The Placebo

In a dry, but interesting reframing of the role of placebo in healing and in research from the Journal of the Royal Society of Medicine the authors assert that the placebo effect can be observed independently of a doctor's direct efforts. Placebo regimens are used in a couple of ways. In one a relatively neutral agent is used to provoke the patient into self-healing. It happens all the time. Doctors have even begun proscribing placebo for parents to use with children.
In another, placebos are used in randomized, double-blind trials (researcher and subject are unaware of which is the drug and which is the placebo). If 40% of group A improves on the drug and 30% of group B improves on the placebo, the effectiveness of the drug is considered to be 10%.
This is a big assumption, but there it is. In psychiatric drug trials, for instance, drug companies use a "placebo washout" to ensure that their drug fares better than placebo. It goes like this: a group of 100 join the trial, say they all suffer from significant anxiety problems. All are given a placebo. 40 get better. Those 40 are removed from the trial. 60 remain. The 60 are divided into two groups, A and B. One is given the drug, one is given placebo. If the drug group fares better that the placebo group the findings are reported as evidence of drug effectiveness (over placebo).
But of course, a huge chunk of people were removed to try to ensure exactly that outcome.
Nevertheless, this is standard practice.

The assumption is that the placebo is "noise" in the study. The authors suggest that not only is the placebo a potentially powerful agent for healing, but that the healing is not just a response to the clinician's care and attention.

The idea is that our bodies are deeply conditioned to healing interventions. For instance, heroin addicts have been noted to get withdrawal relief merely by injecting water into their veins. KNOWINGLY. Deception is not necessary to evoke a healing effect.

The reframing is "Contextual Healing", that the whole context of providing care provides opportunity for healing- from the mechanics of delivery, to clinician's care, to the drug agents themselves.

Some part of each of us is fundamentally healthy. We respond to healing in a multitude of ways.

40,000. This speaks for itself.

The number of U.S. troops diagnosed by the military with post-traumatic stress disorder (PTSD) jumped nearly 50 percent in 2007 over the previous year, as more of them served lengthy and repeated combat tours in Iraq and Afghanistan, Pentagon data released yesterday show.

The increase brings the total number of U.S. troops diagnosed by the military with PTSD after serving in one of the two conflicts from 2003 to 2007 to nearly 40,000....

The incidence of PTSD grew last year as more U.S. troops were exposed to combat -- with force levels in Iraq and Afghanistan reaching more than 170,000 and 27,000, respectively. Also contributing were a lengthening of war zone rotations from 12 to 15 months and the rise in the number of troops serving repeated tours, which sharply increases the likelihood troops will experience symptoms of PTSD.

Holistic Life Foundation DELAYED!

Hopefully we can reschedule this school year...they had to attend to some client matters down in Baltimore.

Music

Back in 1980, well into my very intense Who-phase, a marvelous album came out: The Secret Policeman's Ball. It was a charity for Amnesty International. Monty Python was involved (John Cleese helped with the staging, Neil Innes performed a few tunes). The attention grabber was Pete Townshend who, with a solo album coming out and Keith Moon recently deceased, seemed to be moving past the old band.
These are great performances- I just watched them with my kids. I don't recall when I first saw the movie, but that album was in constant rotation for me.

Drowned
Won't Get Fooled Again

John Williams, the guitarist not the Strauss-pilfering soundtrack composer, accompanies Townshend on "Won't Get Fooled...". He played at the ball as well; it was the first Bach piece I listened to regularly- the "Bouree" from one of the Cello Suites. Here he is playing years later at the Alhambra Palace.

Prelude from Lute Suite #4

And so we can watch Townshend around the same time, here he is in a dressing room playing one of my favorites from "The Who Sell Out", plus a couple of others. BTW, he turned 67 May 19th. Enjoy.

Tattoo

Workshops Part Two

Part One of our workshops intended to raise our students' awareness of their own learning needs was a series of short seminars on the brains, learning environments, sleep, nutrition, and adolescent brain development. Some of the students found it tedious. Some found it helpful.

Part Two was a "conversation cafe" where small groups of students sit down with a teacher/facilitator and discuss the following questions:

What skills do you need? What knowledge do you need? What should TAS emphasize more? What is lacking here at TAS?

To "what skills do you need" students suggested:

the ability to research well
note-taking
time management skills
focusing skills
prioritizing information
organizing/where to start with a paper or project
help expressing what is on my mind
remembering
independent living
skills socializing/social skills
manners
comfort in society
independent learning
more “practical skills”
living and coping skills for college
how to find and apply for a job
cooking/shopping for self
computer skills
test taking
how to kill an animal with your bare hands
career survey/exploration
etiquette
resumes
expressing feelings tactfully
public speaking
writing: basic expository/journalism
raising a family
how to teach a class and organize it

These are all very sensible and realistic. We do offer quite a bit of the above, but clearly some students do not are not aware of this, or do not feel what we offer quite meets their needs. I love how varied and concrete this list is.

What knowledge do you need?

basic knowledge
in-depth courses
personal finance/basic accounting
insurance
architecture
college counseling
career counseling
current events
modern history
politics
WWII
therapeutic music
nutrition
horse science/care
welding/metalwork
goal formulation
driving/general coordination
shop class type skills
college visits/what is college life like?

Again, very astute. These lists show a maturity and perspective taking that I find very comforting. The facilitators did fine work in getting most of the students to contribute- these lists do reflect a fairly wide sample of students.

What should we emphasize more?

meditation
college prep
SAT prep
college field trips
mindfulness
study skills
quiet areas
activities
more class discussion instead of independent reading
shop classes
structured study halls
better organized field trips
more cooking time
student planned field trips with more teacher help
basic living skills
breakfast
timeliness througout the day- classes, blessing, lunch
philosophy/meaning of life
guidance counseling
more freedom in art classes, more basic skills

more small group discussions
greater variety in physical ed: more cardio/stretching
jewelry making
split last period in two
more fundraisers
math and science levels for different abilities and skills
more respect from certain students for the teachers and other students
more intervention from teacher if this is not the case

What is lacking at TAS?

more challenging classes
different course levels
understanding of age differences and skill levels
greater awareness of student interaction
last period of school is too long
quiet areas
teacher-student interaction in larger classes
homeroom groups/guided conversations
grade levels
guest teachers
Shim Gum Do
computer lab
better computers
greater variety in libray/better organized
a public library class

All in all a substantial list.

Next step is to post these on a bulletin board at school and to encourage the students to prioritize it it terms of time frames and degree of need.

Re: Mindfulness in the New York Times

A little criticism of the article...

  It does not mention how Kabat-Zinn and Linehan both have done a great deal
to structure their approach so it is empirically useful, offers anecdotes in
support of mindfulness and sweeping, rather vague claims against it. It does
cite a few studies, but also calls the evidence "thin".

  It mentions nothing of the neurology involved in mindfulness. And perhaps
worst of all, inflates the dangers of it. Dangers? in being mindful? I guess
must be some downside to being self-aware!
 
  I would have preferred that the article had more on a) DBT's success rate
with such a difficult population b) the comparative safety over, say, drugs
c) the many types of practice a therapist can draw on for every type of patient
and d) how a mindfulness approach certainly does not exclude any other type of
approach.

 A primary mistake in reporting on this subject is that rarely is it mentioned
that mindfulness is simply everyday engagement. I guess it is a "kind of sort of"
attempt to introduce it to the NYT readership. But on balance it doesn't seem to
say much at all.

I really should post some information on both Linehan's and Kabat-Zinn's work. It
is very important.

MIndfulness in the New York Times

from this morning's paper:

The patient sat with his eyes closed, submerged in the rhythm of his own breathing, and after a while noticed that he was thinking about his troubled relationship with his father.

“I was able to be there, present for the pain,” he said, when the meditation session ended. “To just let it be what it was, without thinking it through.”

The therapist nodded.

“Acceptance is what it was,” he continued. “Just letting it be. Not trying to change anything.”

“That’s it,” the therapist said. “That’s it, and that’s big.”

This exercise in focused awareness and mental catch-and-release of emotions has become perhaps the most popular new psychotherapy technique of the past decade. Mindfulness meditation, as it is called, is rooted in the teachings of a fifth-century B.C. Indian prince, Siddhartha Gautama, later known as the Buddha. It is catching the attention of talk therapists of all stripes, including academic researchers, Freudian analysts in private practice and skeptics who see all the hallmarks of another fad.

continue on to the article

Holistic Life Foundation

On Wednesday, May 28, HLF will be visiting our school and conducting two workshops in yoga and mindfulness. These three young men have a great story: they saw a need for guidance, mindfulness, and yoga amongst the undersupervised kids in their gritty Baltimore neighborhood. They have brought their program into the schools and the YMCA's. They even are working with a researcher at Johns Hopkins on isolating the clinical effects of mindfulness training.

Welcome, gentlemen!

The Usefulness of Libraries

Robert Darton, Director of the University Library at Harvard, has a very interesting piece in the June 12th issue of the NY Review of Books (which is not the New York Times Book Review, in case you were wondering). He begins with an overview of the technological evolution of books (written language circa 4000 b.c.e., alphabetic script 1000 b.c.e., scrolls 0 b.c.e., the codex, or bound, flip page book 3 century c.e., movable type in China around year 1000, metallic movable type in Korea, two centuries later, Gutenburg the 1450's). Eventually he uses this timeline to argue for the inherent instability of texts and the lasting value of books. The value of books lay in the format's many variations: size and material reflect economic and social information, variant texts indicate many authorial and editorial intentions and accidents. All of this is valuable to a historian.

Needless to say, since 1969 and the early experiments to link up computers, the pace of change in the world of texts has been mind boggling. As January, 2005, there were 60 million blogs, for instance. By July, 70 million. Google is now in the mix, striking deals with Oxford, the NYC public library, Michigan, Stanford, and Harvard to digitize their collections.

Much has been written about a "post-literate" or "hyper-literate" generation, a cohort largely innocent of books. Amongst academics and college students, the web has displaced much of the library's traditional function: a sanctum and a place where you could find information available no where else. Darnton argues that this is still the case and that crucial information will be lost not by the act of digitizing texts, but rather by the growing belief that an authoritative text is online and that the search, as it were, can end there.

He presents several points:

1) Google can not possibly put all texts, and their variants online. Someone will choose the "true" text; someone will be making the decision to leave out thousands of chapbooks, DIY's, trade paperbacks, etc.

2) 60 percent of the books being currently digitized in only one of the above libraries. This is a mere fraction of what is available in research libraries across the U.S. Even if Google manages to digitze 90 per cent of this vast holding, many millions of books may vanish. And if we neglect our libraries because we think everything is on Google, they will vanish.

3) Copyrights are a huge problem. They extend 70 years past the lifetime of the author. This means hundreds of millions of items of text can only be read a few lines at a time, the standard "fair use" asserted by Google.

4) Companies vanish. Google will too. Then what?

5) Human error, computer error. Errors compounding errors.

6) Hardware and software become obsolete. This happens really fast, doesn't it?

7) Since Google plans to digitize many versions of the same book, how will they be prioritized? And how would anyone know which versions have been left out? A quote from the article: "Google employs hundreds, of not thousands, of engineers but, as far as I know, not a single bibliographer."

8) The size and texture of a book cannot be digitized. The article is worth reading for the details here.

As someone who loves the smell of binders glue and old bookshops, and considers human language the ultimate moving target, count me as a Darntonian. I still recall the gasp that escaped me when I stumbled across James Joyce's so-called "Buffalo Notebooks" at the BC library- these are the fascimiles of his notes for Finnegan's Wake- it was like when one first apprehends the true dimensions of an iceberg.

Ten years ago I would have asserted that the record album would remain a vital format. I don't think so anymore. The album- LP, CD, or MP3- is crumbling back into individual songs. A book, however, holds unique information about production in a way that the very standardized music formats of the past and present never have. Maybe the book will last...or at least have a decline in proportion to it longevity. Text maybe unstable, but ink on paper is far less so.

Music

I found this surprising: of the 10 best selling albums in the U.S. of all time, only two are greatest hits collections. I still find the numbers staggering. Remind me again how the music industry manages to lose money every year? Oh, yeah. I remember now. They didn't see the internet coming.

Best Selling Albums (U.S.)
Best Selling Albums (worldwide)

Another interesting tidbit: Thriller, of course, stands alone in worldwide sales. But the next tier of sales has on it three albums easy to guess: Saturday Night Fever (previous to Thriller, the best selling album of all time), The Eagles Greatest Hits (ugh!), Dark Side of the Moon (some of the initial profits from the LP went to financing Monty Python and the Holy Grail, also the longest charting album of all time) and finally...AC/DC's Back in Black. This last one surprised me.

I would love to see the a distribution of sales figures across the globe. How does AC/DC do in West Africa, or Shanghai?