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Friday, February 18, 2011

Poetry Time!

Here's a little ditty I wrote to occupy my time and to share my feelings with the world.

Calm---the train is coming...
Up above, the light still humming.
Your shadow's blue in the morning sunrise,
And you're cold in your coat.

Wrap my thumb
Squeeze as hard as your tired arms will let you!
It's okay---
Just lay down.

Can you tell this: how much you've taken
Can you tell this: when you began to feel unwell
Hell, I guess we'll try to save you.

I see that guy on the rooftop
I never knew what blue felt like:
oh, everything so soft and cold!
Hello---goodbye!  My love, I need a little assistance:
They cut my pantlegs open, and they stole my shoes.

Everything green and living
Sweat's warm, waiting quiet in the night
The sirens came in, blew on by;
They check for your ID
So take in car your next-of-kin
Then all they find is a piece of foil
And the trouble that you're in

I feel the light like a penny velvet
I never knew what debt felt like
I got some pennies in my pockets---if you want, just help yourself

Hello---goodbye!  My love, I need a little assistance:
They cut my pantlegs open, and they stole my shoes.

I am the sun
I am the happy sun that all the children draw
I am the crescent moon that hangs up on your wall
My fingers scribble in the bottom of your sea
I'm pretty sure that naked stretcher was for me

Thursday, February 10, 2011

The Pain Experience - Reviews of Opioids.

Ever since a nasty car/bike crash, of the "Hamburger Helper" variety, I've been suffering from unbearable, debilitating pain in my legs and back.  With a little help from my friends the opioids, I've had a bit of pain relief, and even some help upstairs, but the pain still dominates my life, day in, day out.  Finally, my doctor decided enough was enough, so she dumped me onto the pain management department of a large Jewish hospital in central Toronto.  Now, let it be known that I'm what might be called a "righteous dopefiend"---the only difference between me and John Smith from St Elsewhere's, Anyshire is that he drinks and I take pain meds.

So, because of my experience with these substances of sin, I feel very strongly about what I'm able and/or willing to take.  My doctor has been very understanding of this (my orthopaedic surgeon wasn't!), and worked with me to agree on what I'd be willing to take and what wouldn't cost her a licence.  I am filled with trepidation, because my doctor has honestly informed me that once I was under the care of an algiatrist, he or she would be my sole care provider as regards pain meds.

This is a problem, because when I was seeing the orthopaedic surgeon as my primary care provider, he believed that when it came to pain management, it would be his way or the highway, and that pain was preferable to addiction.  I was offered the choice of Tylenol (the American name for Panadol) with codeine or Tylenol with tramadol.  I am afraid that it will be the same situation with the algiatrist.

I like several opioid painkillers to the exclusion of most others, because they work with few side-effects and they make me feel good too.  I also will not take anything that contains Panadol.  So, for any pain patients that happen to read this, here's my list of what I won't take, and why you shouldn't take it either.

Hydrocodone - this is known in America as Vicodin.  It contains Tylenol---there is no Hydrocodone preparation without Tylenol or Ibuprofen in it.  Also, this is short-lasting, and you will find that you will be taking Vicodin more often than other pain pills---approximately six to eight times per day. *** / 5

Tramadol - this is available as instant-release with Tylenol, or extended release without (this means that the drug is released into the bloodstream over the course of the day and does not need to be taken more than once without).  Women: take this if you don't want to be addicted.  It works well for pain control.  Men: DON'T take this.  The most important organ in your whole body will cease to function.  If you have to take this, take Viagra too. **** / 5 for women, * / 5 for men

Fentanyl - this is available as extended release patches, or instant release lollies.  If you get the lollies and they work, consider yourself lucky, and do a little dance to the opiate gods.  If they don't, talk to your doctor.  Don't take the patches - people have died from a bad patch that leaked too much into the skin.  Fentanyl is VERY strong --- so strong that the effective dose is in MICROgrammes.  Doctors use morphine (pure heroin) as a yardstick.  This is approximately one hundred times stronger, and shorter lasting, so the lollies are used for emergency pain relief only. ** / 5 patch, **** / 5 lolly

Methadone - yes, this is used for pain relief, not just as a heroin substitute.  Fentanyl and hydrocodone are short-lasting; this is long-lasting.  However, it also takes long to act, so this must be taken every day in order to maintain a constant level of pain control.  For those of you that like the pleasant feelings associated with opioid use---also those of you that dislike them---note that Methadone does not cause pleasant feelings, but it doesn't cause drowsiness either.  Comes as a beautiful green syrup. * / 5

Pethidine - the Americans decided they wanted to be different, so they came up with the decidedly more awkward name Meperidine.  Opioids, just like alcohol and marijuana, cause side-effects visible to others and characteristic to them as a class: specifically, the pupils of the eyes narrow.  Pethidine doesn't narrow the eyes, so it is the choice of those wishing to secretly enjoy its effects in the company of doctors.  However, one note: pethidine is far weaker than morphine.  Above a specific dose, which varies between people but tends to be approximately 200 mg, it causes seizures. * / 5

Codeine - it's weak, you can't sleep despite being drowsy, and your bowels slow down to a crawl, making visits to the toilet... interesting, to say the least. ** / 5

What do I take?  Well, I'm certainly fine with good old-fashioned morphia (Avinza, Kadian, Kapanol, Roxanol), oxycodone (anyone heard of OxyContin?), and hydromorphone (Dilaudid, Hymorphan, Palladone).  Those three obey the "rule of threes": hydromorphone is three times stronger than oxycodone, which is three times stronger than morphia.  Those three score perfect fives.

Sunday, February 6, 2011

The Fallacy of Neurodiversity

A famous advertisement for a large technology company in Cupertino, California once said, "Here’s to the crazy ones. The misfits. ... The round pegs in the square holes. The ones who see things differently."  Such words work well to describe individuals who, despite being eccentric, introduce countless innovations into the world, be they in art, technology, science, or medicine.  It would be a blemish on the human condition to see such individuals ostracised, perhaps due to an ignorance of social mores or simple unwillingness to observe the pieties of daily life.

Karl Jung, the discoverer of analytic psychology, doubtless came into contact with such personalities in the course of his work; in fact, Jung was, in all probability, one of the chosen few himself.  Jung acquired fame for his characterisation of human personality; whereas in the infant days of psychology and psychiatry, a man with a somewhat reserved, introspective air might have been considered to suffer from a personality disorder, Jung's analytic psychology simply placed such an individual on a continuum of normal human personality types, labelling him an 'introvert'.

Other such valuable ideas have been propounded by people in a similar situation; a measure of this potential was later devised---it was termed, adequately enough, the intelligence quotient.  With the advent of the modern era, societies had been formed in which people exhibiting an intelligence quotient above average could socialise and innovate, even though the means to quantify intelligence was yet to be discovered. Yale's famed student society, the Skull and Bones, as well as the international order of the Freemasons, stemmed from this heritage; after the invention of psychometric tests, another such organisation, Mensa, was formed.

Such people, like humanity in general, exhibit areas in which their mind is well-conditioned, as well as areas in which assistance is needed.  One may be strongly-minded in, for instance, self-expression through the English language, and yet be out of their depth in basic algebra.  Fictional characters have been created in this mould as well: Sherlock, a 'consulting detective' and lead character of the BBC's eponymous crime drama, as well as Greg House, diagnostic physician and lead character of Fox's House, both exhibit this tendency.  For all his eccentricities and drug use, Greg House is a likable-enough man---he has his faults, but he is a realistic, normal human being.

Sadly, though, there are people, both real and fictional, who exhibit similar traits of high intelligence, but only in one, very particular, narrow area.  Most visbly, it is as if these people's understanding of basic social cues, such as irony, sarcasm, and humour, had evaporated; such individuals tend to live, or be represented as living, a highly regimented life based on one unvarying, dull routine.

The prototypical character, in my own mind, that exhibits this disorder is Sheldon Cooper from the American situation comedy, Big Bang Theory; even more obviously abnormal are Forrest Gump from Forrest Gump, and Raymond Babbitt from The Rain Man.  In real life, one person quite similar to these characters---most similar, actually, to Sheldon---is Temple Grandin, professor of animal science.  Babbitt's deficiencies are explained in the film as stemming from autism, a neurological disorder; Grandin is herself an autism sufferer.  For the rest of this post, I'll assume Forrest and Sheldon suffer from the same.

I always have thought that it must be a rocky road, raising children; when I see a mother pushing a pram down the street, or dealing with an overactive toddler, I think about offering her a handkerchief to wipe her forehead and a couple Nembutal.  I recoil in horror at the thought of investing one's lifetime---bleeding, sweating, crying---to build a better tomorrow, only to discover that the child is, for lack of a better term, cognitively defective and will be receiving colouring books for Christmas the rest of his life.

Now, the thought of the word 'eugenics' may be chilling, as it recalls the inhuman experiments performed on prisoners in Germany under Nazi rule; however, the true meaning of the term is innocuous.  Eugenics is, essentially, planning whether and when to have a family in light of socio-economic and genetic factors; it comes from the Greek for 'good birth'.

The theory of utilitarianism plays a large part in the exercise of eugenics.  Utilitarianism holds that, given a choice, one must always take the path corresponding to the greatest amount of good for the greatest number of people.  By carefully planning a family, one weighs the advantages and disadvantages of procreation.  With modern science have come genetic markers that aid in assessing the probability of certain diseases prior to taking the plunge, so to speak.

Unfortunately, no such screening test exists for autism.  In fact, it is generally assessed by a competent psychologist or psychiatrist in early childhood.  This leaves, in strict utilitarian philosophy, only one recourse: euthanasia.

In this day and age, however, the human life, however flawed it may be, is valued almost to the point of veneration.  Even people dying from terminal diseases often have no recourse but to take their exit from this world into their own hands.  'Pulling the plug' on an autistic child, therefore, is not a realistic possibility, although it would, in all likelihood, be of benefit to civilisation.

Assuming, however, that medical science progresses at the current rate, a scenario will inevitably arise in which autism and other such diseases can be combated.  One such possibility---presumably the more advanced of the two---is an actual cure or full management of autism.  By this, I mean that perhaps the condition can not be 'cured', but palliative treatment might progress to the point that the symptoms become a non-concern.

The second, more controversial, possibility would be the discovery of the genetic indicator for the disease, as well as a test for autism in the amniotic fluid; in this case, the foetus could be aborted before problems start for the family and other interested people.  This is controversial for good reason; abortion essentially amounts to murder of an unborn human.  In addition, abortion following amniocentesis may be denounced, even by pro-choice advocates, as 'playing God'.  These are certainly valid points, and must be well considered before such measures are taken, when and if amniocentesis for autism becomes available.

However, one objection, even to a cure or complete treatment for autism, is absolutely invalid: it goes by the name of 'neurodiversity'.  Neurodiversity is a view chiefly espoused by those suffering from autism, and autism advocates; the majority of autism sufferers do not identify with neurodiversity, but a significant proportion do.  Neurodiversity asserts that atypical (neurodivergent) neurological development is a normal human difference that is to be recognized and respected as any other human variation; to put it more simply, the theory of neurodiversity amounts to the false view that autism is not a disease or disorder of any kind; therefore, the idea of a cure is moot.

Essentially, the fallacy of neurodiversity is an extension, albeit a pseudoscientific one, to Jung's axis of introversion/extroversion; neurodiversity adds another axis, that of autism/schizophrenia, to create a plane.  However, the fallacy here is that, while introverts and extroverts both benefit society (most leaders being extroverts, and most engineers and accountants being introverts), those suffering from autism and schizophrenia do not; quite the opposite.

Introverts display a number of personality traits: shyness, hesitance, a preference for solitude, and moderate difficulty in self-expression.  Artists, writers, musical composers, inventors,  sculptors, and engineers tend to display at least a slight degree of introversion.

Similarly, extraversion is also characterised by certain defining personality traits: enthusiasm, assertiveness, gregariousness, and comparative ease in self-expression.  The archetypal extravert can be found in politics, teaching, marketing, management, and brokering.

In autism, too, certain traits can be found: they are, in fact, the hallmarks of introversion, taken to an almost pathological degree.  Shyness in social situations is one of the hallmarks of an autism sufferer; so, too, is a preference for solitude.  It can be said, then, that autism is a disorder of introversion.  Similarly, higher-functioning autism sufferers may, or may not, have slightly elevated intelligence quotients.

Many autism sufferers also display obsessive-compulsive disorders; OCD sufferers display symptoms such as repeated hand-washing, arranging objects in stacks or lines, or closing and opening doors a specific number of times when entering a room.  Restricted behaviour is also apparent---a limitation in focus, interest, or activity, such as a preoccupation with a particular television show, game, or toy.  This, however, is also a feature of ordinary introversion.

Although sufferers of autism generally display these associated pathologies, these problems do not add up to autism.  What is truly pathological of autism---only autism---is repetition and consistency.  If the depictions of autism in the media are accurate---and I am quite confident of that---autism is characterised by particular repetitive movements of the body.  Most commonly depicted in the media, and also most commonly seen in real life, are movements such as rocking, hand-flapping, spinning, or vocal tics.

In addition, autistic people generally display a particular, pronounced resistance to change; this is echoed in their ritualistic behaviour, such as visiting the toilet, without exception, when visiting a new place, or arm-flapping when happy.

Self-injury, too, when combined with the above, is a diagnostic indication for autism; self-injurious actions in autism are generally repetitive, rather than the wrist-slitting associated with borderline personality disorder, and they include acts such as eye-poking, skin-picking, head-banging, and hand-biting.

Neurodiversity advocates point to the introversion and elevated intelligent quotients as some of the gifts of autism; however, these aren't autistic traits, but merely traits having an increased prevalence with this disorder.  In fact, the spark of neurodiversity was lit by an article in the New York Times, which stated in part: "Neurodiversity may be every bit as crucial for the human race as biodiversity is for life in general. Who can say what form of wiring will prove best at any given moment? Cybernetics and computer culture, for example, may favor a somewhat autistic cast of mind."

How can computer culture or cybernetics favour a rocking, hand-flapping, head-banging, neurologically challenged wreck of a human being?  So, to any parents of autistic children that somehow stumble onto this, I urge you, in the words of Nancy Reagan, to Just Say No to neurodiversity.