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The internet is full of people enraged by the US CDC's reduction – and all but elimination – of isolation guidelines for COVID, pointing out that the CDC's new guidelines seem to be more about what is good for "the economy" – which is to say, good for business interests – than what is good for the health of the people.

I don't think anyone's wrong to be enraged. Nothing that I am about to say is meant to make anyone feel better about the CDC's decision. I do not explain this as any kind of excuse.

There is a sense in which the CDC's decision is right. Not good, mind you, but correct: it brings their guidance back into alignment with our larger society's beliefs about the value of human life and health.

Ours has never been a society that has particularly highly valued the health and well-being of the people of it... Read more [2,460 words] )

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This was a thread I originally declaimed over on Mastodon, to the lords and ladies of the Fediverse, of what is past, or passing, or to come.

So that's the original audience. You, loyal readers, may also find it interesting.

It has been lightly edited, structured, and translated from the original plain text into HTML.







0.

There are two problems that are coming for Mastodon of which apparently an awful lot of people are unaware. These problems are coming for Mastodon not because of anything specific to Mastodon: they come to all growing social media platforms. But for some reason most people haven't noticed them, per se.

The first problem is that scale has social effects. Most technical people know that scale has technological effects. Same thing's true on the social side, too.

For instance, consider the questions "How likely, statistically speaking, are you to run into your boss on this social media platform?" and "How likely, statistically speaking, are you to run into your mother on the social media platform?" While obviously there is wide individual variation based on personal circumstances, in general the answer to those questions is going to be a function of how widespread adoption is in one's communities.

Thing is, people behave differently on a social media platform when they think they might run into their boss there. People behave differently when they think they might run into their mother.

And it's not just bosses and mothers, right? I just use those as obvious examples that have a lot of emotional charge. People also behave differently depending on whether or not they think their next-door neighbors will be there (q.v. Nextdoor.com).

How people behave on a social media platform turns out to be a function of whom they expect to run into – and whom they actually run into! – on that social media platform. And that turns out to be a function of how penetrant adoption is in their communities.

And a problem here is that so many assume that the behavior of users of a given social media platform is wholly attributable to the features and affordances of that social media platform!

It's very easy to mistake what are effects of being a niche or up-and-coming platform for something the platform is getting right in its design.... Read more [7,670 words] )

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This was originally posted to Mastodon here. Slight changes have been made and further commentary added.




This is a true story.

In 2014, I happened to be on site at a software development company, where I wound up being a proverbial fly on the wall during a notable conversation.

I was being shown around by the head of technical documentation, and had just been introduced to the head of engineering. Maybe he was a VP, I don't recall. Anyways, he decided that was the occasion, with me, random contractor standing in front of him, to engage the head of technical documentation in a conversation about how there might be layoffs coming, and he was of the opinion that they should probably lay off his division's tech writers, and make the software developers write their own documentation, to save money.

The head of technical documentation was, of course, flabbergasted and appalled, but substantially outranked, and she had to be diplomatic in her response, tying her hands – and her tongue. Also she was caught somewhat by surprise by this fascinating proposal.

Unbeknownst to me, while this conversation was happening and I was supposed to be being onboarded, my contract was in the process of falling through, because the disorganization of this organization was so high, the parties who had extended me the offer were unaware the organization had put a stop order on retaining new contractors.

And to this day I lament that I did not know that fact, because I was being on my best behavior, and in retrospect I really wish I hadn't been. Because what I was biting my tongue rather than say was...[5,020 words] )

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0.

Oh, dear. To talk about AI, we're going to have to talk about religion.

I'm an atheist. To a first approximation, that means I don't believe any gods exist.

But it would be more accurate to say I don't believe any gods exist yet.

Because if there is anything an American childhood spent soaking in science fiction has taught me, it's that there's nothing modern human beings so desperately, ardently want as gods. So they will stop at nothing to build one.

Gods come in two basic flavors... [4,420 Words] )

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It all started when I decided I wanted to know the origin of the expression "male chauvinist".

I have no idea if the young among you have ever heard this expression. It was very idiomatic back in the 1970s and 1980s. It's basically means "someone who is sexist" or "male supremacist". It was strongly associated with the second wave feminist movement, which promulgated the term.

I think it might be a super useful term to revive, for reasons. Thing is, the more you think about the term "male chauvinist", the weirder it is.

The dictionary is happy to tell you... (Read more [6,880 Words]) )

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[Content warning: I will, alas, necessarily be discussing specific examples of hateful stereotypes, and not just of Jews. Also: sexism, racism, homophobia, and transphobia.]




0.

Different oppressions are different. This is not a radical notion. You've certainly heard the idea before, and you've heard the idea that because of this it's bad to compare oppressions – the assumption being "compare" means engaging in "oppression olympics", which is to say, arguing which minority has it worse.

But there's another sense in which comparing oppressions isn't just okay, I would argue it's absolutely critical: not who has it worse, but how different oppressions work.

Because here's the thing: different oppressions interoperate.

You kind of know this already: you are aware of the concept of "model minorities". You probably have some awareness of how model minority status is used to pit racial and ethnic minorities against one another, to thwart any inclinations they might have to solidarity with one another.

You might not have really thought about it, but that implies something about the different kinds of oppression the different groups are subjected to.

Read more [6,390 Words] )

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The following are excerpts from the excellent essay "The Deep Archeology of Fox News" by Josh Marshall at Talking Points Memo (2023 Mar 3), which is behind a paywall:
The evidence emerging from the Dominion lawsuit against Fox News has the quality of liberal fever dreams. What’s the worst you can possibly imagine about Fox? What’s the most cartoonish caricature, the worst it could possibly be? Well, in these emails and texts you basically have that. Only it’s real. It’s not anyone believing the worst and giving no benefit of the doubt. This is what Fox is.

In a moment like this it’s worth stepping way, way back, not just to the beginning of Fox News in 1996 but to the beginning of the broader countermovement it was a part of and even a relatively late entry to.

Back in the 1950s and 1960s there was something historians and critics of the time called the post-war liberal consensus. It was not liberal in ways we’d recognize today. Indeed, it wasn’t liberal in many ways actual liberals of the time recognized. But it did represent an important level of elite consensus about state intervention in the economy and openness to a more restrained version of the American state created by the reformist periods of the first half of the 20th century.

Though what was then sometimes called “the race question” was “complicated” and not something that could be resolved overnight, there was also in elite opinion a general assumption that the South’s system of legalized apartheid was a source of embarrassment and something from the past that the country had to outgrow, even if not any time soon. (Just as is the case today, what is actually more properly called cosmopolitanism was sometimes misportrayed as liberalism: a general belief in pluralism, values tied to cities and urban life.)

I mention all this because, in the early 1950s and 1960s, what we now recognize as the embryonic modern conservative movement could rightly sense that there were assumptions embedded in elite culture that viewed certain of their core values and aims as backward, retrograde, archaic. When the early founders of modern “movement” conservatism looked at America’s elite consensus, they saw a set of assumptions and beliefs embedded in many elite institutions that ran counter to their aims and values. And they were not totally wrong.

Over the course of the 1960s and 1970s they set about trying to build a series of counter-institutions, ones that wouldn’t, in their mind, have their sails angled permanently toward the winds of liberalism. One key moment in this story was the founding of The Heritage Foundation in 1973. Heritage was founded to be the counter to the “liberal” Brookings Institution. But Heritage was never anything like Brookings, even though in the D.C. of the ’80s and ’90s they were routinely portrayed as counterpoints — one representing liberalism and the other conservatism. Brookings was mainstream, stodgy, quasi-academic. Heritage was thoroughly ideological and partisan. In practice it was usually little more than a propaganda mill for the right. This pattern was duplicated countless times. The “liberal” Washington Post was matched by The Washington Times. Fox News, which didn’t come along for another generation, was not so much the answer to CNN as to CBS News, the iconic broadcast news organization of the first decades of the Cold War.

What we see today in Fox News is most of the story: a purported news organization that knowingly and repeatedly reports lies to its viewers, whose chief executive brazenly works with and assists one party’s candidates by sharing confidential information about the other. [...]

Here we get to the nub of the issue. Because this is not the entirety of the story. One of the things that is clear from the very start of the conservative movement was a basic failure to quite understand the thing they rallied themselves against [...] None of the organizations that the right took issue with — the think tanks, the news publications, the movie studios, the nonprofits, the book publishers — were ideological, let alone partisan, organizations. When the founders of modern conservatism looked at CBS News they saw the shock troops of liberalism and the Democratic Party. Same with Brookings and the Washington Post and all the rest. And when they went to build their own versions of these institutions they patterned them off their own cartoonish understandings of how these operations functioned. The idea that institutions like CBS News or The New York Times were, whatever their faults and unexamined biases, fundamentally rooted in an ethic of news gathering and reporting was really totally lost on them.

So how do we get from this elemental misunderstanding to the raw and casual lying of the Fox of today? Well, that’s the thing: we don’t. Both were there from the very start. It’s all but impossible to disentangle the culture clash, the inability and refusal to really grasp what these institutions were, and the more open culture of propaganda, lying and mendacity. They’re fused together so tightly that getting your head around the relationship between them is more a matter of meditative absorption than anything that can be processed or explained discursively.

[...]
If you want to read the whole thing, you can pay to access it; alternatively, @jayrosen_nyu@mastodon.social has posted about it graciously including a guest link. If you go to his Mastodon post here, https://mastodon.social/@jayrosen_nyu/109966217307755528, you should be able to click through to the article (it's the second link) and read the whole thing.

I have many thoughts about this, both quibbles and amplifications.

One of those thoughts is that it can be explained discursively: I just, coincidentally, did. The "conservative" project – meaning this thing that Marshall here identifies as starting in the 1950s – has always been to shape social truths by arguing them into existence, including by lying.

I have had a huge post brewing in the back of my head for longer than I've had a Patreon account on the topic of cosmopolitanism and its enemies, and another (or maybe another dozen) about the conservative movement that arose in the US in the 1950s (and arguably earlier) that Marshall here alludes to.

Frances Fitzgerald wrote a thing that blew my mind when I read it, about which I've been meaning to write since forever, which is about exactly the same rise of the religious right in the 1950s in the US. It was the final chapter of her Cities on a Hill, which was published in 1987. I'll not unpack it now, and just say that's a book absolutely worth reading. I found it an emotionally challenging read in the best way.
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There are two kinds of truth. One of them we can call social truth: there are things that are so, simply because we agree, in our society, that that is so.

Read more [5,220 Words] )

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The following is a series of "toots" (tweets) I made on Mastodon, lightly edited, in general response to the trending topic of punching Nazis, which had emerged again in the more general topic of reports that a neo-Nazi group in the US has called for a national day of violence against Jewish targets tomorrow, Sat Feb 25.

Note! It turns out this report has been exaggerated by the grapevine: apparently the neo-Nazis are calling for a day of vandalism against buildings, not violence against people. That said, this sort of boundary pushing is often a prelude to violence against people, both in general, and very specifically among antisemites. Discussion as to why for another day.

I feel a need to apologize that it's a bit shouty. This is not the style I usually employ here on DW. Mastodon doesn't support rich text, so one needs to employ a style there that does not rest upon bold face and italic. When all one has is capital letters, perforce one must engage in capitalism.*





Alright everybody, it's time I share my feelings about punching Nazis.

I'm against it.

Punching people can kill them. Dumb schmucks wind up doing hard time for murder because they thought it was "just a bar fight" and someone winds up dead. You should never punch somebody unless you are ready to kill them.

And if you mean to kill Nazis, jesus fucking christ, don't pummel them with your meat clubs like some sort of ape. Be a motherfucking grownup and SHOOT THEM WITH A GUN.

Now, I can hear some of you thinking, "But, Siderea, what about stabbing Nazis with knives?" [1,150 Words] )

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0.

I wrote a series, The Great Age of Plagues, setting out the case for expecting a dramatic increase in the rate of infectious disease outbreaks. I was asked what advice I had for dealing with what is coming.

I thought a lot about this, and I wrote a lot about it, and I eventually came to realize that what I really had to say about it is this.

I would propose that the most important asset for surviving in the world as it is becoming rests between your ears. (Read more [5,380 words]) )

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[Special content warning: discussion of existential threats to humanity. Highly depressogenic content. This might not be the best thing to read if you're given to despair or if despair is unsafe for you. Maybe give this post a pass if you are not in a place, emotionally, to handle it.]

Previous: Part 4: Climate Change, II



21.

It's begun.

There's an argument to be made that it started – slowly, slowly – in the mid-20th century when HIV first crossed into the human population. Arguably, it started with SARS. Arguably, it started with COVID-19.

Inarguably, it has started. Ed Yong, of the Atlantic, called this dawning age "the ‘Pandemicene’". I call it the Great Age of Plagues.

As I have set forth in the foregoing posts.... Read more [4,100 Words] )

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[Special content warning: discussion of existential threats to humanity. Highly depressogenic content. This might not be the best thing to read if you're given to despair or if despair is unsafe for you. Maybe give this post a pass if you are not in a place, emotionally, to handle it.]


Previous: Part 1. Population




6.

So the more of us humans there are, the more vulnerable we are to outbreaks of infectious disease; indeed the more evolutionarily adapted we, as a species, are to survival strategies of forming large groups and enjoying their economies of scale and network effects and so on, the more interdependent we become, the more densely connected our social graphs, and the harder it is for us to socially isolate, and thus the more vulnerable we are to contagion.

Enter Covid-19.

Covid-19 is not just terrible because it kills people and is tremendously contagious and it got a year's head start on our species before we had a vaccine.

Covid-19 may be exceptionally terrible because it may be a disease that leads to increased vulnerability to other diseases.

It wouldn't be the first one.... Read more [5,470 Words] )

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[Special content warning applies]



0.

Way back in June of 2020, I wrote:
Some of you are asking, "But, for how long? How long do we have to live like this?" If you're asking the question, the answer is "forever".
A whole bunch of people wrote anxious comments asking me if I meant that I didn't think Covid was ever going away. More than are visible, because I screened many of them.

I decided not to answer with my real answer at that time. It was pretty clear a lot of people were absolutely not emotionally prepared for it.

My answer was neither that I thought Covid was going away nor that I didn't think Covid was going away.

My answer was, "Covid? Who's talking about Covid?"




1.

I strongly suspect we have entered what future ages, should they exist, might look back and term the Great Age of Plagues.

I don't want to overstate my confidence here, but I also don't want to understate it. In my capacity as your friendly neighborhood oracle, I feel I would be remiss not to bring this to your attention, because if I am right, it will affect the entire rest of all of our lives.

Normally, one predicts the future by going, "If this goes on..." Alas, this is not that. Would that it were. This is a, "If these go on..."

Any one of these three trends alone would presage a rise in infectious illness in our species, but together they make a perfect storm.

They are: population, COVID-19, and climate change.






What follows is a discussion of these three factors, serialized across a number of posts. They are meant to be read as a single work, though, understandably, you may want to take breaks between the sections for obvious reasons.

Special content advisory:

This series of posts is approximately 100% nightmare fuel. It is a catalogue of horrors and accompanying discussion of their imminencies.

This is highly depressogenic content. This might not be the best thing to read if you're given to despair. While I'm not going to tell you what you can and can't read, I would suggest that if you are particularly vulnerable to psychiatric consequences of despair this is not a safe thing for you to engage with. And even those of you who have no particular reason to expect negative medical consequences may want to give these posts a pass if you are not in a place, emotionally, to grapple with them.



The Great Age of Plagues
Table of Contents





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[Content advisory: what it says on the tin.]

It's the US' Suicide Prevention Awareness Month 2022, so I thought it would be a timely occasion for me to discuss one of my little hobby-horse issues: the way lay people conflate suicidality with having depression.

There's a widespread assumption among the general public – i.e. not mental health professionals – that if someone is suicidal, that person must "have depression" or "be depressed", and that that depression is why the person is suicidal.

That's wrong. Suicidality is not exclusively associated with depression. In fact, for psych professionals, it's not even primarily associated with depression. There's a whole list of other disorders that are at least if not more strongly associated with suicidality than depression is, and additional conditions which are also at least somewhat associated with suicidality – not all of which are even psychiatric disorders.

Here's a list of other conditions famously associated with suicidality, other than depression:

• Schizophrenia, and related psychotic illnesses.
• Bipolar Disorders (I and II).
• Borderline Personality Disorder.
• Addictions.
• PTSD.
• Traumatic Brain Injury.
• Certain chronic pain conditions.

Read more [3,010 Words] )

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There's a thing you probably have encountered and maybe haven't really registered as it went by. It usually plays out like this. Somebody else takes a noun phrase – usually there's an adjective or two involved, sometimes multiple nouns – that seems perfectly ordinary and makes sense on the face of it, and which refers to something in the real world, and the speaker makes some bold assertion about it that strikes you as really weird, and possibly highly prejudicial. What they've said leaves you thinking, "wait, how could that possibly be true?"

That's all you get. That's all the sign of what's happening. That's the glitch in the matrix.

There's a lot of reasons that people make ridiculous claims about all sorts of things, and you will always be tempted to write it off as just ridiculous people saying ridiculous things and thinking no more about it.

But if you can catch yourself in that moment, and not reflexively dismiss it as silliness, you could, instead, ask yourself: "Hey, is that noun phrase maybe a technical term of art which means something much more specific and possibly quite different from what the individual words literally mean?"

Doing this? Is a super power. Lots of people can recognize specific technical terms that they are acquainted with. Few people cultivate the more general ability to recognize – or just suspect – that a noun phrase is a technical term they aren't familiar with.

Read more.... [3,770 Words] )

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And to think, I had been going to write a post explaining this.

This is, if not everything I feel about psychological research, a core part of what, shall we say, establishes the level of esteem in which I hold it.

https://xkcd.com/2652/
Our work has produced great answers. Now someone just needs to figure out which questions they go with.
https://xkcd.com/2652/
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0.

Somebody commented on a recent post of mine that a family member was denied a prescription for Paxlovid (ritonavir boosted nirmatrelvir) because they were on sertraline (aka Zoloft), and according to the doctor seeing them, sertraline was on the list of medications that contraindicate Paxlovid.

Now, that's straight up factually incorrect. There are two lists that I know of, the UK's list and the US's list. The US's list [PDF at FDA.gov] doesn't even list sertraline as a medication of concern. The entirety of the FDA's list of antidepressants known or expected to interact with Paxlovid is: bupropion and trazodone. That's it.

The UK's list [PDF at medicines.org.uk] does mention sertraline. But not in the contraindicated list (that's Table 1) – in the "Interaction with other medicinal products and other forms of interaction" list (Table 2). Helpfully that list explains what sertraline is doing there. It says:
↑amitriptyline, ↑fluoxetine, ↑imipramine, ↑nortriptyline, ↑paroxetine, ↑sertraline

Ritonavir dosed as an antiretroviral agent is likely to inhibit CYP2D6 and as a result is expected to increase concentrations of imipramine, amitriptyline, nortriptyline, fluoxetine, paroxetine or sertraline.

Careful monitoring of therapeutic and adverse effects is recommended when these medicines are concomitantly administered with antiretroviral doses of ritonavir.
So first and foremost, this is not a "do not prescribe together" admonition, it's a "careful monitoring [...] is recommended" admonition.

Secondly, note the language it's couched in: "Ritonavir [...] is likely to inhibit CYP2D6 and as a result is expected to".

In other words, they don't have direct evidence. Read more [4,080 Words] )

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Embedded in this video about the Great Resignation is an explanation of Marx's idea (not attributed to him here!) of the alienation of labor. It's more intelligible than most explanations of alienation of labor, which may mean that it is wrong. I don't know; I haven't read Marx on this. If anybody is equipped to discourse on how this is or isn't an accurate representation of Marx' idea of the alienation of labor, I would be interested to hear it.

I am not otherwise enamoured of the video in which it exists. It's fine for what it is; more cogent and the narrator more melifluous than many of his peers. I disagree with its fundamental premise*, and think it has a number of ther issues. Its creator's heart's in the right place.

I also have complicated thoughts about the passage in question. I think the paradigm of alienation of labor as the video presents it has some issues, but is also an important and good idea.

I added paragraph breaks for mercy.

2022 Feb 11: Second Thought on YouTube: "Why Millions Of Americans Are Quitting Their Jobs"



04:38 There's another aspect of work under
04:40 capitalism that is equally important to
04:42 understand. Let's talk about alienation.

04:46 In the not so distant past, human beings –
04:49 at least a portion of the population – had
04:51 relative autonomy and control of their
04:53 lives. Merchants and craftspeople owned
04:56 what are called the means of production.
04:58 The carpenter had control of his
05:00 woodworking process from beginning to
05:02 end. He made his own furniture and he
05:04 owned the finished product until he sold
05:07 it to someone else. The bootmaker made a
05:09 pair of boots and they were his. The
05:11 product of his labor belonged to him. As
05:14 capitalism developed this began to
05:16 change. Factories were built and they
05:19 needed labor. As poor workers flocked to
05:21 the cities from the countryside, they
05:23 took their places along the production
05:25 chain and in exchange for a wage, they
05:28 traded their autonomy – their agency – and
05:31 became just one cog in a much larger
05:33 machine, fracturing the work that used to
05:36 be done by one person or a small team
05:38 into many different hyper-specialized
05:40 pieces, so that now no single worker
05:43 could say they were a boot maker or a
05:45 furniture maker. They just did one small
05:48 thing, day in and day out.

In this new
05:51 arrangement, a tiny handful of people, the
05:54 capitalists, owned the means of
05:56 production – or the means by which goods
05:58 were produced. The workers, without the
06:00 means of production, were left with only
06:03 one thing to sell: their own labor. That
06:06 same arrangement persists to this day
06:08 and the psychological effects are the
06:10 same. Workers become alienated from their
06:13 selves and their own autonomy and
06:15 dignity, from their fellow human beings,
06:17 and from the product of their labor.
06:19 Let's take a quick look at all three.

06:22 First, alienation from the self: When you
06:25 go to work for the capitalist, when you
06:27 surrender your autonomy and become a cog
06:29 in their machine, you experience a
06:31 distinct loss of control over your own
06:33 destiny and sense of self. The things you
06:36 produce are no longer an act of
06:38 self-expression, as a fine pair of boots
06:40 was to the boot maker, but rather an
06:43 endlessly repeated task that is dictated
06:45 to you by someone else. For the vast
06:47 majority of people your job has nothing
06:50 whatsoever to do with your goals, your
06:52 desires, what you want to do with your
06:55 life. It's simply a way to make sure you
06:58 don't starve, that you can keep a roof
07:00 over your head and pay your bills. In a
07:02 sense, this alienation from the self
07:05 reduces human beings to little more than
07:07 animals, acting only out of the direct
07:10 need for self-preservation, that very
07:12 most basic need.

Second, alienation from
07:16 other people and society at large: Once
07:19 you accept the capitalist conception of
07:20 society, the traditional and natural view
07:23 of other human beings as friends and
07:25 community is destroyed. Each other person
07:28 becomes a threat, a challenge to be
07:31 overcome.
07:32 What if they take your job?
07:34 What if they get the promotion and you
07:35 don't? What if they're willing to work
07:37 for less money? This fear, caused entirely
07:41 by a system that pits humans against one
07:43 another for advancement and even mere
07:46 survival, causes intense feelings of
07:48 separation – of being apart from other
07:50 human beings – and for far too many people
07:53 it becomes accepted as normal, as the way
07:56 things are.

Third, alienation from the
08:00 product of your labor: In a capitalist
08:02 society for 99 percent of the population, what
08:06 you produce does not belong to you.
08:09 You sell your labor in exchange for a
08:11 wage, and whatever you produce during the
08:14 hours you've sold becomes the property
08:16 of the capitalist. That property is then
08:19 sold, netting the capitalist a healthy
08:21 profit. In stark contrast to workers
08:24 owning the means of production – the boot
08:26 maker, for example – the products workers
08:28 produce under capitalism do not benefit
08:31 the worker at all. In fact, they become
08:34 yet another challenge to overcome.
08:36 Whereas the boot maker can make a pair
08:38 of boots and then they are his to do
08:39 with whatever he likes – wear them or sell
08:42 them – workers in a factory may produce a
08:44 hundred tvs a day and own none of them.
08:48 They would have to pay the money they
08:49 receive in their wage to buy the very
08:52 thing that they have produced with their
08:54 labor.

08:55 That's alienation in a nutshell and it's
08:58 an essential feature of capitalism. It
09:00 also goes a long way towards explaining
09:02 why so many people are miserable in
09:04 their jobs. In a time when simply going
09:07 to work could mean dying, when your
09:09 existing economic precarity is made
09:11 worse by a global pandemic, and when
09:13 billionaires become even more massively
09:16 wealthy as a million of your fellow
09:18 human beings die, 09:19 it should be very clear why so many
09:22 americans are leaving their jobs.



* Even if everything it says about alienation of labor is correct, it seems to me very unlikely alienation of labor is the cause of the Great Resignation.

For one thing, work being brutalizing, dehumanizing, inadequately remunerative, and even lethal is not remotely new and has not historically caused mass numbers of people to quit their jobs. So to make the case that people are quitting their jobs because those jobs are awful, one must first make the case that either the awfulness of jobs now is worse than its ever been or that workers' tolerance for the awfulness of jobs is the lowest its ever been. I am completely willing to believe it in the case of front-line medical professionals, who are two years into the worst global health crisis of their lives which has had an enormous negative impact on the awfulness of their jobs. Everybody else, well, perhaps one of those cases could be made, but I haven't heard it yet. I'm not closed to the idea, just duly skeptical.

For another thing, the indoctrination of the workers that this is what work is and how this sort of alienation is normal (as the passage describes) only increases and becomes more entrenched with each passing human generation after the Industrial Revolution. To no humans in history has the alienation of labor been more normalized that us. We are the last people to suspect of rebelling against it; we are the least likely to have the psychological wherewithal to do so. Objecting to modern "work under capitalism" for being alienating really strikes me as fish objecting to be wet: how would they even know that that was what they were experiencing? I mean I entirely agree people should be moved to quit over alienation of labor, but it seems beyond far fetched to think that they are doing so.

I've noticed this sort of tendency on the left to recourse to psychological explanation for worker behavior, which... so much for material analysis.
siderea: (Default)
I am nominally on vacation this week, in that I told all my patients that I'm taking the week off and not meeting with them. I am, nevertheless, still doing a lot of work-related things, including trying to write a Siderea Post to get out for December. We'll see how that goes. I've been struggling with exhaustion and low mood and poor concentration, which has made writing challenging. I'm definitely experiencing some burnout, in large part, I think, because I didn't take adequate time off this year. I'm going to try to do better about taking breaks in the coming year.

Also, I've had a critical weakness in my self-care game, which I am now realizing I need to get serious about. I saw a new PCP in November who quite reasonably asked me what I did for fun, and I was like, "Oh, hmmm, fun... I remember doing that..." The problem is that while I am not incapable of experiencing enjoyment, I've lost either the capacity or opportunity to enjoy most things I used to do for pleasure. Like, you know, ensemble voice and woodwind music-making and going out for fine dining and shows. Obvious stuff like that, but also unobvious stuff that is apparently an effect of being a therapist. Like I'd noticed many years ago that being a therapist really seemed to diminish my pleasure in movies and fiction; I once said in a movie review, "this is like my job, only boring". I'm not incapable of enjoying books and movies, but the odds that I will enjoy any particular one have gone way, way down, and the odds that it will bore me or stress me out have gone way, way up.

More recently, I've discovered that I am radically less able to emotionally tolerate reading non-fiction therapy-related things that discuss bad things happening to people, which, like, is all the non-fiction therapy-related things I want to read. I've got a book on my nightstand by a really interesting author about a topic I am very interested in, but it has to do with child abuse (comparatively mild child abuse even!) and I am coping with the case studies so badly – my mood has taken a nosedive after every chunk I read – that I've realized I need to at the very least not read it on vacation. So apparently I can't be doing that for fun, like I used to (don't judge) anymore either.

I came to realize more consciously that I've been in a state of not being able to do any of the things that seemed like they would be enjoyable and not able to enjoy any of the things I was able to do. Well... maybe not any.

Realizing I needed to do something to approximate recreation I pulled my harp out of the closet, and I've started practicing daily. And, yes, it is turning out that playing harp is better than not playing harp. I'm four days in, and am making an intention of doing it every day. Unfortunately, I can't do it much, because I have lost a lot of hand strength and stamina, and if I overshoot, I'll fall back into repetitive strain hell, so my practice sessions are necessarily pretty short. But the only way past that is through it, so onward.

My todo list never seems to get any shorter, for at least two really irritating reasons. First of all, every single thing on it takes longer and is more involved than even my cynical/paranoid estimates allowed for.

For instance, one of the banks where I have bank accounts was bought by another bank. They sent me a little torrent of mail about the change over, telling me to watch my mail for the new ATM card I would be receiving. Of course the ATM card never shows up so eventually I look through the mail to see what I'm supposed to do, and there's a phone number you are to call if you don't get a card; I call it, and it is a recording saying that if you didn't get a card in the mail, to present in person at a branch during normal banking hours. Swell. So I eventually managed to take some time during the business day away from my job to spend an hour in a branch to get an ATM card. As a side note, while I'm there, they of course look up to see if I were issued a card in the first place, and it turns out: nope. There is no card number to cancel because, despite the half dozen or more mailer saying I was going to be shipped one, they never issued me one. (The teller has the temerity to then say, "Well, did you even have an ATM card with the old bank?" I just took out my wallet and plucked out my old ATM card and put it on the counter.)

Everything has been like that lately.

The other thing is that the government keeps throwing rocks at my head. Some of this is federal law changes that pertain to health care practitioners – I'll tell you about the No Surprises Act in a moment – and some of it is things like the fact that yesterday, I checked my mail and discovered I have a summons to jury duty. Le sigh.

The entire profession of psychotherapy just woke up to the fact that there's something called the No Surprises Act that goes into effect Jan 1, 2022. Americans, you will be seeing a lot of press about how wonderful it is and how it will protect you, the consumer. Some of it is even true. Some of it, not so much.

The best, most charitable spin I can put on it is that it is a well-meaning law that maybe works great for medical care in hospitals, which is what everyone seems to always imagine when it comes to health care, and they just failed to think about what it would look like to apply to psychotherapy.

But I'm not feeling really charitable.

The law is supposed to prevent patients from getting stuck with large bills "by surprise", after having received medical care.

But the law only applies in the case of patients who don't use their insurance. It actually specifies that these protections are only for people who are uninsured or otherwise self-pay. If you use your insurance to pay for medical services – or try to – then these protections don't pertain to you.

Well, just one little problem with that. At least in psychotherapy. I can't say how this works in the rest of medicine, but in psychotherapy, surprise bills are basically something that only can happen to patients who use insurance.

Psychotherapy is, to my knowledge, the only branch of medicine in the US for which there is a very large self-pay market. Those of use who don't take insurance, we don't issue surprise bills. In fact, many of us don't bill at all. I, personally, have never billed a patient, at all, ever. I don't need to, because like many other psychotherapists who are strictly self-pay (also called private pay), I run my practice as pay-as-you-go. I tell my patients on intake that I do not allow patients to carry unpaid balances except by advance arrangement, entirely so that they don't abruptly get socked with a huge bill later on. And unlike in the rest of medicine, I, the actual healthcare provider herself, as is typical for private pay private practice psychotherapists, discuss my fees and the cost of receiving treatment from me directly and forthrightly with my patients. Frequently, even. I do not ever want my patient to get surprised by our financial dealings, except maybe happily, so I not only am super transparent and clear about fees and costs, I work overtime to keep the channel of communication open about money, so that if a patient has a financial problem, I know about it so I can lower my rates.

No, surprise bills in psychotherapy are almost entirely the product of a patient trying to use their insurance to pay for psychotherapy and it not working. Surprise bills come from insurance companies misleading their insureds about therapy being covered, and the insured booking appointments with a therapist under the impression the insurance is going to pay for it, only, oopsie doodle, the insurance company decides eventually that nope, they don't feel like doing that, so now you're on the hook for months of weekly therapy sessions. "Oh, did we list that therapist as being in-network for your plan on our website? Our bad! So sad. It was an honest mistake, you know how hard it is to keep track of which therapists are actually taking our insurance product. But, I'm sure you understand, we're not going to pay for all the therapy you had over the last three months while we came to this conclusion."

Hey did I ever tell you about how BCBS of MA, back when I worked for a clinic, refused to pay for the therapy of a patient of mine for months because apparently – as best our billing specialist could figure out – the patient had a first name like "Mary Ann" but somewhere in their system someone had once entered it as "Ann Mary" so even though we had all the right insurance ID numbers for that patient, and the name in our computer matched the name printed on the patient's insurance card, the insurance company kept insisting they had no idea who this patient was and clearly their medical bills were none of their problem? Yeah.

Yeah, in psychotherapy, surprise bills are a product of the insurance industry and, with the exception of the odd private pay psychotherapist who doesn't run on a pay-as-you-go model (WHY?) don't happen to self-pay patients.

So the patients who need this protection don't get it, and those of us whose patients don't need it get to do additional, Kafka-esque paperwork that doesn't even make sense in the case of psychotherapy. I get to spend my vacation making up a new form and making versions for every patient on my caseload. And my patients get more mystifying, confusing paperwork, which even if they wish to opt out of receiving, they can't.

Also, apparently there's something in there about having to have an arbitration services in case a patient objects to one of the bills I don't send them? Good times.

Meanwhile, coming soon to media near you: painting healthcare providers who complain about any of this as rascals who have been caught ripping off their patients.

So there's that.

The pandemic continues apace. I have a lot I feel I should apprise you of, but also I am so very tired of having to cover it, and would really like to share my thoughts on other things, instead. This is one of the great bummers of global catastrophes: the emergent need to focus on survival really sucks up all the oxygen in the room. Sometimes literally.

Anyhoo, I should get back to doing that. It's not like I don't have a lot to say about the pandemic.
siderea: (Default)
I was looking into just who Dr. Eric Feigl-Ding is, and thus only now found this remarkable article from late March 2020, which uses him as its example and point of departure.

It remains a remarkable testament to what happened.

Excerpts, emphasis mine:

2020 March 26: NYMag Intelligencer: "Why Was It So Hard to Raise the Alarm on the Coronavirus?" by David Wallace-Wells:
A bit before midnight on January 20, a Harvard epidemiologist named Eric Feigl-Ding posted a long, terrifying Twitter thread mostly summarizing, and in a few places contextualizing, a new, pre-publication paper on the infectiousness of the novel coronavirus that had, at the time, forced Wuhan into a total lockdown but had not yet been detected outside of China. The context he added was, mostly, alarmism.

“Holy mother of god,” the thread began, “the new coronavirus is a 3.8!!!” That figure referred to what’s called the reproduction number, or “R0,” of a disease: how many people would be infected by a single sick person. “I really hate to be the epidemiologist who has to admit this, but we are potentially faced with … possibly an unchecked pandemic that the wold has no seen since the 1918 Spanish Influenza. Let’s hope it doesn’t reach that level but we now live in the modern world 🌎 with faster ✈️+ 🚞 than 1918. @WHO and @CDCgov needs to declare public health emergency ASAP!”

The thread has since been deleted, though you can still read a preserved version of it here. It was, for many Americans, if not the first time they had heard of coronavirus, perhaps the first time they had seen a global alarm raised over it. And in doing so, it produced what is by now a sort of predictable backlash: other scientists and science journalists taking issue with it, en masse, pointing out that the paper had not yet been published; that Feigl-Ding’s comparison to the infection rate of SARS was inaccurate; that most estimates of the R0 number were now lower than 3.8. Feigl-Ding’s tweets got more readers than those of his critics’. But those credentialed in epidemiology and public health were much more likely to see the criticism as sober and responsible, Feigl-Ding himself as an irresponsible alarmist, and the impulse to raise alarm a deeply reckless one. An Atlantic story about it was headlined “How to Misinform Yourself About the Coronavirus.”

Two months later, we are, inarguably, in the midst of a global pandemic. It took three months for COVID-19 to reach 100,000 confirmed cases globally; ten more days to reach 200,000; just four more to reach 300,000, and three to reach 400,000. [...] In just two months, what sounded like hysteria to scolding experts has become conventional wisdom among even cautious epidemiologists. “We’re looking at something that’s catastrophic on a level that we have not seen for an infectious disease since 1918,” Dr. Jeffrey Shaman, a Columbia professor projecting the spread of the virus, told the New York Times on Friday. Where had I read that before?

[...] And the broad message? The purposeful incitement of public alarm? If the question is whether Feigl-Ding was right to be alarmed by what he was reading, whether alarm was an appropriate response to what we knew even then about the infectiousness and lethality of this disease, and whether it was therefore responsible to induce panic in the public, we can say — with the benefit of hindsight, yes, but also definitively — it was. And if the question is whether, on January 20, the world as a whole should have freaked out considerably more about the coronavirus, initiating emergency planning and launching medical preparation on a war footing immediately, the answer, eight weeks later, is blindingly obvious: Yes, of course we should have, and we would all be in a much better, safer, and probably more prosperous place if we had.

[...]

Hindsight is 20/20, of course, and there are surely plenty of situations where we would want to guard against overreactions as zealously, or more zealously, as we would underreactions. But in a time of good governance, this is a central function of government: to prepare for the risks that the public can’t process rationally. And though we often feel, on social media especially, that we live swimming in a sea of alarm, it may be the case, instead, that the general din prevents us from hearing real cries of alarm by teaching us that almost anybody raising their voice above the crowd is a nut, or a narcissist, or a troll.

This is bad. As I’ve written before about climate change, when the news is alarming, the only responsible response is to be alarmed — and raise alarm. And like runaway climate change, the threat of a global pandemic, which graybeards have been warning about for years, is a reminder that we should always build public policy around the precautionary principle, rather than waiting until uncontestable and inarguable evidence arrives that action is necessary. If we wait that long, it will always be too late. Would it have been better if Feigl-Ding’s tweet thread had made a more precisely accurate comparison to SARS, and included some more caveats around the R0 3.8 figure? Perhaps. But science proceeds by increments, and in times of rapid, onrushing crisis the direction is important, too, not just the degree. The fact that we are now living more or less precisely through the situation Feigl-Ding warned us about in January suggests that two months ago we should have understood that this outcome was, at the very least, a possibility, and therefore worth planning for — rather than dismissing it as irresponsible fearmongering.

[...]

So, what happened? Why were so few sufficiently alarmed about the threat as it emerged, and why were those raising the alarm largely dismissed or sidelined? Aside from perhaps some amount of heightened personal anxiety and a few more fights in supermarket aisles over bundles of toilet paper, it’s hard to see a meaningful cost that heightened public anxiety about this virus would have produced over the last few months. But as I often say about the question of climate anxiety, if you are worried about the psychic cost of contemplating a bleak future, surely you should be more worried about the psychic cost of living through it, should we do nothing to avoid it. And, especially in the absence of public leadership, with the country and indeed much of the world operating in a vacuum of guidance that forced individuals to make possibly dangerous social choices entirely on their own, it’s very easy to see what benefit more public alarm about COVID-19 would have produced: more handwashing, and of a more vigorous kind; more temperature-checking; more isolation by those who felt a little sick; more voluntary social distancing, and then, when public “shelter in place” orders began finally to arrive, more complete honoring of those orders. Instead, almost everywhere in Western Europe and the U.S., we have chosen to be less alarmed. Already, that has proven a deadly choice.

[...]

But there are more quotidian explanations for our indifference — indeed, these are probably the most powerful explanations. We are selfish, and don’t want to even entertain the possibility that what we take to be our “needs” could be threatened or taken away. As recently as a few weeks ago, even the most apocalyptic among us probably didn’t truly believe that devastation at such a scale was possible, that the little fortresses of our modern lives could be so assaulted by a distant virus. A virus! That was the sort of thing that threatened the global south, we thought, or was limited to the “wet markets” and exotic-animal-cuisine cultures of Asia we felt so culturally superior to. It is a cruel irony, if possibly a temporary one, that this pandemic, which promises to be the most deadly in a century, emerged not out of the tropics or the global south but was passed around the world along vectors of globalization and cosmopolitan wealth, and has not yet even passed into the parts of the world which, for centuries, Westerners regarded as diseased and pestilent. Instead it’s our imperious cities incubating this virus, and which may well unleash it soon on the impoverished nations of the world. [...]

Indeed to judge from our preparation, we still felt invulnerable just weeks, or even days, before lockdown. The bias wasn’t just cultural, but cognitive. We didn’t believe anything could happen that didn’t have a precedent in recent memory, having built up conceptual models of what was possible over periods of just a decade, in some cases less. We’d lost so much esteem for experts over the last few decades that we found it more comfortable to substitute our own nonexistent expertise and common-sense heuristics (“how much worse than SARS could it really be?”) than to trust those telling us this was different. [...]

But the experience of Eric Feigl-Ding suggests two additional, related problems. First, and less significant, a culture of sanctimonious concern-trolling on elite social media, smaller of course than the problem of disinformation and yet problematic precisely because it suggests any kind of alarmism is disinformation. Second, and more important, a widespread cultural conviction that keeping your cool and trusting the political and social status quo is preferable to a radical response, any radical response — in all ways, at all times, and in the face of all kinds of threats. Indeed, that the ideal political and social response, no matter the particular crisis, is not responding to the threat but just grinning and bearing it. [...]
Read the whole thing here.

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