Kid perspectives on contracts

We recently had some windows added to our house. If you live in a northern lockdown state, this might not sound like a big deal: cut out some wood with a reciprocating saw, get a glass module (double pane to save the planet), frame around the glass module, touch up the paint. In the Florida Free State (TM), however, you need to do the following:

  • cut through cinder block and rebar
  • put a lintel above the opening that you just cut so that the house doesn’t fall down
  • pour some new concrete with rebar around the window opening
  • add wood framing just inside the new opening
  • bring in a window company at $3,700+/opening to install an impact-rated window into the wood and concrete with massive screws every 7 inches or so
  • deal with the building inspector multiple times already by this point
  • install new stucco on the concrete that you’ve just poured
  • paint the exterior
  • install new drywall on the interior
  • paint the drywall

The window company said that in pre-Biden times it was possible to find a general contractor to do all of the above (except the window item itself) for $5,000 per opening. We had four openings so it should have cost us about $20,000+ for the general contractor and $14,750 for the windows themselves.

Of course, the old $20,000 is the new $40,000 or maybe $100,000. The window company’s usual partners refused even to look at the project, deeming it too small. Our architect worked with a mid-sized contractor regularly and he quoted $37,250 for his part of the work. A small-time guy who’d done some stuff very reasonably for us in the past quoted $18,000. We’d had huge price discrepancies for some other items at the house, e.g., install a mini-split A/C in the garage so it didn’t occur to us that the $18,000 was a mistake until after we saw how many guys and subcontractors the contractor put on the project and how many weeks it took.

Towards the end of the project, he came back to me and opened by saying that he knew that I owed him only $18,000 because that’s what he quoted. But he had some paperwork to show that the proper cost was closer to $40,000 and explained that he’d made mistakes in preparing the quote, leaving out a lot of concrete work.

I asked out 8- and 10-year-olds what they would have done in the situation. I tried to prepare them for the scenario by asking what if the Honda dealer quoted us $1,000 for new tires and then said they’d made a mistake and asked for $2,000 when the car was completed. They both said that the Honda dealer should be held to the contract. Then I asked them about our specific contractor, whose friendly careful people they’d seen in the house for all four months of the one-month project. They gave the same answer: hold the guy to his bid. I tried to get them to back off from this position by pointing out that the Honda dealer might be worth tens or hundreds of millions of dollars while our contractor was just a regular working guy and had a lot of subcontractors to pay, but I couldn’t make them see a distinction.


Excerpts from the Notice of Acceptance that is part of the building permit:

(Readers might reasonably wonder what I decided to do. I paid $37,250, which the competitor had quoted, since that was the only reference that I had for a correctly quoted job. It seemed like a fair price for the quality and quantity of work that was done. (Plus, the guys who were sawing concrete blocks and doing other onerous tasks in the Florida heat and humidity will need money to pay off college graduates’ loans transferred by Joe Biden to the general taxpayer.) It wouldn’t be logically consistent, but if the Honda dealer made a mistake and gave me a written quote that they later said was lower than it should have been, I wouldn’t voluntarily pay more.)

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Situationism in the news thanks to the Berkeley professor who suggested moving out of the Bay Area as a dating strategy for heterosexual men

“UC Berkeley professor under fire for telling student to ‘get out’ of California’s Bay Area if they want a girlfriend” (New York Post):

“If you want a girlfriend, get out of the Bay Area. Almost everywhere else on the planet is better for that. I’m not kidding at all,” [Berkeley Computer Nerdism prof Jonathan Shewchuk] reportedly said, according to screenshots of the comment posted to social media.

“You’ll be shocked by the stark differences in behavior of women in places where women are plentiful versus their behavior within artillery distance of San Jose and San Francisco.”

The professor was highlighting Situationism:

… the theory that changes in human behavior are factors of the situation rather than the traits a person possesses. Behavior is believed to be influenced by external, situational factors rather than internal traits or motivations. Situationism therefore challenges the positions of trait theorists, such as Hans Eysenck or Raymond B. Cattell. This is an ongoing debate that has truth to both sides; psychologists are able to prove each of the view points through human experimentation.

The last part of the Wikipedia intro is interesting. It’s #Science and everyone collects a fat paycheck, mostly from taxpayers, but there are no answers!

CNN, 2015, “I have a fiancé, a girlfriend and two boyfriends”:

Miju Han lives in the Bay Area, works as a product manager and shares a charming apartment with her fiancé.

Here’s what makes her love story a bit different: She’s also in three other relationships. In addition to her fiancé, Han has been seeing a woman for two years (they recently said, “I love you”). She also dates two other men.

Han, 27, says she never quite colored inside the lines. She grew up in the South, was attracted to women and fascinated by programming. In 2010, she moved to the Bay Area and has since worked at several major tech companies.

Professor and Mrs. Shewchuk:

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Randomized controlled trial of therapy for teenagers

“These Teens Got Therapy. Then They Got Worse.” (Atlantic, by Olga Khazan; paywalled, but readable in the Google cache):

Researchers in Australia assigned more than 1,000 young teenagers to one of two classes: either a typical middle-school health class or one that taught a version of a mental-health treatment called dialectical behavior therapy, or DBT. After eight weeks, the researchers planned to measure whether the DBT teens’ mental health had improved.

The therapy was based on strong science: DBT incorporates some classic techniques from therapy, such as cognitive reappraisal, or reframing negative events in a more positive way, and it also includes more avant-garde techniques such as mindfulness, the practice of being in the present moment. Both techniques have been proven to alleviate psychological struggles.

The author and editors forgot to capitalize “Science”!

This special DBT-for-teens program also covered a range of both mental-health coping strategies and life skills—which are, again, correlated with health and happiness. One week, students were instructed to pay attention to things they wouldn’t typically notice, such as a sunset. Another, they were told to sleep more, eat right, and exercise. They were taught to accept unpleasant things they couldn’t change, and also how to distract themselves from negative emotions and ask for things they need. “We really tried to put the focus on, how can you apply some of this stuff to things that are happening in your everyday lives already?” Lauren Harvey, a psychologist at the University of Sydney and the lead author of the study, told me.

But what happened was not what Harvey and her co-authors predicted. The therapy seemed to make the kids worse. Immediately after the intervention, the therapy group had worse relationships with their parents and increases in depression and anxiety. They were also less emotionally regulated and had less awareness of their emotions, and they reported a lower quality of life, compared with the control group.

Most of these negative effects dissipated after a few months, but six months later, the therapy group was still reporting poorer relationships with their parents.

Last year, a study of thousands of British kids who were put through a mindfulness program found that, in the end, they had the same depression and well-being outcomes as the control group. A cognitive-behavioral-therapy program for teens had similarly disappointing results—it proved no better than regular classwork.


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Elon Musk and videogames

When not working, does the world’s greatest innovator sit in a cardigan reading books, à la Jimmy Carter or Bill Gates? Elon Musk by Walter Isaacson:

One key to understanding Musk—his intensity, focus, competitiveness, die-hard attitudes, and love of strategy—is through his passion for video games. Hours of immersion became the way he let off (or built up) steam and honed his tactical skills and strategic thinking for business.

Musk had enjoyed all types of video games as a teenager in South Africa, including first-person shooters and adventure quests, but at college he became more focused on the genre known as strategy games, ones that involve two or more players competing to build an empire using high-level strategy, resource management, supply-chain logistics, and tactical thinking.

His only indulgence was allowing breaks for intense video-game binges. The Zip2 team won second place in a national Quake competition.

In 2021, he became obsessed with a new multiplayer strategy game on his iPhone, Polytopia. In it, players choose to be one of sixteen characters, known as tribes, and compete to develop technologies, corner resources, and wage battles in order to build an empire. He became so good he was able to beat the game’s Swedish developer, Felix Ekenstam. What did his passion for the game say about him? “I am just wired for war, basically,” he answers.

This seems like a good time to drag out a TED talk by a neuroscientist, Daphne Bavelier. This was sent to me by a neuroscientist who hates video games and has spent years trying to prevent his son from playing them. He admits that there is no scientific basis for his hatred and cites Prof. Bavelier.

What is the rationale for telling kids to get off their Xboxes if Elon Musk thrived on shooter games and #Science says that games are beneficial?


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On the effectiveness of the Anti-Defamation League

The Anti-Defamation League (ADL) claims expertise in eliminating hatred. When they started, they were experts in getting American haters to love Jews. In their own opinion, at least, they were so good at this that they expanded. Here’s just their civil rights section:

They want to make sure that low-skill Americans have plenty of competition from low-skill immigrants:

ADL fights tirelessly for immigrants and refugees seeking safety and a better life in the U.S. Through legislative advocacy, amicus briefs, and public awareness efforts, we have promoted just and humane immigration and refugee protection policies throughout the decades.

The ADL will make haters realize that #LoveWins:

ADL has long fought in the U.S. and abroad to advance LGBTQ+ equity, encouraging legislation that protects individuals’ rights and providing education resources that make schools, workplaces and communities more welcoming and inclusive.

What have we seen in the past few weeks? Muslim immigrants to the U.S., whose right to settle here was pushed by the ADL, rallying and pointing out that the Islamic Resistance Movement (“Hamas”) is not a terrorist organization, but the Israeli government and all supporters of Israel are (video). Twitter and Facebook jammed with anti-Israel content. A young woman in a hijab in NYC and her friend giving the finger to a billboard truck advocating for the return of hostages held by Hamas (video). Depending on your political point of view, you might agree with these anti-Israel positions, but I think that everyone can agree this is not what the ADL was trying to accomplish.

Maybe the ADL could be more effective with people if they would spend more time soaking up the ADL message? From the New York Post:

One of the NYU students who brazenly ripped down posters of Israeli hostages is an activist “extremely passionate about fighting racial profiling” who blamed her behavior on misplaced anger.

Yazmeen Deyhimi — a junior at the top university who once worked for the Anti-Defamation League — admitted to tearing apart banners that were plastered outside NYU’s Tisch Hall, in a shameless act that was caught on video.

“I have found it increasingly difficult to know my place as a biracial brown woman, especially during these highly volatile times,” she wrote.

According to her LinkedIn profile, Deyhimi is an advocate against Muslim bigotry and spent a summer working with the ADL as a CSC education intern when she was just 15 years old.

“After review, we can confirm that one of the participants was part of an ADL high school level summer internship in 2019,” a spokesperson for the organization told The Post.

The ADL had a whole summer to convince this young person that Jews are lovable!

If the ADL has failed spectacularly at its original mission, at least the Ministry of Truth is working effectively there:

The ADL has since taken down a blog post announcing the Long Island native as one of the 12 student leaders joining the program, describing Deyhimi as “extremely passionate about fighting racial profiling and championing gender equality.”

Does supporting Hamas impair a migrant’s claim for asylum in the U.S.? Not according to the Deplorables at the Daily Wire… “The U.S. Gov’t Hired A Pro-Hamas PLO Spokeswoman To Handle Asylum Claims”:

Speaking of Deplorable, what does Ron DeSantis have to say about the ADL’s passions for Islamic immigration and using propaganda to eliminate hatred? From Twitter:

No Gaza refugees, period.

It’s a fools errand to think we can separate a terrorist from a ‘freedom lover’ in Gaza.


  • the College Terror List, which was disappeared by the Ministries of Truth at Google,, DuckDuckGo, and all of the other righteous folks. This page contains various statements by elite college students who don’t seem to have been reached by the ADL’s message about the wonderfulness of Jews. Harvard: “We … hold the Israeli regime entirely responsible for all unfolding violence”; Stanford: “while Palestinian resistance is legal under international law, Israel’s breathtakingly violent actions are illegal collective punishment under the Geneva Convention”; Swarthmore: “Since early Saturday morning, Palestinians in Gaza and the West Bank have valiantly confronted the imperial apparatus that has constricted their livelihoods…”; George Mason: “Every Palestinian is a civilian even if they hold arms. A settler is an aggressor, a soldier, and an occupier even if they are lounging on our occupied beaches.” (preserved by Ghostarchive; the only way to find it is with the Kagi search engine (see below))
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Tesla price cuts and human psychology

People who paid last month’s price for a Tesla are upset that this month’s price is a lot lower. See “‘I feel duped’: Tesla price drop angers current owners” (Bloomberg/LA Times), for example:

Marianne Simmons, a self-professed “Tesla fan girl,” bought her second electric vehicle from the company in September: a white, high-performance Model Y costing more than $77,000. Then the company slashed prices on Thursday and she realized she could have bought the same car today for $13,000 less.

That’s the reality facing owners of Tesla vehicles after the company cut the price of its cars as much as 20%, part of a push from Chief Executive Elon Musk to increase sales volume in the face of weakening demand. For existing customers, the resale value of the cars they own will take a hit along with the drop in prices of new models.

Throughout coronapanic and Bidenflation, I’ve been wondering why car makers didn’t just auction every car as it came off the line (to dealers, not to consumers, except for Tesla). Why bother having a list price at all? Maybe the reaction to the Tesla price cut is part of the reason. Let’s move our minds back to the pre-Biden era. When sales slow down and car companies offer massive incentives to clear inventory, consumers don’t get upset. The list price of a car stays the same, but the price would come down from MSRP to dealer invoice to dealer invoice minus $2,000 “cash back” (back when $2,000 was real money!). Somehow people were okay with this variation. But a variation in the official list price cannot be tolerated!

I’m in Cambridge, Maskachusetts this week and the residents deal with this upsetting issue by continuing to operate their beloved Saabs:

(I didn’t see it when I lived here, but looking at these 140-year-old wooden houses brings to mind my Houston friend’s comment that the entire Northeast is “dilapidated”. He won’t go anywhere north of Washington, D.C. without a compelling reason.)


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Individual Americans show Vladimir Putin how tough we can be

“More than 1,000 gather at SF’s City Hall to protest Russian invasion of Ukraine” (SFGate, 2/4/2022) will no doubt strike fear in the hearts of the any foreign military. The accompanying photo shows that a handful of the Followers of Science are equipped with hearts brave enough to go outdoors without a protective cloth mask (our 6-year-old pointed out, however, that “one has a chin diaper”):

The bellicosity of this partially masked Army of the Righteous is described in the text:

Many waved blue and gold Ukrainian flags, and there was a sea of signs within the crowd. Some read “Russians Go Home,” “No USSR 2.0” and “Support Ukraine.” Expressing both sadness and anger, the crowd chanted “Stop Putin” and “Hands of Ukraine.”

“The reason I’m here is to raise awareness of Putin’s war and show the world that Ukrainians in America stand with those in Ukraine,” said SF resident Andy Soluk, who held a flag.

While the shooting war raged and folks in San Francisco were sending thoughts and prayers, what other foes were significant enough to get the attention of the Army of the Righteous? Were they, perhaps, fighting to provide housing for the thousands of their brothers, sisters, and binary resisters who live in Bay Area tent cities? Working with Barack Obama to continue the planet healing that began in 2008? Here’s a February 25, 2022 letter from administrators at University of California Berkeley:

The campus leadership recognizes that it’s hard to adjust to the reality of masks no longer being required (even if they’re still recommended in some settings). That’s why our campus will be one of the last places in the Bay Area to still require masks prior to when our mandate is lifted on March 7. These changes are indeed difficult and I encourage anyone who would feel more comfortable wearing a mask to continue to do so. But I also encourage you to grapple with the fact that the consensus within the public health community is that it is no longer necessary to mandate masking.

Imagine the tenacity and inner strength of a person who can surmount the trifecta of (1) adjusting to reality, (2) coping with the difficult mask order change, and (3) grappling with the new facts of Science!

(Separately, regarding the impending mask-optional vaccine-and-booster-required Berkeley campus, Science tells us that (1) mask orders and vaccine coercion were highly effective at reducing SARS-CoV-2 infections and (2) the virus will be with us forever, including in potentially dangerous new mutants, Combining (1) and (2), it makes logical sense to drop these proven-effective-by-Science policies and let any future plague rage exponentially. Now that those who Follow Science know exactly how to fight COVID-19, they aren’t going to bother to exert any effort in that fight.)

And, in case that you think the valorous are limited to San Francisco, a friend in Colorado sent me the following today:

I sat in on the Zoom call our public health dept had on ending mask mandate a week ago. When asked why if they decided to end it on Monday the end wouldn’t go into effect till Friday they said they had to give people time to absorb and adjust to the new reality.

I also loved that they are voting on, and agreed to, ending a mask mandate on a zoom meeting because it was still too risky to meet in person.

Fortunately, many local business have followed the science and kept their own mandates in place.

On a vaguely related theme of cultural difference, can readers who speak Russian please tell us what the Russian recruitment video says? And, if military service is compulsory for Russian males, why do they have recruiting videos at all?

And our state-sponsored media (NPR) reminds us to curl up into the fetal position. From “5 ways to cope with the stressful news cycle” (2/25/2022; URL: “anxiety-tips-self-care”):

Russia invaded Ukraine this week, … don’t forget to care for yourself in other ways … Breathe … Nourish yourself. The kitchen is a safe space for a lot of us.

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University of Nevada students prove that Freud was right about the super-ego?

From Wikipedia’s entry on Id, ego and super-ego:

The super-ego (German: Über-Ich) reflects the internalization of cultural rules, mainly taught by parents applying their guidance and influence. Freud developed his concept of the super-ego from an earlier combination of the ego ideal and the “special psychical agency which performs the task of seeing that narcissistic satisfaction from the ego ideal is ensured…what we call our ‘conscience’.” For him “the installation of the super-ego can be described as a successful instance of identification with the parental agency,” while as development proceeds “the super-ego also takes on the influence of those who have stepped into the place of parents — educators, teachers, people chosen as ideal models”. [Fauci!]

The super-ego aims for perfection. It forms the organized part of the personality structure, mainly but not entirely unconscious, that includes the individual’s ego ideals, spiritual goals, and the psychic agency (commonly called “conscience”) that criticizes and prohibits their drives, fantasies, feelings, and actions.

“UNR students walk out to protest end of campus mask mandate” (NBC, 2/14/2022):

UNR students and some faculty walked out Monday to protest the end of the Nevada mask mandate.

About 50 students marched from the north end of campus down to the quad, calling on President Brian Sandoval to reinstate the mask requirement on campus.

The video shows that quite a few of the Science-following students have chosen to protect themselves from deadly aerosol SARS-CoV-2 by wearing cloth masks.

Only very loosely related… a photo from the Blue Angels performing at the Reno Air Races 2016:

and three World War II fighters racing…

(Flying 70-year-old planes close to the ground at 500 mph was safe, but being outdoors in the desert in the fall of 2020 was unsafe and therefore the 2020 races were canceled.)

The tastefully understated downtown….

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Medical School 2020, Year 3, Week 31 (psych week 1)

A chapter on diseases of the brain, perfectly timed for Valentine’s Day… (an MIT Economics professor back in the early 1980s told us that romantic love was a mental defect. “You’re giving control over your happiness to another person.” (The no-fault divorce revolution wasn’t fully established at the time, so he didn’t mention that losing more than half of one’s earnings and wealth was also a common outcome…))

Psychiatry clerkship begins with orientation in the clerkship director’s large office. The pediatric psychiatrist makes us all sign that we have reviewed the safety HR training modules and then summarizes them: “When entering the unit, make sure no one is behind or near the door. And don’t wear earrings or necklaces.” [One of Jane’s patients pulled a hoop earring off a nurse, tearing through her ear lobe.] He goes through the required clerkship competencies, including several lectures. He confides, “I feel bad about all the hurdles you have to go through. The more I complain, the more metrics they create. It’s a losing battle, I just gave up.”

After orientation, our team meets on the inpatient psychiatry unit: attending, two social workers, care team leader (CTL, head nurse), and one medical student (me!). We will take care of roughly 10 patients at a time. The attending, a 64-year-old former astrophysicist, who looks and sounds like Dr. Sean Maguire (Robin Williams) in Good Will Hunting, introduces himself then instructs the resident to lead rounds. My resident, a star second-year resident (PGY-2) wearing a stylish polo and sleek slacks, takes me aside: “Today, just watch how we round on patients. Tomorrow ,you’ll lead the interviews for each patient.” He continues: “The inpatient unit is the ICU of psychiatry. Our goal is not to cure them; it is crisis stabilization. If they tried to commit suicide, stabilize their mood and coordinate outpatient resources after hospitalization.”

Rounds begin and are a whirlwind of new patient cases. He presents the first patient outside her dorm room: “32-year-old female with several psychosocial stressors overdosed on Xanax. She is engaging in group classes and denies SI [suicidal ideation].” The resident: “Sometimes the patient just needs to get out of the stressful environment. The average length of stay for a patient is six days. The rack rate is $18,000 per day, but most insurance reimburses about $2,000 per day. Insurance will ask what we did, and the answer is ‘not much except continue her medications and encourage her to use the milieu [group classes, normalization from speaking to other patients]’.”

The next patient is a 43-year-old schizophrenic with ID [intellectual disability] who came in an acute psychotic episode. Our resident: “Schizophrenia is a brain attack, just like an MI [myocardial infarction]. If we don’t prevent it, it will happen again, and the patient loses brain cells each time.” He has been admitted three times within the past two months to our unit, and had several inpatient stays at state hospitals within the past few years. He lives in a “group home.” Attending: “These are basically nursing homes for mentally unstable individuals. Most are run by national companies. They make a fortune.” The patient presented with auditory hallucinations telling him the devil is inside him.

Our goal is for him to be given a long term injection of antipsychotics to prevent medication noncompliance. He is on a TDO (temporary detention order) and, because we have the alternative of giving him daily pills, he has the option of declining the injection. If he declines the injectable, we could try to get a judicial override, a tough argument when there is a conceivable way for him to take his PO meds. The resident says that he has seldom seen a judicial override applied for and never seen one granted, even for patients who are admitted every 2-3 weeks (paid for by Medicare/Medicaid).

We walk in and introduce ourselves. He is restless, withdrawn, and delivers literal responses with a flat affect. Can you tell us how you slept? “Yes.” As the resident struggles to get substantive answers, Robin Williams interjects: “Okay, Johnny, we’ll we will be outside if you want to talk to us.” He then explains: “Don’t let the patient take control of the interview. Watch, in a few hours he’ll be wandering the halls searching for you.” I ask about his restlessness. “That’s a sign of someone who has been schizophrenic since a young age. It soothes him. Schizophrenia is a devastating disease. People with bipolar and depression can be highly accomplished individuals, but you never hear of accomplished schizophrenics. They don’t exist, because the disease will devastate their intellect and motivation.”

On Thursday we discharge the patient after he agreed to get the long term injectable shot. We learn the next day that the Medicaid cab driver kicked him out at a gas station two miles away from his group home. “Fortunately, he walked the remaining distance back to his group home, but we definitely have a protocol issue,” said the resident. “The cab drivers need to know they have to drop these patients off at the specified destination, and if there is some sort of trouble, they should call the police.” Attending: “There is also a presumption that if we are discharging the patient, he/she should be sufficiently medically stable to not get kicked out of a cab.”

The next patient is a 45-year-old bipolar type 1 who stopped taking her meds because she felt good. Five days later she presented in a manic episode with SI. She has several psychosocial stressors: (1) custody litigation regarding an 8-year-old son, (2) the boy’s father taking him across state lines without her permission, (3) a 25-year-old daughter living with a “strange man” in her garage, and (4) the daughter’s theft of $100,000 from a neighbor’s house. She is afraid that her daughter might go to prison and that she herself is being investigated “because I did not call the police for a few days after learning about the theft.”

[Editor: If the patient’s memory can be relied on, the fact that the 25-year-old stole $100,000 and remains free is a great argument for identifying as a white woman!]

Our next patient is a 24-year-old male presenting for SI with plan. He is either delusional or merely extremely high on marijuana. [Editor: We were informed by our political leaders in Massachusetts that marijuana is the best medicine for most conditions and, indeed, marijuana retail was considered “essential” and remained open while schools were shut for coronapanic.] He is obsessed with finding his real parents: Michael Jackson and Halle Berry. The rumor on the floor from the nurses is that his listed “father” in Epic is actually his older brother, and his Epic “mother” is the brother’s male-to-female transgender girlfriend. Attending: “Do you think these wacko family arrangements are dependent on SES [socioeconomic status]? Or do you think lower SES just can’t hide it as well? I tell you, humans are a sick, sick species.” For the benefit of the nurses and patients, our patient performs a pre-discharge moonwalk and a cappella R&B song (self-written and composed). Resident, impressed by the show: “Hey, maybe he is the son of Michael Jackson.”

Our next patient is a 19-year-old African American found lying in the middle of a congested road blocking traffic. “I thought if a car hits me, fine,” she says. “If not, they’ll bring me in so I can speak to a psychiatrist. I want to know if I can stop taking my medications so I can get pregnant.” She has a history of bipolar disorder, but has not been able to afford her medications for several months. A case manager signs her up for Medicaid based on her lack of employment. During a phone call with her boyfriend, he informs her that she might have gonorrhea. We consult a hospitalist to deal with this.

Our next patient is a 38-year-old Caucasian polysubstance abuser. He could go home, but he has “several crack ladies” living in his house. He says that they refuse to leave and injected him against his will. I ask whether he could go to a church-run rescue mission. Our resident: “Yes, but people hate those places because you have to hand over all your money so you can’t buy drugs. When they leave, they then  have to beg for money to get drugs. He needs to kick out the women from his crack den house.”

We finish rounds in time for a new admission, a 34-year-old morbidly obese African American G3P2 bipolar at 35 weeks with uncontrolled type 2 diabetes. There are multiple fetal anomalies and a planned C-section at 36 weeks. Her prior two children were “adopted out” [Resident: “that’s usually lingo for removal by CPS”]. She receives disability payments based on diagnoses of bipolar disorder and anxiety. Roughly three weeks ago, she was feeling so good that she decided to stop taking her anti-psychosis medications. This resulted in a two-week manic episode with no sleep. The crash came yesterday and she tried to kill herself with an overdose of Geodon. Every few hours, all night and day, she says that she is having labor contractions, which forces the nurse to cart her off to L&D. The folks there refuse to do the C-section any earlier than 36 weeks, so the result is a standoff between psych and L&D.

Friday is a rainy day. Our resident: “When it rains it pours. We expect a significant surge in admissions whenever there is bad weather.” We skip rounds to admit the first patient, a 45-year-old African American cocaine addict presenting for suicidal ideation and hallucinations. He’s on disability due to back pain. The resident and I go back after our initial H&P to chat with him in the afternoon. We talk about basketball for 45 minutes. Our patient won state championships in high school, but never played in college. “NBA players are sissies compared to back in the day. The rules don’t allow you to touch the other guy. You cannot compare the old players to the current players scoring.” As the completely coherent and wide-ranging conversation winds down, the resident says, “Come on man, you made this up didn’t you? It’s nothing personal, we know you know what to say to get admitted.” Our patient: “Yeah.”

(We learn that the patient is a regular at the community basketball gym where our resident also occasionally plays. The resident takes the patient’s phone number. “I plan to play with him; neat guy.”)

The last patient I see is a 38-year-old nurse with a history of alcoholism. She has had multiple intervals of sobriety, most recently for ten years. She relapsed last week due to stress from the car accident death of her 45-year-old husband. She tells us that she passed out in her car in the outside clinic parking lot and the next thing she remembers is being in the emergency room. The social worker later finds out that she actually clocked into work, but passed out in front of the physician before the first patient arrived. Her blood alcohol level was .35 (the legal limit for driving is 0.08; 0.40 will kill half of adults who don’t have significant tolerance).

She recounts being beaten as a child by her alcoholic parents and being forced by them to consume alcohol at age 9. Robin Williams asks the social worker to see if we can help her to keep her job. He takes over the interview and asks whether she has completed the 4th (confession of sins to another) and 5th (making amends) steps in Alcoholics Anonymous (yes and yes).

Outside the room, Robin Williams explains, “Try to determine if a patient with alcoholism is motivated to change. If you believe that the patient was sober for ten years, you can work with them. They can benefit from the scarce resources we provide versus the typical patient who comes in for safe detox. Alcoholism is a chronic disease. Relapse is a part

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Even with COVID-19 anxiety, there is always room for climate anxiety

For readers who demand to know why I continue to pay for a NYT subscription… “Climate Change Enters the Therapy Room” (NYT, today):

Ten years ago, psychologists proposed that a wide range of people would suffer anxiety and grief over climate. Skepticism about that idea is gone.

It would hit Alina Black in the snack aisle at Trader Joe’s, a wave of guilt and shame that made her skin crawl.

Something as simple as nuts. They came wrapped in plastic, often in layers of it, that she imagined leaving her house and traveling to a landfill, where it would remain through her lifetime and the lifetime of her children.

She longed, really longed, to make less of a mark on the earth. But she had also had a baby in diapers, and a full-time job, and a 5-year-old who wanted snacks. At the age of 37, these conflicting forces were slowly closing on her, like a set of jaws.

In the early-morning hours, after nursing the baby, she would slip down a rabbit hole, scrolling through news reports of droughts, fires, mass extinction. Then she would stare into the dark.

It was for this reason that, around six months ago, she searched “climate anxiety” and pulled up the name of Thomas J. Doherty, a Portland psychologist who specializes in climate.

Eco-anxiety, a concept introduced by young activists, has entered a mainstream vocabulary. And professional organizations are hurrying to catch up, exploring approaches to treating anxiety that is both existential and, many would argue, rational.

Though there is little empirical data on effective treatments, the field is expanding swiftly.

Caroline Wiese, 18, described her previous therapist as “a typical New Yorker who likes to follow politics and would read The New York Times, but also really didn’t know what a Keeling Curve was,” referring to the daily record of carbon dioxide concentration.

Ms. Wiese had little interest in “Freudian B.S.” She sought out Dr. Doherty for help with a concrete problem: The data she was reading was sending her into “multiday panic episodes” that interfered with her schoolwork.

Note that both patient and therapist are described as living in Portland, Oregon, but they met via videoconference.

I’m still confused how people who are convinced that 50 percent of humanity will die due to climate change can simultaneously be concerned that COVID-19 will kill up to 1 percent of humanity. (Also, the folks convinced that climate change is an existential threat tend to also be passionate supporters of unlimited migration from low-carbon-output societies to high-carbon-output societies. It is tough to think of a better way to accelerate climate doom than bringing millions of people from low-income countries to the carbon-profligate U.S.)

If you’re anxious about climate change and need a decent place to relax for the next few years, consider William Jennings Bryan’s old house in Miami. It will soon be inundated by the rising sea and can be yours for $150 million. From the preceding link, “sitting directly on the water” is a selling point.

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