Oxford University Press's Blog, page 918
August 1, 2013
The Clooneys and the Kennedys
Rosemary performing “Come On-a My House” in The Stars Are Singing.
The story of Rosemary Clooney’s rise, fall, and rise again to the summit of American music is unparalleled in American showbiz history. From her emergence at the archetypal girl-next-door in the Fifties, through to her late life renaissance as an interpreter par excellence of jazz and popular song, Clooney’s 57-year career scaled all the heights. But for almost seven years, from 1968 to 1975, Rosemary Clooney was missing, the victim of a catastrophic mental breakdown that almost destroyed her career and her sanity, and which was triggered by one thing — the curse of the Kennedys.When two young Irish couples shared their marriage vows in the middle years of the 19th century, no one realized that the weddings — one in Massachusetts, the other in Kentucky — would be the foundation stones of two dynasties. Patrick Kennedy’s marriage to Bridget Murphy gave birth to America’s most charismatic political family whilst Nicholas Clooney’s betrothal to Bridget Byron began a chain of descent that begat not just Rosemary Clooney, but a generation on, actor and director George, Rosemary’s nephew.
For a time, it seemed that the Clooneys’ destiny might be a political one too. With her parents both largely absent during her childhood, Rosemary spent much of her time with her paternal grandfather, Andrew, and it was he who instilled a liberal tradition into the Clooney line that lasts to this day. An active politician and local mayor, Clooney Senior was, said Rosemary’s brother Nick, “closer to libertarianism than we would like.” It was at one of Andrew’s rallies in the 1930s that Rosemary made her public singing debut.
Rosemary with Miguel, Gabriel and Maria Ferrer, left to right, c. 1959.
Rosemary’s innate musicality, coupled with a natural flair for acting, made her one of the biggest stars of Eisenhower’s America. Hit records and movies, her own TV series, and a showbiz marriage to actor José Ferrer delivered a fairy story of small town girl made good. When JFK launched his bid for the White House in 1960, Rosemary immediately recognized a kindred spirit. Kennedy’s father, Joe, had promised to “sell him like soap flakes” and with the candidate linked into Sinatra’s Rat Pack through his sister’s marriage to actor Peter Lawford, America’s first Hollywood Presidency was born.
Rosemary had sung for the Democrats at various events running up to the Election and stayed close afterwards. In 1962 after singing at a dinner for the new Ambassador to Ireland, a late night call from Lawford found her cooking scrambled eggs at the White House with the President and his coterie. They talked into the early hours. When Rosemary made to leave, she was stunned by the President’s final question. “What was it,” he said, “that kept her off-the-shoulder jacket from falling off?” She paused before revealing a simple clip.
After the events in Dallas brought Camelot crashing down, Rosemary found herself battling demons of her own. Her marriage had collapsed, her money was gone, and her career post-Beatles revolution was on the slide. With her home in Beverly Hills and five kids to look after, she was beginning to tailspin. Prescription drugs had become an irredeemable temptation. Nevertheless, Rosemary had met and grown even closer to the President’s brother, Robert Kennedy. When he made his bid for the White House in 1968, Rosemary was one of the first people he looked to for support and by the time he contested the California Primary in the spring, she was with him every step of the way. On polling day, she flew with him to Los Angeles and sat in his car as he drove through the city. She was waiting for him at the Ambassador Hotel when the shots rang out.
Rosemary with Buddy Rogers, March 1974.
RFK’s death was the final straw. In the days that followed, she substituted the reality that everyone else saw with a world of her own. Kennedy wasn’t dead. It was a conspiracy, a plan by something or someone to teach everyone a lesson. Even a telephone conversation with Kennedy’s widow, Ethel, failed to persuade her that the blood she had seen in the Ambassador Hotel had been that of the murdered Senator. Three weeks after Kennedy was buried, Rosemary traveled to Reno for a three-week season. Halfway through, she stopped the show, berated the audience and walked off stage. She headed for Lake Tahoe, purposely driving the wrong way up the old mountain road and “playing chicken with God.”A month’s hospitalization and years of mental therapy followed but she did come back, bigger and with a world-wisdom that she used to breathe life into her musical interpretations like no one before or since. She reinvented herself in a jazz idiom, surrounded by the brightest and best of a new generation of jazz players, and continued to sing until her death in 2002. She was lucky — and so were we.
Ken Crossland is the co-author of Late Life Jazz: The Life and Career of Rosemary Clooney. He has written two other books, including The Man Who Would Be Bing: The Life Story of Michael Holliday and Perry Como: A Biography and Complete Career Chronicle.
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Psychiatry and the brain
Even before the much-heralded DSM-5 was released, Thomas Insel the Director of NIMH criticized it for lacking “scientific validity.” In his blog post entitled “Transforming Diagnosis,” Insel admitted that the symptom-based approach of DSM is as good as we can get at present and that it yields “reliability” by disciplining the use of diagnostic terminology among professionals. But (he went on) DSM-5 does not reveal the nature of a mental disorder, which is to be found largely in the head. In an interview with the New York Times, Insel said “his goal was to reshape the direction of psychiatric research to focus on biology, genetics and neuroscience so that scientists can define disorders by their causes, rather than their symptoms.” At the same time, Insel has announced a new initiative called Research Domain Criteria Project (RDoC) at NIMH to develop a new nosology that eventually will replace DSM categories. He writes that this program began with a number of assumptions, two of which are:
“A diagnostic approach based on the biology as well as the symptoms must not be constrained by the current DSM categories.”
“Mental disorders are biological disorders involving brain circuits that implicate specific domains of cognition, emotion, or behavior.”
Insel sells RDoC as a replacement of DSM on grounds that “patients with mental disorders deserve better.”
No doubt, patients deserve the best. But is RDoC really the direction in which psychiatry and mental health medicine ought to go? Does a nosology that explicitly pre-privileges the brain and genetics and that begins with the assumption that mental disorders are brain disorders start from a reasonable assumption? Or is this more likely an empirically contentious, discipline non-neutral position about the nature of mental disorders?
Sometimes scientists believe that mental disorders are based in the brain. They don’t recognize that just because a disorder necessarily involves the brain doesn’t mean that it is of the brain (viz. a brain disorder). Consider: One of the reinforcement schedules that is responsible for much human and non-human animal learning is the so-called variable ratio schedule of reinforcement, in which reinforcement is delivered occasionally and unpredictably. It is a powerful schedule for the acquisition of new behavior and well-suited for creatures like us who often must persist in trying to satisfy needs in the face of possibilities of protracted failure. However, when pursued in certain environments, the schedule can lead to gambling addictions and to other patterns of imprudence that qualify as disorders. The brain contains a capacity to squander a family’s resources on a final trifecta.
To get a gambling addict to disengage from a harmful schedule of reinforcement at race tracks or casinos you don’t need to fix the brain. It is not broken. It is behaving as it should from a biological point of view. Indeed, to redesign the brain so that it makes gambling addictions impossible would be a huge mistake.
Our proposal is this: In any particular case of mental illness, even a kind or type of mental illness, the brain may not be at fault. As a brain, it may be in perfectly good working order.
To be sure, we all wish for superior psychiatric diagnostic labels for mental illnesses and for the explanation of the onset and course of illness. Certainly none of us wishes to strip reference to the brain and biological science of an important role in our understanding of mental illness. We need help from brain science for much that we want to know about a disorder. But we need other disciplines as well.
The best picture of a mental illness is not likely to be found in a single, precise, biologically privileged ‘frame’ (viz. a biological marker). The best picture is more likely to be found in the overall manner of organizing the most useful perspectives about an illness that we have or otherwise achieve. Perspectival multiplicity, when properly channeled and evidentially controlled, is often not just the best but the only way in which to understand a phenomenon. Imagine, for example, trying to understand a soccer or tennis match just by deploying the physics of space, time, and motion. It just cannot be done. We need references to human psychology, history, and cultural context.
Ironically, despite his impatience with DSM-5, both DSM-5 and Insel’s aspirational RDoC share one methodological prejudice in common. Both disfavor etiology or history and context in defining mental disorders. In DSM’s case, present symptom clusters are placeholders for eventual filling in by something like RDoC’s neurobiological markers supplemented perhaps by genetic markers. In both DSM and RDoC, mental disorders are conceived exclusively in synchronic or present-tense terms, not diachronically as complex social-emotional-behavioral syndromes with complex histories and long backtracking arms.
To see where and why non-brain science is important to our understanding of mental illness, we need to assemble a number of points that cannot be assembled here. Mental illness will not be understood by those who live in disconnected sets of scientific rooms or aspire to a single pre-determined resting place of theory.
George Graham is the co-editor of The Oxford Handbook of Philosophy and Psychiatry with KWM Fulford, Martin Davies, Richard Gipps, John Sadler, Giovanni Stanghellini, and Tim Thornton. He is a former president of the Society for Philosophy and Psychiatry, and teaches philosophy at Georgia State, having taught at Alabama-Birmingham and Wake Forest. Owen Flanagan is also a former president of the Society for Philosophy and Psychiatry, and teaches philosophy at Duke, having taught at Wellesley.
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Where’s Mrs Y? The effects of unnecessary ward moves
It’s a Thursday morning in February, and I have just arrived on the ward to start my ward round. Mrs Y, a lady in her 90’s with dementia, was admitted with pneumonia a few days ago. She is on the mend, rehabilitating well, and we planned to get her home tomorrow with some extra home care. Now she is nowhere to be seen.
“She was moved out to the dermatology ward last night” the senior charge nurse tells me apologetically. “No beds again, and we had half a dozen patients in the acute medical unit waiting to come up.”
At the end of the ward round, I make my way across to the dermatology ward. Mrs Y is thoroughly disorientated, wandering around and becoming more and more agitated. She is proving to be challenging to care for; the dermatology nursing team lack the skills to look after frail patients with dementia. Later that day, she falls on the way back from the toilet, giving herself a nasty bang on the head. Her discharge is delayed by several days whilst she recovers from her fall and her confusion.
This story will sound familiar to all too many of us who work in hospitals looking after older, frail people, and it is all too familiar to our patients and their loved ones. Boarding (the practice of moving patients from ward to ward in hospital to make room for other patients) is bad care. As explained in our editorial in Age and Ageing, moving frail, older patients makes them more vulnerable to falls, more likely to become confused and disorientated (delirium), and the need to hand over care to a team that is unfamiliar with the patient and family leads to miscommunication and delays in planning care and discharge.
Most importantly, older patients do best when they are looked after by specialists in the care of older people, working on a specialist ward with specialist nurses. Moving to a non-specialist ward means that they don’t get the benefit of the best care, which means that they are more likely to become unable to look after themselves, more likely to enter a nursing home, or more likely to die.
Patients don’t want to be boarded, but few are asked if they mind. Families don’t want it, and nor do clinical staff — 90% of doctors in a recent survey would object if their relative was being boarded. So what is the solution? Boarding is a symptom — a symptom of a system of health and social care that is not working as it should. It is not the fault of individuals, and exhorting individuals to improve isn’t going to work. The solution lies with us all: government, hospital management, GP practices, social work departments, and hospital staff. We need enough beds, but we also need new ways of looking after older people that mean they spend less time in hospital.
Hospitals are not always good places for older people, but sometimes a hospital admission is necessary. Boarding is dangerous, inefficient, and is a classic example of the type of bad care discussed by the Francis report. The solution will take all of us working together, but the one thing that each of us can do individually is be a voice for our patients. Boarding is not acceptable, and we should speak up and say so at every opportunity.
Miles Witham is Clinical Reader in Ageing and Health, and Marion McMurdo is Professor of Ageing and Health, at the University of Dundee, Scotland. Their academic work focuses on clinical trials of exercise, nutrition and medications to improve physical function and quality of life in frail older people; they both work as Consultant Geriatricians, looking after older people in a specialist clinical service. They are the authors of the paper ‘Unnecessary ward moves’ in Age and Ageing.
Age and Ageing is an international journal publishing refereed original articles and commissioned reviews on geriatric medicine and gerontology. Its range includes research on ageing and clinical, epidemiological, and psychological aspects of later life.
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July 31, 2013
An ice cream quiz
We’ve all heard of the classics: vanilla, chocolate, rocky road, mint chocolate chip. But what about the crazier end of the spectrum? Flavors like cherry blossom, chocolate marshmallow, chorizo caramel, sea salt, chai tea, or cinnamon toast. Perhaps surprising to the average consumer, these are all flavors of ice cream.
Ice cream is particularly relevant this time of year, because the entire month is dedicated to the frozen confection. Did you know that it was a US President who first designated July as National Ice Cream Month? Ronald Reagan set aside the month to honor the sweet treat in 1984. Going even further, he established the third Sunday (sundae?) of July — which this year is the 21st — as National Ice Cream Day.
In honor of the decadent dessert, we’ve created a quiz for you to test your knowledge of all things ice cream, drawing inspiration from The Oxford Companion to Food and Drink in America, 2nd Edition. To get in the right mindset, think about hot fudge sundaes, banana splits, brownie sundaes, root beer floats, and ice cream sandwiches. You might not be getting a visit from the ice cream truck, but this is the next best thing. And once you’re done, treat yourself to a scoop of your favorite — whatever flavor that might be.
Get Started!
Your Score:
Your Ranking:
Native of Southern California, Audrey Ingerson is a marketing intern at Oxford University Press and a rising senior at Amherst College. In addition to swimming and pursuing a double English/Psychology major, she fills her time with an unhealthy addiction to crafting and desserts.
Stephanie Rothaug is an intern in the publicity department.
Oxford Reference is the home of Oxford’s quality reference publishing, bringing together over 2 million entries, many of which are illustrated, into a single cross-searchable resource. With a fresh and modern look and feel, and specifically designed to meet the needs and expectations of reference users, Oxford Reference provides quality, up-to-date reference content at the click of a button.
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Monthly etymological gleanings for July 2013
As always, I am grateful to our correspondents for their questions, suggestions, and corrections. Occasionally I do not respond to their queries because I have nothing to say and keep trying to find a quotable answer.
Spelling reform.
I have received a few comments on why English spelling remains frozen despite so many attempts to defrost it and proposals for changing the situation. Some people find the existing spelling rational, but the time it takes to learn to write (right, rite, wright) English tells a different story. All the objections to “the thaw” have been raised and met many times. Therefore, I find academic discussion of spelling reform unproductive. To my mind, the only thing worth the trouble is reaching out to the public. There was a time when men were supposed, even expected, to smoke. Today they are advised to refrain from smoking, and lo and behold, smoking (the smell of alcohol and tobacco that turned on the females of Jack London’s generation) is no longer a sign of masculinity. Moreover, smokers know that they are doing something wrong. By contrast, a smoking woman was a shocking oddity. But once women decided that they would not allow anyone to tell them what to do, they became the main consumers of cigarettes (“You’ve come a long way, baby.” Right?). Such is the pressure of public opinion. To convince the world that English spelling should be reformed, the support of influential politicians is needed. It may be hard to agree on the implementation of the reform (because there is no consensus on where to begin and how far to go), but at least the movement will reach a stage of practical work. At the moment, most of us preach to the choir, and the choir is disjointed and pretty small. If someone has a plan in addition to what has come to be called a vision, will you kindly share it?
Goths and other tribal names.
The origin of tribal and ethnic names is sometimes transparent and sometimes nearly beyond reconstruction. Occasionally, it becomes a bone of contention. Two classic examples are Rus and Slav. Every time historical linguistics begins to serve politics it finds itself in hot water. Can Slav be related to slave? (Incidentally, a most doubtful etymology.) Is Rus a Swedish word of possibly Finnish origin? Entire historical schools have arisen around such controversies. Tribes often call themselves by such names as “all people,” “free people,” and “our own people.” They may emphasize their warlike qualities (“people of the ax”) or refer to some place name. The origin of the word Goth has not been clarified to everyone’s satisfaction. Several other names sound similar, for instance, Gauts (Beowulf was a Gaut). In this context, place names like Gotland and -götland suggest themselves at once. The ancient form of Goth seems to have been Got- (not Goth-), and perhaps the Goths were the people of some area called Got-, whatever its origin. Fortunately, the Goths are extinct, and no one’s feelings can be hurt, whatever the solution of the problem. Even more puzzling than the etymology of Goth is the fact that one of the most powerful tribal unions of the Middle Ages has been assimilated so completely and so quickly.
If you will.
For a long time I have been collecting examples of the if you will pay your debts, you will be able to move on. Those are sentences without the slightest touch of modality, that is, the implied meaning is not “will you oblige us by paying your debts?” If you will opens purely conditional sentences (unless we start with the supposition that every time we see will in such constructions, it has a modal coloring, but reasoning so dooms us to a vicious circle), despite the rule that English conditional and temporal clauses don’t need an auxiliary verb of the future. One of our correspondents suggested that when in place of will would have made the sentence grammatical. I doubt it. When you come back, give me a call, not when you will come. I have no theory, but the ancient rule (no will in conditional clauses) seems to be slowly but steadily losing ground. Perhaps the modal sense of if you will influenced the traditional usage. In this blog, I have often referred to the occurrence of would in sentences in which I can sense no modality (he says that he would arrive much later). It is probably a phenomenon of a similar type. Such inconspicuous changes in syntax are among the most elusive ones for a contemporary observer.
Raining cats and dogs.
In my fairly recent post on the etymology of rain, I reminded our readers of a rational explanation of the idiom it is raining cats and dogs. John Larsson and John Cowan cited parallels from the Scandinavian languages and Welsh. It appears that many people liken streams of water falling from the sky to sharp nails, spikes, and rods. (See the examples in the comments.) It would be interesting to find out whether the speakers of northern Europe arrived at this image independently. Parallel development is quite possible but need not be taken for granted, because idioms and words are borrowed equally often. Especially curious is the German idiom es regnet Schusterjungen, in which Schusterjungen (literally, “shoemaker’s apprentices”) may have had the figurative sense of “studs” Danish has det regner skomagerdrenge (skomager-drenge) (ned), an analog of Shuster-jungen. However, I have been unable to find confirmation of the implied sense of skomagerdreng and Schusterjunge “stud.” The Grimms’ dictionary says relatively little on this idiom. The great Danish dictionary is more informative. It cites Swedish and Norwegian parallels and refers to some literature. But obviously, the idea that shoemakers’ apprentices used to walk especially often in the rain is nonsense.
Some adjectives to be avoided.
A friend of our blog sent me an attachment to the article from “An Irishman’s Diary” on why certain adjectives are the enemy of meaning (it was Voltaire who called them this). Among such enemies we find not only the buzzwords to be avoided (naturally, like the plague) but also the useless adjectives that add sham ceremony to the statement without clarifying its message. One of them is iconic, trodden to death (it is paste, not a diamond: despise it). Another one is significant, as in significant benefits (how significant, in what respect?). Considerable is no better. Stay away from Orwellian and Kafkaesque. All of us can probably cite many more such pretentious, pompous words whose only purport is to suggest that the speaker is a well-read person. The most “significant benefit” of a good education is the ability not to flaunt it.
Tidbits.
(1) The meaning of the abbreviation lb. It goes back to Latin libra, part of the phrase libra pondo “a pound of weight.” I have checked the available information on the Internet and found it fully reliable (all the commentators say the same).
(2) Hobgoblin. Hob is a well-known name of the devil (one of many), so that hobgoblin means something like “devil-devil”—a tautological compound in which the first element reinforces the second. The word was a particularly lucky find because hob rhymes with gob. However, while coining gobbledygook, Lewis Carroll must have been thinking of the word gobble.
(3) Might as well and its synonyms. By a curious coincidence, I have received two similar questions. One of our correspondents has heard the phrase might as least, and the other might as lief, both allegedly meaning “might as well.” As far as I can judge, the first is a dialectal variant of might as well and cannot be recommended under any circumstances. The second makes sense because as lief “willingly” exists (“I would as lief go there as stay here”), but it is not a synonym of at least.
(4) Engl. harp and Latin corb-. A semantic bridge can be drawn between a woven basket and the strings of a harp. Many other words have been proposed as cognates of corb-; some of them inspire little confidence but are not improbable. I have not referred to Pierre Guiraud because so many of his ingenious etymologies are highly speculative and because in this blog, contrary to my articles and books written for specialists, I do not find it necessary to give an exhaustive survey of the literature.
(5) The flow—pluere problem. The best article on this question is, in my opinion, “Methodologisches zu fluere—fließen” by Raimund Pfister in Münchener Studien zur Sprachwissenschaft 25, 1969, 75-94.
(6) In Dutch, f and v are different phonemes. English speakers have a hard time mastering Dutch f, v, and w, so that their judgment about them should be taken with caution.
(7) Has anyone come across the word meleda (as in meleda puzzle) used in English prior to 1978? My search has not produced earlier examples, but I have no access to powerful search machines. If someone can help our correspondent, please do!
Returning to the Goths. This picture shows a page from the Codex Argenteus, the most important text in Gothic. It is a fourth-century translation of the New Testament.
Anatoly Liberman is the author of Word Origins…And How We Know Them as well as An Analytic Dictionary of English Etymology: An Introduction. His column on word origins, The Oxford Etymologist, appears on the OUPblog each Wednesday. Send your etymology question to him care of blog@oup.com; he’ll do his best to avoid responding with “origin unknown.”
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Image credit: The picture shows a page of Codex Argenteus. Public domain via Wikimedia Commons.
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From RDC to RDoC: a history of the future?
Back in 1963 the New York Times reported enthusiastically that “….a young doctor at Columbia University’s New York State Psychiatric Institute has developed a tool that may become the psychiatrist’s thermometer and microscope and X-ray machine rolled in to one.” The tool in question was a precursor of the Research Diagnostic Criteria (RDC) with its operationally defined criteria for psychiatric diagnosis. The young doctor was of course Robert Spitzer who within a few years was to become chair of the APA task force that produced the equally well received operational-criteria-based DSM-III.
Set against the back drop of discontent that has greeted DSM-5, Thomas Insell’s enthusiastic launch in April this year of the National Institute of Mental Health’s Research Domain Criteria (RDoC) project came as a welcome return to the optimism and proper ambition of the heady days of the RDC. Insell has cause to be up-beat. These too are heady days. Psychiatry once again, as in 1963, has promising new tools to hand: imaging, epigenetics, and the rest. DSM has failed to deliver on the promise of these new tools. Patients, Insell says, deserve better.
But will they get it? Will RDoC succeed where RDC (it seems) has failed? No one doubts the promise of the new neurosciences. RDoC — like RDC in its day — is a step (no more) towards some as yet unspecified future psychiatric diagnostic classification. As such Insell is surely right that RDoC will prove more hospitable to the neurosciences than the 500+ categories of DSM-5. But what hope the product bottom line? Will RDoC in the end prove any more effective than RDC and its successor DSMs in translating new knowledge of brain functioning into tangible improvements in patient care?
One way to improve the odds is to strengthen the voice of experience. The buzz on the service delivery side of mental health in the UK is ‘co-production’: an equal voice for patients and carers as ‘experts by experience’ alongside clinicians and managers as ‘experts by training’. So why should we not have co-production in research? Sure, functional magnetic resonance imaging (fMRI) and the like require high-level specialist training. But psychiatric fMRI is about the brain basis of complex mental states to which the voice of experience alone can ultimately speak. In research, moreover, there is a growing resource of doubly qualified ‘experts by experience and training’. So what’s to lose from co-production in research? And with co-production in research goes by extension co-production in the translation of research back into practice.
Co-production it should be said straight away, presents many challenges. Not the least of these for co-production in neuroscientific research are all the methodological and conceptual challenges of bridging between object (observations of the brain) and subject (the contents of experience).
This is where — as a two-way translational bridge between object and subject — philosophy has a role to play. Philosophy, as no less a neuroscientist than Nancy Andreasen pointed out some years ago, is a natural partner to the neurosciences. The centenary of the philosopher-psychiatrist Karl Jaspers’ General Psychopathology in 2013 is auspicious in this respect. Jaspers’ key message for the (equally new at the time) neurosciences of 1913 was that psychiatry uniquely demands in equal measure object (causes/explanations) and subject (meanings/understanding). Yet psychiatry adopted a predominantly causes-only approach that, mediated by the mid-twentieth century logical empiricism of the philosopher Carl Hempel, led, ultimately, to DSM-5.
Modern philosophy of psychiatry, although developing otherwise in parallel with the new neurosciences, has been throughout strongly practice-oriented. The field has indeed blossomed through a dynamic two-way relationship with practice. Besides traditional areas of phenomenology and the philosophy of mind, a novel philosophy-into-practice development has been the clinical skills-based approach of values-based practice. Building on a series of training and policy initiatives values-based practice has recently been incorporated into the UK’s National Occupational Standards for Mental Health as part of a wider reframing around co-production and recovery. There is co-production too in research. Matthew Ratcliffe’s group at Durham University is running a number of phenomenology-based projects in partnership with service user organizations. In Oxford we have a co-production scoping study underway with the Mental Health Foundation. And expect to hear more in this connection of the young philosopher and cognitive scientist Philipp Koralus’ Erotetic Theory of Reasoning and its potential contribution to the emerging field of ‘computational psychopathology’.
So in 2013 let’s welcome Research Domain Criteria as warmly as Research Diagnostic Criteria was welcomed back in 1963. Let’s welcome too, and engage fully with, the new neurosciences. But let’s also welcome and engage fully with the methodological and conceptual challenges of translating research into practice. Otherwise we risk a history of the future in which the small ‘o’ added by RDoC to RDC ends up as just another big zero.
Bill Fulford is a Fellow of St Catherine’s College and Member of the Philosophy Faculty in the University of Oxford and Emeritus Professor of Philosophy and Mental Health at the University of Warwick. He is lead editor of the Oxford Handbook of Philosophy and Psychiatry, series editor of the OUP book series International Perspectives in Philosophy and Psychiatry, and co-editor of the journal Philosophy, Psychiatry, & Psychology.
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Five quirky facts about Harry Nilsson
(1) Harry nearly had no career at all after he accepted a dare as a teenager to slide down a fast running flume at Wofford Heights in California. After sliding down the waterway for several miles at high speed he narrowly escaped with his life by grabbing a metal bar above his head and hauling himself out of the rapid current.
(2) Harry’s career as a songwriter started when he was working night shifts at a bank in Van Nuys. He would finish work at 1 a.m., then go to a nearby office and write songs all night, passing out in a chair as the sun came up. After no more than a couple of hours’ sleep, he’d spend the day seeing music publishers, selling the songs he had written. Some of his greatest hits, including “1941″ and “Without Her” were written during this nightly regime.
(3) Harry had a fascination with numbers, and his mental acuity was so great that if you told him your date of birth, he could instantly tell you which day of the week you were born.
NILSSON’S WEDDING TO UNA O’KEEFFE, WITH BEST MAN RINGO STARR (LEFT)
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ZAK NILSSON IN 1975
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HARRY NILSSON SR. AND NILSSON
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HARRY WITH JOHN AND ANNA MARTIN
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BETTE NILSSON
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HARRY IN BROOKLYN, CIRCA 1946
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(4) Harry’s London flat in Curzon Place was redecorated before he moved in. On the bathroom mirror was a hangman’s noose. Although Harry swiftly changed the mirror, both Mama Cass and Keith Moon were to die in that apartment.
(5) Harry never appeared live during his career as a professional singer. His London TV specials were done without an audience, and he lip-synched to his records on early TV appearances. He only started doing live concerts after his recording contract ended and he began to appear at Beatlefest events to campaign for gun control after the murder of his great friend John Lennon. As he was never paid for these, he maintained he retained his “amateur” status as a performer until the end of his life.
Alyn Shipton is the award-winning author of many books on music including Nilsson: The Life of a Singer-Songwriter, A New History of Jazz, Groovin’ High: the Life of Dizzy Gillespie, and Hi-De-Ho: The Life of Cab Calloway. He is jazz critic for The Times in London and has presented jazz programs on BBC radio since 1989. He is also an accomplished double bassist and has played with many traditional and mainstream jazz bands.
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July 30, 2013
The mysteries of Pope Francis
If you’ve visited Rome, you may have noticed that the Jesuit headquarters, right off St. Peter’s Square, overlooks — “looks down on” — the Vatican. Jesuits are fond of reminding visitors, with a smile, of this topographical curiosity and its symbolic freight.
Much Vaticanology depends on this sort of it-can’t be-just-an-accident logic. What is Pope Francis, the first Jesuit Pope, really up to?
It is hard to overestimate the importance of Francis’ Jesuit background in shaping his approach to the papacy. He is a rare bird. He is a Jesuit who has had a significant career within the Society of Jesus, as a provincial superior of the order in Argentina. As archbishop of Buenos Aires, Francis became prominent as well as in the episcopal arena. He is about as cosmopolitan a pope as the church has seen since John XXIII, who was a professional diplomat.
Moreover, when he was a leader in the Jesuits, Francis participated in drafting the statement, put together a decade or so ago, by the Latin American provincials of the Society of Jesus, that criticized “the Washington consensus” espousing neo-liberal economics and the gospel of the free market. Francis’ rhetorical credentials on the social question are indisputable. Since the mid-1970s the Society of Jesus has taken a strong stand in favor of a “preferential option for the poor.”
During his visit to Brazil, Francis was dubbed “the pope of the people.” Once we probe beneath the populist language, however, Francis runs up against obstacles and interests tied more to the constraints of the papal office than to his Jesuit origins.
Pope Francis at Varginha, 27 July 2013. Photo by Tânia Rêgo/ABr (Agência Brasil), CC by 3.0-Brazil, via Wikimedia Commons.
Besides matters of social justice, the big issue facing Catholicism is “the sexual question”—the rights of women, gays, etc. in and outside the church. It is hard for Francis, for any pope, to move on the latter set of issues. They touch directly on the hierarchical configuration of the church, its sexism, in ways that matters of economic policy do not. They cut to the quick of institutional Catholicism.
It is possible to argue that the sexual question, at least as it applies to controversies like the ordination of women and married men, is secondary to the preferential option for the poor. Such concerns have a hot-house air to them. Yet observers of the church in Latin America have been struck by the appeal that evangelical “sects” have for women. Women preach regularly on the evangelical channels coming out of Rio and São Paulo. The support that evangelical churches give to women, many of them down-and-out, struggling with feckless partners, has overtaken the faded attractions of liberation theology.
In effect, two things are going on here. First, evangelicals pay attention to and include women. Second, many draw on variations on the prosperity gospel. Neither is a tune that Francis plays.
Nevertheless, the new pope is developing a strategy of his own. It is to shift priorities rather than change doctrine outright.
John Paul II and Benedict XVI wound up fixating on matters of authority and sexuality, in an extended reaction to the ’60s. This agenda lingers, but it is showing signs of wear. Pope Francis cultivates a more tolerant manner than either John Paul II or Benedict. His talk of social justice is less strident, less radical than the language used by some of his Jesuit peers; he sounds like a social democrat. And his attitude toward gays sounds more accommodating.
Again, the shift is in the register of the voice more than the substance of the message. Jesuits gained fame not only as explorers but as confessors at the courts of Europe. Confessors listen. There is something to the old saying that it is not what you say but how you say it that matters. The advice is cogent for an institution to which fewer and fewer people pay attention, no matter what it pronounces upon.
Will the strategy succeed? If “succeed” means to stem the drop in adherents not only in Latin America but in the United States, the answer is doubtful. The twin inroads made by evangelical churches and secularization are unlikely to be undone.
At the same time, Francis’ style may manage to dial down the religious temperature. This could be a genuine contribution in polarized times. One of his great predecessors, the American Jesuit John Courtney Murray, pulled this off when he drafted the decree on religious liberty that was adopted half a century ago at Vatican II. Then, Catholicism came to recognize democratic pluralism as a legitimate political system. The church faces a similar challenge today in dealing with the internal politics of its treatment of women and gays and dissent in general.
Faced with the challenges of modernity, the church has behaved like a patriarch that has never quite grown up. That predicament is increasingly anomalous and probably untenable. As a Jesuit, Pope Francis knows a bit about casuistry. He also knows about the importance of imagery, trial balloons, bullet points, and the culture of propaganda. Nuance is the coin of the realm in the land of absolutes.
Peter McDonough has written two books on the Jesuits and others on democratization in Brazil and Spain. His most recent book is The Catholic Labyrinth: Power, Apathy, and a Passion for Reform in the American Church. He lives in Glendale, California. Read his previous OUPblog posts.
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Dress as an expression of the pecuniary culture
Thorstein Veblen was born on 30 July 1857 on the Wisconsin frontier, the sixth of twelve children. His early life was relatively unstructured, although he finally picked up two doctoral degrees, in philosophy and economics. At the age of 35 he got his first academic job, at the University of Chicago. Although he had a reputation as an indifferent lecturer, a difficult colleague, and a bit of a womanizer, he gained recognition as a man with important new things to say about the relation of cultural forces to business transactions. In 1899 he published The Theory of the Leisure Class, which came out of a series of papers he presented on the place in American society of the most affluent. In the excerpt below, he examines constantly changing women’s fashion as an example of “conspicuous waste”.
The dress of women goes even farther than that of men in the way of demonstrating the wearer’s abstinence from productive employment. It needs no argument to enforce the generalisation that the more elegant styles of feminine bonnets go even farther towards making work impossible than does the man’s high hat. The woman’s shoe adds the so-called French heel to the evidence of enforced leisure afforded by its polish; because this high heel obviously makes any, even the simplest and most necessary manual work extremely difficult. The like is true even in a higher degree of the skirt and the rest of the drapery which characterises woman’s dress. The substantial reason for our tenacious attachment to the skirt is just this; it is expensive and it hampers the wearer at every turn and incapacitates her for all useful exertion. The like is true of the feminine custom of wearing the hair excessively long.
But the woman’s apparel not only goes beyond that of the modern man in the degree in which it argues exemption from labour; it also adds a peculiar and highly characteristic feature which differs in kind from anything habitually practised by the men. This feature is the class of contrivances of which the corset is the typical example. The corset is, in economic theory, substantially a mutilation, undergone for the purpose of lowering the subject’s vitality and rendering her permanently and obviously unfit for work. It is true, the corset impairs the personal attractions of the wearer, but the loss suffered on that score is offset by the gain in reputability which comes of her visibly increased expensiveness and infirmity. It may broadly be set down that the womanliness of woman’s apparel resolves itself, in point of substantial fact, into the more effective hindrance to useful exertion offered by the garments peculiar to women. This difference between masculine and feminine apparel is here simply pointed out as a characteristic feature. The ground of its occurrence will be discussed presently.
So far, then, we have, as the great and dominant norm of dress, the broad principle of conspicuous waste. Subsidiary to this principle, and as a corollary under it, we get as a second norm the principle of conspicuous leisure. In dress construction this norm works out in the shape of diverse contrivances going to show that the wearer does not and, as far as it may conveniently be shown, cannot engage in productive labour. Beyond these two principles there is a third of scarcely less constraining force, which will occur to anyone who reflects at all on the subject. Dress must not only be conspicuously expensive and inconvenient, it must at the same time be up to date. No explanation at all satisfactory has hitherto been offered of the phenomenon of changing fashions. The imperative requirement of dressing in the latest accredited manner, as well as the fact this accredited fashion constantly changes from season to season, is sufficiently familiar to everyone, but the theory of this flux and change has not been worked out. We may of course say, with perfect consistency and truthfulness, that this principle of novelty is another corollary under the law of conspicuous waste. Obviously, if each garment is permitted to serve for but a brief term, and if none of the last season’s apparel is carried over and made further use of during the present season, the wasteful expenditure on dress is greatly increased. This is good as far as it goes, but it is negative only. Pretty much all that this consideration warrants us in saying is that the norm of conspicuous waste exercises a controlling surveillance in all matters of dress, so that any change in the fashions must confirm to the requirement of wastefulness; it leaves unanswered the question as to the motive for making and accepting a change in the prevailing styles, and it also fails to explain why conformity to a given style at a given time is so imperatively necessary as we know it to be.
For a creative principle, capable of serving as motive to invention and innovation in fashions, we shall have to go back to the primitive, non-economic motive with which apparel originated, — the motive of adornment. Without going into an extended discussion of how and why this motive asserts itself under the guidance of the law of expensiveness, it may be stated broadly that each successive innovation in the fashions is an effort to reach some form of display which shall be more acceptable to our sense of form and colour or of effectiveness, that that which is displaces. The changing styles are the expression of a restless search for something which shall comment itself to our aesthetic sense; but as each innovation is subject to the selective action of the norm of conspicuous waste, the range within which innovation can take place is somewhat restricted. The innovation must not only be more beautiful, or perhaps oftener less offensive, that that which it displaces, but it must also come up to the accepted standard of expensiveness.
The Theory of the Leisure Class by Thorstein Veblen (1899) is a landmark study of affluent American society that sets out to discuss “the place and value of the leisure class as an economic factor in modern life”. The Oxford World’s Classics edition is edited with an introduction and notes by Martha Banta, Distinguished Professor Emerita at the University of California, Los Angeles.
For over 100 years Oxford World’s Classics has made available the broadest spectrum of literature from around the globe. Each affordable volume reflects Oxford’s commitment to scholarship, providing the most accurate text plus a wealth of other valuable features, including expert introductions by leading authorities, voluminous notes to clarify the text, up-to-date bibliographies for further study, and much more. You can follow Oxford World’s Classics on Twitter, Facebook, or here on the OUPblog.
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Image credit: Die Pariserin bei ihrer Toilette. By Dupons Brüssel, April 1899 [Public domain], via Wikimedia Commons.
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How DSM-5 has been received
The reception of DSM-5 has been marked by very divergent points of view. The editors of the manual congratulated themselves for their achievement in an article for the Journal of the American Medical Association entitled “The Future Arrived.” Yet critics remained adamant, and their views have had wide currency in the media. Those most hostile to psychiatry accuse DSM-5 of being an unscientific collection of dubious categories. Others focus on the way that DSM-5 undermines the concept of normality.
Perhaps the most stinging critique came from Thomas Insel, Director of the National Institute of Mental Health, who has stated that psychiatry “deserves better.” Insel wants to abolish all categories of mental illness, and replace them with a complex scoring system to describe the dimensions of psychopathology. His long-term agenda is to base psychiatry on neuroscience. But these ideas, however ambitious, cannot be supported at this point by empirical data.
The voices of moderate critics (a group I hope I belong to) have not been fully heard. If you sit down and read DSM-5, it is not dramatically different from DSM-IV. Yes, a few categories (generalized anxiety disorder, adult attention-deficit hyperactivity disorder) have been expanded. Yes, grief is no longer an exclusion for depression (although the manual cautions practitioners about making the diagnosis in the bereaved). But the most radical ideas proposed for DSM-5 have been dropped, or put in an Appendix (Section III), mostly for lack of evidence. Thus, risk psychosis has been removed, and the classification of personality disorders is unchanged.
Why then has opposition to DSM-5 been so passionate? Of course, some people will take any opportunity to bash psychiatry. But the main problem is that the process of revision was botched. Ambitious ideas were floated, most of which lacked empirical grounding. Moreover, the wish of the editors to create a “paradigm shift” led them to exclude important experts from the revision process—particularly those who were prominently involved in writing DSM-IV. If you are writing a document that cannot yet be based on solid science, you should at least work harder to obtain consensus.
My view is that while DSM-5 is flawed, it only reflects what is happening to psychiatry as a whole. You can’t blame the manual for the rampant over-diagnosis and over-treatment that afflicts contemporary practice. Also, as research shows, most clinicians haven’t followed previous editions of the manual carefully, and they won’t use DSM-5 systematically either.
What critics and supporters can lose sight of is that DSM-5 is only a provisional system for the diagnosis of mental illness. We just don’t know enough to do better. And we should not believe those who claim that breakthroughs in research are imminent. Understanding the brain, an organ that contains 100 billion neurons, will take decades, possibly a century. Moreover, even a perfect model of the brain could never be the basis of a complete theory of mental illness. You need to apply higher levels of analysis, ranging from an understanding of the psychosocial environment to the concept of mind.
For these reasons, I find much of the commentary on DSM-5 to be misplaced. Instead of supporting or attacking a book, we need to keep in mind how little we know about mental illness. While many psychiatric interventions are effective, that is as much a result of luck as of science. Let’s be humble, and remember that DSM-5 is just a tool, and it is not the only one clinicians can use. Most of the problems with psychiatric diagnosis will not be answered in DSM-6 — and probably not in any of our lifetimes.
Joel Paris is a professor of psychiatry at McGill University (Montreal, Canada), and a research associate at the SMBD-Jewish General Hospital, Montreal. He is the author of 15 books, most recently The Intelligent Clinician’s Guide to the DSM-5®, and 183 peer-reviewed scientific articles. read his previous blog post “Clinician’s guide to DSM-5.”
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Image credit: psychiatrist with patient. © TrentVino via iStockphoto.>
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