Note to self: "crazy like us, the globalization of the american psyche" by Ethan Watters

Notes to self is the place where I write about interesting stuff that I happen to read/watch/listen. It is less about writing a review and rather about recording my thoughts and considerations.

The book is about the use of the American (or western) concept of "mental health" or "psychiatric disorders" in non western contexts. It is divided into 4 case studies, each of them describing the introduction of a particular "disorder" in a particular country. The overall theme is that non-western cultures have their own way to deal with mental illness, and the introduction of the "western" way typically causes great damages.

Anorexia in Hong Kong: a form or anorexia had existed in Hong Kong long before the arrival of the western mental categories. It had very different symptoms and causes from the western one, and a meaning that was close to the local culture. After a highly-publicized death for anorexia, a large prevention/awareness campaign followed. Except, this campaign was targeting anorexia in its western sense. What followed was an epidemic of western-style anorexia. The campaign had effectively added a new element to the pool of symptoms available (within the local culture) to express distress. Interesting "endogeneity" problem in which identifying a disorder creates the disorder - relevant mechanism in mental health.

Schizophrenia in Zanzibar: In many non-western societies, mental health illnesses are not disorders but conditions/individual characteristics. I'm tall, you are short, he likes to strawberries, she likes to shout for no apparent reasons. A "condition" does not imply any guilt - everyone is what he/she is. A "disorder" implies that there is something wrong with the person. A "condition" does not require any cure. A "disorder" needs a cure. 

Before the introduction of the "western" way of thinking about schizophrenia in Zanzibar, families with a schizophrenic member were generally accepting, patient, resigned. After the arrival of the "western" way, families started looking for a cure, being frustrated (implicitly at their schizophrenic family members) for the lack of progress, attaching stigma to the person who is ill. Ultimately, patients were worse off, because  schizophrenia gets worse in emotionally-charged environments.

Question: should we call diseases or disorders only things that actually have a cure? After all, what is the point of calling something a "disorder" rather than a "condition" if there is no cure? I'm thinking about, for example, down syndrome. Also, if tomorrow someone invents a pill to become tall, will being less than 180 cm be considered a disease?

Post Traumatic Stress Disorder (PSTD) in post-tsunami Sri Lanka: first of all, it is striking how none of the most common treatments for PSTD (based, by en large, on "re-experiencing the traumatic experience" shortly after the events) have shown any effectiveness, even in the western world. Despite this, thousand of western "experts" travelled to Sri Lanka after the tsunami to provide PSTD treatment to the people affected, especially children. Except that, in the local culture, (a) mourning and healing is a social process, (b) talking explicitly about a traumatic experience risks generating violence and revenge within the community. Hence, local people were used to talk about their traumatic experience only indirectly, using metaphors. Western experts were, in fact, destabilizing local communities and preventing the process of healing.

Depression in Japan: something similar to "depression" has long existed in Japan. It was something close to "deep melancholy", and was considered with respect. It was not considered a "disease" but rather a condition associated with a particularly sensitive soul. Japan was not a great market for antidepressant.

Therefore, a bunch of pharma companies organized a congress, where they engineered a strategy to "import" western style depression (and its cure) to Japan. They enlisted leading scientists (local and foreign), started a media campaign, convinced the government, massaged data and results. They succeed. 

 

Note to self: "do no harm" by Henry March

Notes to self is the place where I write about interesting stuff that I happen to read/watch/listen. It is less about writing a review and rather about recording my thoughts and considerations.

I just finished "do no harm: Stories of Life, Death, and Brain Surgery" by Henry March, a leading british neurosurgeon. The motivation of the book is the following: doctors (in particular surgeons, in particular neurosurgeons) are very reluctant to talk/discuss/admit their mistakes. Probably because their mistakes involve people dying or being left permanently disabled, doctors have a hard time facing them. Hence the goal of the book: putting the mistakes of the author out in the open with the hope of starting a conversation.

Actually, I somewhat disagree with the idea that the book is about mistakes. In my opinion, it is more in general about "the hidden side" of medicine and in particular neurosurgery - including its mistakes. The book is filled with the day-to-day life of a doctor, including the most mundane experiences and frustrations (such as the fights with the hospital management). It is about how decisions are made (surgery or no surgery?), the difficulties in handling patients, the human side of announcing a catastrophe to a relative. As the book often explains, patient have unrealistic expectations toward doctors, drugs, treatments and medicine - as a way to cope with difficult moments. The book feels like a counterbalance to that: everything you probably do not want to know as a patient, but nonetheless is the day to day of medicine.

It is extremely well written - all of it. I went through it as fast as I with thrillers. The most engaging parts are the descriptions of the surgeries. The list of brain structures, how they look under the microscope, what happen if the surgeon cuts few millimeters too much or too little - death, fatal bleeding, loss of speech, or a tumor that may regrow. Most of the surgeries described are successful, but many are not (otherwise, there would not be much suspense).

Final consideration. The book is full of dialogues between March and his colleagues about whether and how to treat a patient. In these dialogues, there are many sentences along the line of "I hope he dies - after what happened the only alternative is being almost brain dead" or "I don't think we should operate. The best we can do is to keep him alive but wreck his brain, better let him die". Now, these sentences did not shock me particularly - for the most part I agree with them. What struck me is how normal it is for doctor to say these things - they were not whispered but rather said openly in meetings. Final thought is: maybe there should be a broader discussion on what is better/worse than death - broader in the sense of involving the larger community rather that only doctors.

 

 

 

 

The solution to humanity's problems tastes like bacon.

It sounds like the holy grail of vegetables. Packed with iron, calcium, magnesium, and protein, a type of seaweed called dulse also happens to taste like bacon. Well, sort of. When the little-known algae started making headlines for its flavor, we tried frying some up.

The verdict: Yes, with its savory, umami, and salty taste, it's sort of like bacon. A smoked version is even more bacon-like. It probably wouldn't be mistaken for meat in a blind taste test. But pan-fried in a little oil? It's crispy and delicious.

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How the Internet of Things will change the world.

 "Smart, Internet-connected objects (aka “the Internet of Things” or “IoT”) are becoming more and more common. For example, internet-connected printers, thermostats, lighting systems are now widely available. For the moment, the main advantage of buying a “smart” object over its “dumb” equivalent is that a “smart” object can be controlled from a smart-phone, and from everywhere in the world. Which is convenient, but not really revolutionary. However, the interesting question is: what is it going to happen when most objects around us will be internet connected? In other words: what will be the true impact of the internet of things? "
... 

https://teamupstartup.com/blog/how-the-internet-of-things-will-change-the-world/ 

Leaving the Euro - keeping the Euro

Grexit isn't what people take it to be. The standard narrative is that Greece is approaching a fork in the road. It must either stay in the euro or adopt a new currency. I don't think this is an entirely accurate description of the actual fork that Greeks face. Over the next few months, Greece will either:

  • A) stay a member in good-standing of the institution called the "Eurozone" and continue to legitimately use that institution's currency, the euro, or
  • B) leave the Eurozone while continuing to use the euro 'illegitimately.'*

This means either the status quo of de jure (official) euroization or de facto (unofficial) euroization. In both cases, the euro stays.

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Low tech and ingenious: transformative ideas that do not require new technology.

When we think of an innovative idea, we immediately think of new, frontier technology. We instinctively believe that all good ideas that rely on old, well-established technology must have already been invented. As it turns out, this belief is wrong: once in awhile some truly brilliant person comes up with an ingenious way to use something very old to produce something very new.

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Waterloo and how to "leave" the euro

Belgium commemorates waterloo with a €2.50 coin. "The coins, which can only be spent inside Belgium, display a monument of a lion atop a cone-shaped hill on the site of France’s humiliation, as well as lines indicating where troops were positioned when forces led by Britain and Prussia defeated Napoleon in the countryside near Brussels."

As a corollary, does this mean that Greece can "exit" the euro by minting a bunch of 7, 11, 34 euro coins?

Source: http://www.nytimes.com/2015/06/10/world/eu...