show a performance boost greater than either one alone,” he said. “It’s not rocket science.”
–John Schwartz, “A Cure-All for Jet Lag? Try Caffeine and Naps”, New York Times, April 30, 2008

Acuity on the inpatient ward has been high as of late.

In the span of two weeks, I

• surpassed my previous record of volume of serotonin- and dopamine-hammering agents prescribed to a single patient,
  
• received an invitation by an extremely attractive drug rep to do some consulting work for her employer (curiously, immediately after delivering a withering grand rounds talk that properly eviscerated said employer for questionable research ethics),
  
• admitted three acutely psychotic 18 and 19 year-old Chinese college students (all studying at the same local university, but without any social ties to one another),
  
• was invited to dinner by one of their fathers after a family meeting that included one of his apparently marriageable (and non-psychotic, and attractive) 27 year-old daughters,
  
• revealed my own religious background, for the first time, to two patients and one mother, and
  
• had two bouncebacks of patients with florid borderline personality disorder just when I thought I had gotten them out of my hair.

Each of these list items probably deserves its own entry. But the most draining activity by far has been being challenged to sit with a person whose “either-or” thinking leads her to cut or overdose when confronted with the slightest perturbation from her shaky equilibrium. Teaching rudimentary concepts of cognitive- and dialectical-behavioral therapy on the inpatient ward is a deeply frustrating task. But what you dislike most in other people are the characteristics that are most ingrained in your self, right? Lately I have been trying to take some of my own advice to heart. Instead of “either-or” language, I have been training — begging — myself to use the language of “both-and” in an attempt to appreciate the tensions inherent in everyday life.

For example:

Today, I both felt a little isolated while eating dinner by myself and was relieved to have the freedom to experiment with a new technique of stir-frying my string beans.

I felt both frustrated with the nonvolitional late nights of these past few weeks and appreciative of the opportunity to engage in deep self-reflection.

And so on.

Making a hard decision in the context of uncertainty is something that the uber-maximizing Democratic voters apparently cannot do at this point in time.

The question of the superdelegate count will become more and more important in the coming weeks, but what amuses me most about this process is that the superdelegates cannot recognize that their indecision is likely going to cost their party the election as McCain cruises on unmolested.

Dan Ariely describes this phenomenon in his book:

Choosing between two things that are similarly attractive is one of the most difficult decisions we can make. This is a situation not just of keeping options open for too long, but of being indecisive to the point of paying for our decision in the end. Let me use the following story to explain.

A hungry donkey approaches a barn one day looking for hay and discovers two haystacks of identical size at the two opposite ends of the barn. The donkey stands in the middle of the barn between the two haystacks, not knowing which to select. Hours go by, but he still can’t make up his mind. Unable to decide, the donkey eventually dies of starvation.
–Dan Ariely, Predictably Irrational: The Hidden Forces That Shape Our Decisions

More about options here and here.

“The first time I heard it, I was kind of surprised. It’s not like it was a thought of my own, it was more like a voice. It had an eternal quality to it.”

“What made you surprised to hear it?”

“Well, it happened when I was looking at an electrical socket. And it looked like there were two nails sticking out of it. And that’s when I knew I was supposed to blind myself.”

“Did you want to blind yourself?”

“Well, no, not really. But at the same time, I thought this might be an obedience thing. Every time I looked back at that electrical socket, I kept seeing those nails. Anyway, I went to sleep, but then I woke up again, and I just knew what I had to do. So I went to Walgreen’s, and I was looking for nails. I couldn’t find any, so I bought some needles instead.”

“Needles?”

“Yeah, well, I thought, ‘These are just needles, it’s not the same thing as nails, but it might do the trick’. But then when I was walking home, I saw this rusty nail on the sidewalk. And then the message came that I was supposed to use it. So I took it home.”

“Can you tell me more about what you were thinking at the time?”

“Well, I brought the nail home, and I didn’t really want to use it. I was thinking, ‘What if I get infected?’, or ‘What if I get lockjaw?’, and I didn’t really want to get lockjaw. But the voice was saying, ‘DO THIS AND TELL THEM THAT I AM THE LORD’. So I put the nail in a Mason jar, filled it with water, and then I stretched out my hands to bless it. Then I said, ‘For you and for Christ’, and I felt this energy go out from me. Then I drank the water and stuck the nail in my eye.”

“Did it hurt?”

“Actually, surprisingly, no, it didn’t.”

The first time you go to the Grove, the immensely successful and completely fabricated commercial center in Los Angeles, you will try to hate it. But then you will watch the old-fashioned trolley passing by, or the dancing fountain as it splurts jovially to the cadence of a Sinatra song, and you will drop your snobby urban integrity and walk around consuming things in a mouth-breathing stupor just like everyone else.

“You want to hate the Grove, but you just can’t,” one Angeleno friend said.

“The first rule of L.A. is to stop hating the Grove,” another said.
–Mike Albo, “Only your money is not pretend”, New York Times, April 24, 2008

Stumbling on hope…

Few of us can accurately gauge how we will feel tomorrow or next week. That’s why when you go to the supermarket on an empty stomach, you’ll buy too much, and if you shop after a big meal, you’ll buy too little.

Another factor that makes it difficult to forecast our future happiness is that most of us are rationalizers. We expect to feel devastated if our spouse leaves us or if we get passed over for a big promotion at work.

But when things like that do happen, it’s soon, “She never was right for me,” or “I actually need more free time for my family.” People have remarkable talent for finding ways to soften the impact of negative events. Thus they mistakenly expect such blows to be much more devastating than they turn out to be.
–Claudia Dreifus, “The smiling professor”, New York Times, April 22, 2008

Stumped? Just cross your arms.

In this set of psychology experiments, one set of subjects was instructed to solve a puzzle with their hands on their thighs, while the other set was told to sit with their arms folded. The former group only lasted for about 30 seconds, while the arms-crossed students persevered for 55 seconds. In the second experiment, the arms-crossed students came up with more solutions.

Experiment 1 established that arm crossing in an achievement context led to greater persistence on an unsolvable anagram, demonstrating that proprioceptive cues can influence achievement behavior. Experiment 2 replicated this finding, and also revealed that the increased persistence elicited by arm crossing facilitated performance. A mediation analysis confirmed that this performance difference was due to greater persistence in the arms crossed condition… Future research may also seek to identify the precise mental constructs activated by arm crossing. Although the present work demonstrated a specific behavioral tendency elicited by arm crossing within achievement settings, the cognitive nature of this response has yet to be fully explored.
–Ron Friedman and Andrew Elliot, “The effect of arm crossing on persistence and performance”, European Journal of Social Psychology, April 2008

Mercy will you follow me
Mercy will you follow me
Till my final breath at last I take
Mercy will you follow me
Mercy will you follow me
Till the chains of this old world I finally break
–Counting Crows

This is how they rolled back in the day:

The great 17th-century diarist Samuel Pepys has left us a horrifying account of the removal of his “bladder stone” without anaesthetic (and without alcohol too), by one of the more skilful surgeons of his day. Having trussed his patient up like a chicken with long linen strips, the surgeon first inserted a thin silver instrument lubricated with warm water and milk of almonds through Pepys’ penis into his bladder to hold the stone in place. Then he made an incision between the scrotum and anus into the neck of the bladder, grasped the stone with pincers and extracted it. It was said to be as large as a tennis ball of the period. Pulling this object through a three-inch incision was no mean feat. The wound was not stitched, simply left to heal itself and kept open with a small roll of soft cloth dipped in egg white. A cold syrup of lemon juice, radishes, and marshmallow was prepared for the great author, now fainting with shock and pain, to drink. His belly was anointed with oils, and oil of earthworm was held in readiness for possible convulsions. Astonishingly, Pepys recovered in 35 days, proudly preserving his stone in a specially made case.
–Terry Eagleton, “Literary healing”, The Lancet, April 19, 2008

So gangsta.