places and spaces…

Posted on Saturday 21 January 2017

Cartograms of the 2016 presidential election [with the country scaled by population rather than area]. On the left, colored by who won the county. On the right, color gradient by percentage vote in county.

Can you say Urban versus Rural?
    January 21, 2017 | 10:16 AM

    Hmm, political Rorschach test? I see the Batman signal, so, who will swoop in and save the day?

    Seriously, the fact that political parties are affiliated with colors, well, let’s just go back to white and black, and then it could be a legitimate Rorschach, eh?

    Personality Disordered Society, check out John Goodman’s column at today, while he is focused on the Left now, it equally applies to the Right as well. And we’ll be asked to treat it…

    January 21, 2017 | 10:20 AM

    By the way, I’ve been occasionally staring at the box in your banner picture, and have to ask, is that an artsy skull on the side of the box facing front?

    I guess this post is making me fond of Rorschach, I’ll add the link to remind readers who he was and what he contributed to mental health assessment…

    James OBrien, M.D.
    January 21, 2017 | 10:59 AM

    Rorschach was one of those old-timey psychological tests I was naturally attracted to but that has failed to live up to expectations. It was one of those things I really wanted to be valid because of the “cool” factor, but alas, it didn’t hold up:

    In forensic work, Rorschachs via the Exner method, which took a bit of training, were routine in 1990, and today you almost never see them in a report.

    Frankly I think the cartograms look like a wounded bird. Which is apt.

    January 21, 2017 | 8:14 PM

    I have to disagree with Dr. O’Brien. There has been a lot of validation work done on the Rorschach since the article you link to above. Frankly it is the best test for inaccurate perception and thought disorder we have. And it is widely used in forensic settings in my part of the country (Chicago).

    James OBrien, M.D.
    January 21, 2017 | 11:53 PM

    Must be a regional thing. I’m in California and I can’t say I’ve seen one in the thousands of reports I’ve reviewed this century.

    January 22, 2017 | 12:04 AM

    Those pictures on the footstool are four traditional representations of the mythic Thunderbird from various Inuit cultures moving up the west coast of Alaska/Canada.

    January 22, 2017 | 1:43 AM
    January 22, 2017 | 1:43 AM
    January 22, 2017 | 1:44 AM
    January 22, 2017 | 1:50 AM

    1bom, the map at the bottom here “huge rural support” is certainly in keeping with your query:

    January 22, 2017 | 9:07 AM

    Dr N:

    Thank you for the clarification, I’ll look that up so I can educate myself.

    By the way, Rorschach is a nice subjective test, this ongoing debate is a bit perplexing, but have fun with it.

    January 22, 2017 | 10:29 AM
    James OBrien, M.D.
    January 22, 2017 | 11:00 AM

    It’s clearly urban vs. rural:

    The two blue areas in the middle are Penn State and Harrisburg. The counties around Pittsburgh (Paris of Appalachia) went Trump 2:1. Those are traditional blue collar Jacksonian Democrats, I know I grew up there. Shockingly, she barely won Centre County, a hard core college town. Many of these people voted for Obama twice.

    Maps of Ohio, Florida, Michigan, Wisconsin etc. all show the same thing.

    James OBrien, M.D.
    January 22, 2017 | 12:28 PM

    So here’s a hypothetical…what’s your Tarasoff responsibility if Madonna comes to your office and says what she said publicly in that idiotic speech? But hey, she’s all for the love and not the hate, despite the vocalized homicidal ideation.

    By the way, someone in her entourage please tell her she’s not 25 and that she’s turning into Norma Desmond.

    January 22, 2017 | 12:56 PM

    Nationally, vs in a more restricted subset, the rural vs urban pattern 1bom references appears present.

    January 22, 2017 | 7:27 PM

    A corollary to the statement below:
    If this very thing were said about Barack Obama, what would I be saying and doing now. (veiled threats regarding current or past CIC are equally corrosive)
    ““If Barack Obama did this very thing, what would I be saying and doing now?” — and then say and do it.”
    (hat tip to Bernard Carroll for the NYT article reference).
    We’ll see how the original statement, and the corollary, play out.

    January 23, 2017 | 1:03 AM

    I appreciate the reference, IBYM, and it’s an interesting article that I enjoyed reading, but it springs from a false equivalency. The former CIC was elected through due process and was fit for command. The individual presuming to this office currently is not a legitimate CIC and is unfit for command. So even if both of them did or said the same identical thing, the response of a third party could, and should, be very different.

    The primary obligation in Dr. Carrol’s hypothetical situation is ethical, not legal. Anyone who has difficulty differentiating between an anger management issue and a credible threat could be working with someone that’s outside their scope of competence, and should seek additional training and experience before taking on this client.

    The secondary obligations would also be ethical: To consult with colleagues and one’s personal therapist if one felt one’s own political views might be compromising one’s ability to provide effective therapy.

    Because that could happen to anyone, and it’s something therapists don’t talk about enough.

    January 23, 2017 | 4:34 AM

    The former CIC was elected through due process and was fit for command. The individual presuming to this office currently is not a legitimate CIC and is unfit for command.
    I hate the outcome of the current election, and dread the consequences which I believe will be long lasting. However, I do not consider what I was suggesting to be false equivalency. I considered statements that Obama was not legally elected and that his presidency was not legitimate to be corrosive (and there was no paucity of such statements the past 8 years), and consider that true for our current president as well. Trump being elected through due process does not make the outcome any less dreadful. Considering the outcome dreadful does not make the outcome illegitimate. I believe that this pattern in recent years of ongoing questioning of the legitimacy of the president undermines the fabric of our nation in damaging ways and, if anything, continuing this pattern will potentiate the problems Trump may create.

    James OBrien, M.D.
    January 23, 2017 | 10:30 AM

    There have been a lot of unhinged statements coming from educated people who should know better:

    If Keith Ablow had said that about Obama eight years ago, he would have been mercilessly shunned by all his colleagues. If Ted Nugent had talked about blowing the White House eight years ago, he’d be in Leavenworth.

    Then you have the throwaways telling us how we need to coddle people with safe spaces and enable, but wait, that’s not enough, applaud their primal screams.

    Losing elections is not trauma, it’s part of life. If you’re traumatized by an election result, and you don’t live in Venezuela or some despotic hellhole, chances are the problem lies in Axis 2. Snowflakes should meet up with some of the combat veterans I talk to for a little perspective.

    I can think off the top of my head about eight things I don’t like about Trump’s policies (because of demographics and debt alone, 4% growth is going to be impossible) but none of those involve idiotic KKK (a Democratic institution BTW) or Hitler analogies.

    I would also invite older snowflakes to make a chart of their GAF versus who is President. There is no correlation. Anyone who thinks they can’t be happy because of who is President should read Daniel Gilbert’s books or anything Buddhist. It is very possible to be happy even if you think the nation is going in the wrong direction.

    January 25, 2017 | 1:51 AM

    “If you’re traumatized by an election result, and you don’t live in Venezuela or some despotic hellhole, chances are the problem lies in Axis 2.”

    Uh, no. The days when psychiatrists and therapists could label patients as borderline or cluster B or whatever on such a fatuous pretext are long gone. Hey, you can say whatever you want online, but if you do that in the real world, the consequences can be quite traumatic for both the patient and the clinician.

    I love it when keyboard kommandos wring their hands and parrot fashionable cliches about fragile students needing safe spaces or whatever. They are no different from the cowards who called our generation wimps because we had long hair. The country will be in much better hands once the “Greatest Generation” finishes bowing to empty seats and dodders off the stage.

    What’s traumatic is not the ELECTION, but the IMPACT of addled plutocrats (backed, I might add, by a hostile foreign government) as they struggle to implant their babbling surrogates into the highest offices of the country. If someone wanted to haul your family– legal citizens– into some detainee facility at the border, or take away your insulin, I think you’d change your mind about whether that meets the criteria for trauma.

    But just because we’re planning to fill up those interment camps, don’t compare anyone to Hitler, because that’s– well, unhinged, beyond the pale, absurd, and just plain impolite. With you all the way on that one. The comparison is ridiculous. Hitler did not have access to a nuclear arsenal, and also painted some damn fine watercolors, while the surrogates seem to have no skills whatsoever.

    As for Ted Nugent, he actually did threaten to kill the President– a real President– in 2007 (“I told him to suck on my machine gun”) and, last I checked, he is not in Leavenworth. But no one would know, because fortunately, no one gives a shit about Ted Nugent (though ‘Stranglehold” is a great song. You should check it out.)

    Peace and Love, baby..

    January 25, 2017 | 2:09 AM

    I fundamentally disagree with Dr. O’Brien’s implication that if a LGBT youth, or a child with parents who have tenuous legal status, experiences deep concern about the possible impact of the current election, that the best approach might be for them to speak with combat veterans and in so doing wake up to what overly sensitive snowflakes they are.

    Perhaps I am creating a straw man out of Dr. O’Brien’s position. Consistently creating straw men out of the reasoning of others might not be the greatest of ideas. I’ll go back and read his positions more carefully.

    In the meantime, I found this article of value:

    January 25, 2017 | 2:29 AM
    James OBrien, M.D.
    January 25, 2017 | 8:05 AM

    “Perhaps I am creating a straw man out of Dr. O’Brien’s position.”

    You are. Because not all disagreement or negative emotion is trauma.

    James OBrien, M.D.
    January 25, 2017 | 10:43 AM

    “What’s traumatic is not the ELECTION, but the IMPACT of addled plutocrats (backed, I might add, by a hostile foreign government) as they struggle to implant their babbling surrogates into the highest offices of the country. If someone wanted to haul your family– legal citizens– into some detainee facility at the border, or take away your insulin, I think you’d change your mind about whether that meets the criteria for trauma.”

    But that’s not PTSD. That’s a situational problem. That doesn’t deny that they are angry, it’s just not PTSD. PTSD by definition requires an actually experienced, not hypothetical life threatening event. And your last hypothetical would be a delusion because there’s no chance of that happening and he never propose that.

    If you’re worried about drug prices and availability, I would point out that one of the first targets Trump went after was big pharma and monopoly pricing. If he actually does that he will have done more to advance the cause of this blog than Obama ever did. I found it strange that Obama never did anything about this at all (Medicare pays 15k a month for leukemia drugs in some cases) despite all the equality and fairness rhetoric. This is not a traditional left right divide. Trump yesterday received big support from the AFL-CIO for this.

    January 25, 2017 | 3:22 PM

    Fair point about big Pharma, Dr. O. I’m responding to something I’m seeing in my practice, which is that is people are very worried about losing coverage. (Some Trump supporters I know worry about this as well, though they don’t happen to be clients.) The impact of his policies on drug prices– should clients be able to maintain coverage– remains to be seen. (The impact on Pharma stock prices last week was noticeably negative, which would provisionally support your argument here.)

    I’m not sure what you mean by my “last” hypothetical, but the internment camps do exist:

    And yes, I am still quite a ways from diagnosing any of my student clients w/ PTSD, and pretty much for the reasons you say. (None of them claim to be diagnosed with PTSD, either– at least so far!) I do think we are edging closer to #3 & #4 in Criterion A, (which do not require an actually experienced event) and I wouldn’t be surprised if we started seeing that later in the year.

    1BYM, thanks for the links, I look forward to reading them. Disagree with your idea about the corrosive effect of questioning legitimacy of the CIC in general, but I certainly agree that harping or obsessing on this would certainly be counterproductive. Thanks for hearing me out.

    James OBrien, M.D.
    January 25, 2017 | 6:10 PM

    Any further expansion of the definition of PTSD to make the mere perception or false claim of life threatening trauma on a relativistic subjective basis will render all future research on the subject useless. We saw what happened with MDD.

    January 25, 2017 | 6:54 PM

    At risk of closing this thread, as I noted earlier, I fully agree with what John Goodman wrote a week ago at, the Democrats ran on identity politics and when they lost, well, their identities were at the very least marginalized if not downright rejected. Just to make sure no one can accuse me of being a hack Republican, look at all those people behind Trump, and I would bet nearly half of them were downright critical and dismissive of Trump just 9 months ago, as they never saw him winning the Republican nomination. But, pandering and opportunism always, and sorry but the word works here, trumps consistency and appropriateness, much less adhering to principles.

    And thus why the losers that Perry and Carson who for me are exhibit A & B of hypocrisy and selling out are part of his cabinet today.

    This election in my opinion really was about voting for the alleged lesser of two evils, and the irony of the above picture of Dr Nardo’s post shows quite the divide that runs across and within this country. And if you read at my blog site, I have been railing about how we are over waist deep in a Personality Disordered Society, so, read up on the general definition of Personality Disorder and step back and see the parallels to both ends of the Republocrat Party.

    Whether the preaching is for violence or just blatant dismissal of an alternative point of view, it is about rigidity and inflexibility. Just be careful, when one starts practicing those immature and pathological defenses those of us learned about in our training, it does not elevate the user of said ineffective defenses to a mature and respectable position.

    Which again in my opinion why we ended up with the choice of Hillary or Donald. Think about this folks, 125 million people voted for what were obviously deeply flawed and unqualified people to lead this country. I leave you with this image, remember when Michael J Fox is trying to convince Christopher Lloyd’s character Doc Brown from “Back to the Future” Fox was from the future when they meet in the 1950s, Lloyd asks who was President in 1985? “Ronald Reagan, who’s the Vice President, Jerry Lewis?!”

    Amazing how 30 years later, who’s laughing at whom now!?!?

    I love leaving with an image, I hope you appreciate my efforts at some conclusion with a chuckle, Dr N:

    the line is about 2 minutes into the 3 minute scene…

    January 25, 2017 | 7:22 PM

    Dr. O’Brien, Yes, you have been specifically referencing “trauma” and “PTSD.” I was not referencing trauma and so should not have taken your comments as invalidating towards the concerns of the youth I was referencing. We’re each talking about different things.

    James OBrien, M.D.
    January 26, 2017 | 12:33 AM

    My intention was not at all to invalidate feelings but but them in a cognitive behavioral context and separate “issues” from “trauma”. I do believe issues should be dealt with, not catastrophized, and on this day it is only fitting for the beloved Mary Tyler Moore to weigh in:

    January 26, 2017 | 9:11 AM

    I suppose Internet communication at times leaves itself too open to misinterpretation. “You can’t be brave if only wonderful things happen to you” seems an interesting response to the concern of youth I was referencing. Seems to play into the snowflake theme. So much of this discussion hangs on subtleties of phrasing. I suspect that if we keep going back and forth we’ll figure out that we simply disagree (though I’m not sure we would have consensus at this juncture on precisely what we disagree about). However, we would likely concur now that neither of us experience disagreeing with each other as traumatic.

    James OBrien, M.D.
    January 26, 2017 | 10:37 AM

    So why didn’t any of this happen under Hopey McFourPutt? I guess obscene undeserved profits weren’t a problem after all if pharma contributed to your campaign:

    CMS can’t negotiate drug prices? What kind of insanity is that?

    January 26, 2017 | 4:08 PM

    I hope it is not just me, but when there is profit to be made in health care, inevitably it means there are lives that are expendable. Sorry, not just a play on words, you can’t have the letters F-O-R in the concept of profit when it comes to honest and well intended health care agendas.

    But, especially when physicians forget that basic premise, well, why the antipsychiatry lobby does have some legitimate traction out here on the Net.

    Oh, and let’s have one more moment of candor, you really think Trump is honestly going to go after Big Pharma? Come on, what do Narcissists do first, talk the game, and then dump the failures on others.

    Ahh, isn’t that what we watched the last 8 years prior?!?!

    James OBrien, M.D.
    January 26, 2017 | 4:56 PM

    I think he’ll have to because financially he has no choice. Medicare can’t keep paying 15K a month for leukemia drugs. Pharma can’t keep asking and getting what they want. An unsustainable situation can’t be sustained.

    He already got Boeing way down on the cost of the two Air Force Ones. I think he means business on this.

    There’s a lot of his economic plan I don’t like but if he does this it will be great.

    I also think the VA will get better under him because it simply can’t keep getting worse. Some of these recent scandals are sickening.

    James OBrien, M.D.
    January 27, 2017 | 9:18 PM

    BTW, Dr. H., not a smidgen of Cluster B pathology (sarc):

    January 28, 2017 | 12:21 AM

    The tone of this thread continues to grow more distasteful. Since “this is not the place for contentious interpersonal dialog” nor “categorical or ad hominem comments about each other” I will limit myself to that breach in etiquette.

    James OBrien, M.D.
    January 28, 2017 | 12:41 AM

    In what way were you personally insulted? Specific example…

    January 28, 2017 | 12:59 AM

    My stating that the tone of this thread continues to grow more distasteful (stated immediately following your latest comment) fell under both categories. The breach in etiquette I referenced is my own. I was not personally insulted.

    January 28, 2017 | 8:36 AM

    Hence why I thought we were reaching critical mass several comments above when I started with at the risk of closing this thread.

    Politics are an intense issue, especially in 2017…

    January 28, 2017 | 8:42 AM

    Oh, and by the way, I was waiting after about 3 minutes into that above link for Kirk to turn to Spock and say” what the hell!?!?”.

    James OBrien, M.D.
    January 28, 2017 | 10:50 AM

    I actually feel sorry for her and Lena Dunham and I hope they get help. That was pretty bad, and may I add, a terrible cultural appropriation of Maya Angelou, who can actually pull off that style while being coherent. Infantile regression outside the service of the ego or anything is not mentally healthy and shouldn’t be applauded. Anyone who says Trump is a Nazi deserves to be tuned out as much as anyone who says Obama was Pol Pot. I can think of many responsible ways to criticize Trump that wouldn’t involve turning the volume to eleven every day and wearing a foam uterus hat. If they keep that up and he will win Connecticut next time, because eventually rational people tune out. And the voters will also notice that the pro-life marchers were well behaved by comparison. All of this is not meant to reflect anything about my own politics, just my observation that actions and chanting hyperbole that never happens have consequences, and its not enough in life to have the feelz without a rational plan and having the feelz with a plan isn’t an actual accomplishment. The feelz without a plan need to be dealt with in therapy, not at the town hall.

    January 28, 2017 | 11:19 AM

    Sorry, I don’t feel pity or concern for people who spew hate or extremism or hostile zealotry. They’re only interested in an agenda to further their own cause, or at least maximize division and to perhaps achieve conquest by having that division play out.

    My theory of living in a personality disordered world seems to fit more and more as things progress. People resort to pathological, immature defense mechanisms that because of the pervasiveness of them, people feel that this is the appropriate mechanism to handle problems.

    So, rational, appropriate, genuine people need to ostracize and marginalize people who are inappropriate!

    That may come across as equally rigid and insincere, but, Life’s too short to put up with people who are jerks.

    From what we have as representations in our political system, irregardless of Democrats or Republicans, this reflects to me that our constituents as a whole, are jerks!

    And as of this comment, I sense this thread is going to have a line written across following my conclusion here.

    Again, my apology if it comes across as rude insensitive, I just call it as I see it, and after 23 plus years of Psychiatry, let’s face it, we are dealing with more more people who really just can’t be negotiated.

    James OBrien, M.D.
    January 28, 2017 | 12:28 PM

    I feel both pity and contempt, since someone like Lena Dunham is also a predator and liar (by her own admission). Yes life is too short for jerks, but I still love my fellow citizens in the agape sense and I worry about their mental and physical health and poor choices in life. Life is also too short to hate (it’s a calorie burner, and I’m lazy) half the population, and someone should have told Hillary that before the deplorable comment.

    Anna Freud wrote Ego and the Mechanisms of Defense. I wonder what she would say about Ashley Judd’s personality structure versus Ben Watson (even if you don’t agree with Ben Watson):

    January 28, 2017 | 2:36 PM

    Hmm, pity and contempt, getting drawn into the web of the personality disordered? Maybe I read you incorrectly, you pity those who have to endure the contempt of the rigid and inflexible who only shriek their impaired narratives?

    I have trouble feeling pity for contemptuous beings, because those who prey and disrupt need folks who want to feel pity, so it allows the contemptible to stay in the picture…

    Sorry, deeply flawed and interpersonally challenged folks have their places to be “cared, pitied, and treated”, and those places are correctional facilities, and possibly alternatively, graveyards.

    Natural selection for our species has been thwarted by too much empathy and hope for change…

    Not at moment one the impaired has failed us, but, there is a “when” moment these folks reach with us who have offered support and option for change. These certain politicians, celebrities, and other people of influence and power have gone way beyond that “when” moment for me, hence why I don’t vote for any level of evil, lesser or greater. Nor support celebrities, athletes, or other type of entertainers who are just heinous to witness outside their arenas or theaters.

    The power of abstinence in not voting or withholding financial support by not paying to watch their forms of entertainment does have great power…

    Oh, and not voting does give us who do so the right to complain, to say to those who will vote for the lesser of evils there is no mandate by your winning candidate, and certainly minimal support while they are in office!

    People need to consider this, it is our efforts to marginalize or ostracize, because, hey, does this country even know the word “shame” much less practice it these days.

    I leave this thread with what Thomas Sowell said (paraphrasing) before he retired from his writings, “we don’t hear ‘none of my business’ or ‘risque’ anymore, because those words or terms are lost in our culture”. Lost, or ignored, or just mocked???

    January 28, 2017 | 2:39 PM

    Sorry for the above, I guess I misused the bold HTML items somewhere…

    Just intended for the words “when”, and at the end for “risque” and “none of my business”. Ignore the rest of the highlighting in between.

    Have a nice and sunny weekend.

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