MJ

I have largely ignored Jackson's passing, not for lack of interest but for general revulsion at the whole celebrity/tragedy angle. Let me leave it at this, he was obviously and chronically terrorized by his father and exploited by just about everyone else. Then the pharmaceuticals found a home, to wit, his being sued a couple of years ago for 100,000 in pharmacy bills.

as per Furious Seasons:

I was blown away on Saturday when, during cable news coverage of Michael Jackson's death, two doctors offering analysis were very critical of Jackson's reported long-term, chronic use of both painkillers and anti-depressants and noted that they could affect someone's heart health (while that's likely obvious to one and all with painkillers, it's probably not so obvious with anti-depressants). Sadly, I cannot find transcripts of either doctor on Fox News and CNN, but I can assure you they said it and it was a stunner to me, given how the mainstream media ignored the connection between anti-depressant use and sudden cardiac death in women, as reported by researchers in the Nurse's Health Study. It's also a stunner to me in light of how naive we've been as a culture when it comes to using anti-depressants very casually while assuming that there's no long-term impact from using the drugs.

Jackson was allegedly on a staggering cocktail of prescription drugs: thrice daily injections of Demerol; Dilaudid; Viccodine; and 120 mgs. a day of Zoloft and 40 mgs. a day of Paxil. He was supposedly taking the anti-depressants for OCD and social phobia issues. What Jackson was taking at the time of his death isn't entirely clear, since his toxicology report won't be available for many weeks and also since last night his personal physician, Conrad Murray, reportedly told Los Angeles police detectives that he hadn't injected Jackson with Demerol and, in the words of the doctor's lawyer, "There was no Demerol. No OxyContin."

He said nothing about anti-depressants, however.

So we shall see how all this prescription business plays out. Of course, Jackson was known to have used painkillers for many years to treat chronic pain problems and it's entirely possible that he'd become addicted to them. It's entirely possible that Michael was hooked on anti-depressants as well. Certainly, SSRIs can be very addictive (or create physical dependency, if you prefer) for some people.

That said, I want to make it clear that I am not blaming Zoloft and Paxil for Jackson's death. I am not saying that taking either drug will give any specific person a heart attack. But I am saying that, for now, that the two anti-depressants are inextricably entwined and linked to the death of MJ.

The research on long-term anti-depressant use is thin to begin with and there's not a lot of research on links between anti-depressant use and heart problems, but it is obvious to me that there is clearly something going on here and, as I wrote back in March, the nurse's study should be a big wake up call to doctors who've had patients on anti-depressants for many years and for patients themselves.

An Estimable Monday...

It is a little cool, but my summer begins with my first swim in the very chilly Cook's Creek. Last nights swim was a bit of a shock, but this morning after a longish run in the hills me and my hot pup Milton splashed around until our bones began to crack from the cold.
Whenever I take him running in a new place I leave a long rope on him. It gives me an extra moment to grab him, should we run into anything untoward (like the skunk that pasted us last week). Milton isn't terribly obedient; he is, however, fairly reasonable. Our interests largely overlap.
I noticed this morning something about the processes of information. Picture this: You are running down a steep, narrow, wooded path. It is mostly stones jutting this way and that, green and blue-grey with moss and lichen. The soil is damp, and the small logs here and there are slippery. A large, red-brown, and joyful dog runs ahead of you, dragging behind him an eight foot long yellow rope which drifts side to side and occasionally under your feet as you run.
Your footing is very particular, and a fall would be pretty painful. Yet your brain negotiates the whole complex exercise smoothly, despite very different foot falls being required every running step.
What complicates things is the rope. If I step on the rope I will suddenly yank Milton's neck, which I do not want to do; if I hesitate, I would likely twist an ankle and fall. Unfortunately, the rope is necessary at this stage of Milton's "training", especially in those woods.

While running I recognized three rather distinct and surprisingly non-influencing lines of mental activity. By this I mean that the first two did not effect each other and the third, though a product of the first two, took a while to come to any action:

1) running down the rocky path requires snap experience- and coordination-based judgments that also tap into a feedback loop regarding the body's strength and performance. These tiny adjustments seem to use primarily the eyes, the conforming of the feet on the uneven ground, an awareness of general inertia, and an awareness of general ability to meet each feature of the path safely.

2) tracking the rope and not wanting to land land on it made no difference whatsoever whether or not I landed on it. I was running quite fast, for me anyway, and clearly the judgments about what my feet should do and what I should do were insulated from each other. A safe step trumped skipping the rope.

3) lastly, the awareness of these two processes not only operating, but of their each having an independent time sense. And then there is the recursive aspect of being aware of being aware, etc etc.

Normally, we assume that time is relatively uniform, at least subjectively speaking. Anyone reading this blog probably has some idea of Einstein's frames of reference in his Special Relativity (i.e. time elapses at different rates for different observers of a given event). Interesting to think, then, that within our own brains are very different rates of time.

Think of summer. I can hold these two thoughts simultaneaously: it seems like a long time ago that we had graduation/I can't believe it is almost July, summer is evaporating. Or, when each day seems so long and the weeks shoot by. Time is not uniform even for ourselves.

Fortunately, someone is working on it:

Your brain, after all, is encased in darkness and silence in the vault of the skull. Its only contact with the outside world is via the electrical signals exiting and entering along the super-highways of nerve bundles. Because different types of sensory information (hearing, seeing, touch, and so on) are processed at different speeds by different neural architectures, your brain faces an enormous challenge: what is the best story that can be constructed about the outside world?

Here's a link to the rest.

Milton Erickson

There are a lot of very interesting Miltons out there. John Milton Cage, John Milton, Milton Friedmen (this is not an endorsement of his economics!), and Milton Erickson. Who?
There are a lot of therapists who consider this self-taught American one of the very greatest clinicians ever. Here is a passage I stumbled over this morning:

At age 17, he contracted polio, and was so severely paralysed that the doctors believed he would die. On the critical night where he was at his worst, he had another formative "autohypnotic experience".

E: As I lay in bed that night, I overheard the three doctors tell my parents in the other room that their boy would be dead in the morning. I felt intense anger that anyone should tell a mother her boy would be dead by morning. My mother then came in with as serene a face as can be. I asked her to arrange the dresser, push it up against the side of the bed at an angle. She did not understand why, she thought I was delirious. My speech was difficult. But at that angle by virtue of the mirror on the dresser I could see through the doorway, through the west window of the other room. I was damned if I would die without seeing one more sunset. If I had any skill in drawing, I could still sketch that sunset...

I saw that vast sunset covering the whole sky. But I know there was also a tree there outside the window, but I blocked it out.

(interviewer): You blocked it out? It was that selective perception that enables you to say you were in an altered state?

E: Yes, I did not do it consciously. I saw all the sunset, but I didn't see the fence and large boulder that were there. I blocked out everything except the sunset. After I saw the sunset, I lost consciousness for three days. When I finally awakened, I asked my father why they had taken out that fence, tree, and boulder. I did not realize I had blotted them out when I fixed my attention so intensely on the sunset. Then, as I recovered and became aware of my lack of abilities, I wondered how I was going to earn a living. I had already published a paper in a national agricultural journal. "Why Young Folks Leave the Farm." I no longer had the strength to be a farmer, but maybe I could make it as a doctor.

Another Glorious Day, this time on a Wednesday...

And we open with great news for TAS from SCOTUS. The Supreme Court, in a 6-3 ruling, held that a school district can be required to reimburse a family for private school if the student's need were not adquately met. This includes situations in which the student did not have a prior IEP. Here is a quote from the dissent:

“Special education can be immensely expensive, amounting to tens of billions of dollars annually and as much as 20 percent of public schools’ general operating budgets,” Justice Souter wrote. “Given the burden of private school placement, it makes good sense to require parents to try to devise a satisfactory alternative within the public schools.”

Obviously, that sort of reasoning, were it guiding the majority opinion, wouldn't help TAS very much. But thanks to a combination of conservatives (Alito, Roberts), quasi-progressives (Ginsburg, Stevens, Breyer) and the usual swing-vote Kennedy, the interests of individual students are being asserted over that of a school district's management problems. Interestingly,
both pro-voucher and usually reactionary justices joined Souter's dissent. Go figure. I look forward to reading the whole opinion.

Here is a good summary from the reliable SCOTUSBLOG (and here for the NYT article)

Today, the Supreme Court held that parents of disabled children can seek reimbursement for private education expenses regardless whether their child had previously received special-education services from a public school. By a vote of six to three, the Court held that the Individuals with Disabilities Education Act (IDEA) authorizes reimbursement whenever a public school fails to make a free appropriate public education (FAPE) available to a disabled child. Interestingly, the Court granted certiorari on the same question in 2007 but affirmed the opinion below by an equally divided court (Justice Kennedy recused himself), indicating that at least one Justice changed his or her vote.