My wife read over my last post about recent comic book movies and thought it wrong of me not to link this:
So there you have it.
My wife read over my last post about recent comic book movies and thought it wrong of me not to link this:
So there you have it.
Our six-year-old daughter took me to see The Lego Movie a few weeks ago. My takeaway: this is what the Matrix trilogy should have been.
Read on only if you don’t mind spoilers of both films.
My parents went with our daughter the first go-around seeing the movie and, having not seen The Matrix, totally didn’t realize the The Lego Movie is more or less a spoof thereof. It blatantly and hilariously borrows from The Matrix: from its “chosen one” plot to its philosophical premise–the world as we know it is a facade. Here’s how the Wachowski siblings could’ve done it better.
1. The Lego Movie knows its place in the world
Yup. It’s a movie about Legos. Produced by the company that creates Legos. With the intent of selling you Legos. Should we pretend that the Matrix trilogy didn’t try really hard to sell us video games? The Lego Movie never pretends to be something it’s not and its wry self-aware humor makes its blue pill a little easier to swallow. Yes, The Matrix offers a few chuckles. It’s also got a hell of a lot of plot holes as well as a premise that doesn’t make a lot of sense in spite of (or because of?) its Platonic cred. We can give The Lego Movie a pass on its plot holes because it presents its comedy front and center. If a movie wants to sell you “big ideas” it’s best not to shout, “THIS MOVIE IS ABOUT BIG IDEAS” upfront.
One of my favorite movies of all time is Big Fish. It’s absolutely hilarious and its final scenes left me bawling uncontrollably. I almost never cry during movies. The poignancy snuck up on me. Yoon Ha Lee writes some of the best short space opera around. She describes herself as a writer aiming to “assassinate the reader.”
“The thing is that I don’t want the reader to see the short sharp point clearly from the beginning, but I want it to make sense afterward as the angle of attack.”
Sorry, Matrix. You broadcasted it a mile away and the point was not all that sharp. Lego Movie? I never saw it coming. And for the record, I sniffled just a little.
On the subject of philosophy…
2. The Matrix is morally bankrupt
The “heroes” of The Matrix would have us believe that confronting a life of deceit is an inherent good that justifies any means. Call me crazy. I feel like they need to support that theorem a little better. Also, I’m not sure what’s more disturbing–the callousness with which the “good guys” kill people they purport to want to save and so readily call them “the enemy” or the fact that after all of that, the movie trilogy has an out-of-left field “we can live in peace” ending.
3. The Lego Movie handles its philosophical dilemma with more nuance
Neo is the Chosen One. “Chosen One” narratives are problematic as all hell. They’re about the elite and able saving the masses through arbitrary means at the discretion of the storyteller. They tell us little about the world or the human condition. You could say there’s something Christlike about Neo’s sacrifice at the trilogy’s end. If Christ had an uzi.
Alongside The Lego Movie‘s purpose of, you know, selling us all more Legos, is a message that manages to be naive, audacious, and heartwarming at once. There’s something beautiful about the way it resolves its own “Chosen One” story. There’s worth and uniqueness in all of us. Even the “bad guy.”
Corny? Sure. At least it makes sense in the context of the film.
So those are my two cents. If you still don’t believe me, consider this–The Lego Movie earned a higher score on Rotten Tomatoes than The Matrix. This blog is strictly my opinion. But Rotten Tomatoes? That’s science.
In the spirit of my pledge to avoid a New Year’s resolution and rather practice more serenity in the New Year, I decided not to lose weight, but make doughnuts. It was quite literally the first thing I did in 2014. On January 1st, I took dough out of the fridge and deep fried for like the fourth time since 1/1/13.
Most of that frying, as it turns out, had to do with doughnuts. Good old fashioned yeast doughnuts.
Why? Because I love them. They’re a “sometimes” food for sure and I rarely partake, but I can think of few other foods that evoke such regressive passion in me. And it’s not because I used to have them all the time either. My mother was a great Southern cook, but she didn’t cook a lot of unhealthy food. Yes, butter was a default seasoning, but I remember her biscuits as rather lean. If there was a way to pan-fry something one might normally deep-fry, she did it. In fact, the only things I ever remember her deep-frying on any kind of consistent basis were tempura vegetables. ‘Cause apparently I was a finicky eater in the days before we up and moved to Korea and that was a guaranteed way I’d eat my veggies.
No. We didn’t eat doughnuts at home. We didn’t eat them out much either. They were an indulgence. An oasis of junk-foody goodness in a desert of healthy-but-unexciting stuff. The first time I ever had a Krispy Kreme, I was in middle school and it was a revelation–fresh-glazed, hot out of the oil. Like nothing I’d ever eaten before.
So, yes, we’ve challenged ourselves to eat healthier food this year. We try for a Meatless Monday (usually Sunday). I’ve managed to hook our daughter on certain bean dishes and Indian dal. That stuff is important. But in terms of pleasure-sensor-pricking, doughnuts were my Holy Grail.
Last year, my wife gave me the Bouchon Bakery cookbook for Christmas. I mentioned this in a previous post–which means I’ve been blogging for over a year now (wow). It’s an amazing foodie book. I loved the illustrations. I loved the step-by-step instructions for complex baking operations. I also loved the insights into running a commercial bakery empire. I’m a big fan of Thomas Keller. His is not my all-time favorite roast chicken recipe (that would be Judy Rodgers’), but the way he describes eating chicken butts borders on pornography. Bouchon is not primarily his cookbook, but I loved his thoughts on cooking. And there were recipes too. One of the first I made from the Bouchon Bakery cookbook in 2013: doughnuts.
I wanted to love them. I really did. Unfortunately, I found them a tad dry and bready. They were good enough hot from the oil, but hardly the overindulgence I’d craved. They tasted like doughnuts designed with responsible grownups in mind and you know that isn’t right.
So, if you ever happen to read this, Thomas Keller, know that I love you. Your bakery’s doughnut recipe just isn’t for me.
I started with the Bouchon recipe and about doubled the butter. Then I up-tweaked the amount of milk to create a more moist dough. Then I fiddled with a few other ingredients. And the mixing directions (which I found odd and time consuming). And the frying temperature. My final recipe, after testing several tweaks, is pretty-much completely different from Bouchon’s recipe. Fresh from the oil, they’re almost as melt-in-your mouth gooey as a Krispy Kreme. A tad more butter or vegetable shortening could push them over the edge, but I like them just like this. They taste more substantial–like something that’s okay for a human being to eat. I suppose doughnuts, like life, are a balancing act.
A few notes: I usually weigh my ingredients with a kitchen scale and have listed weight in grams because I find metric more precise and useful when crafting recipes. It’s easier to figure out the proportions of ingredients to each other. I’ve also found after years of baking, I get far more consistent results measuring by weight than volume. When working with yeast-dough, a few splashes of water or flicks of flour can make a significant difference in the final product.
So please try. Enjoy. Indulge. Just not too often.
Now in all seriousness, I do kinda need to lose weight this year.
250 grams all-purpose flour
125 grams milk, warm room temperature
57 grams butter, room temperature (about half of a 4 oz. stick)
50 grams egg, room temperature (about 1 large)
35 grams sugar
5 grams yeast
5 grams salt
2.5 grams vanilla extract (about ¾ teaspoon)
In an electric mixer with the dough hook attachment, stir together the flour and the yeast. Once the yeast is combined, add the salt and sugar. Mix in the milk, egg, and vanilla extract and knead on medium-high for about five minutes, or until the dough is sticky and cohesive. scraping the bowl as needed. Then add the room-temperature butter in several pieces. Mix for several more minutes until the butter is evenly absorbed.
Turn the dough onto a lightly-floured countertop. Stretch it into a rectangle and then fold it back on itself like a letter. Repeat in the other direction. Place the dough into a covered, lightly-oiled bowl or glass measuring cup and let rise for about an hour. The dough may have risen by about 50%. Turn it out onto the lightly-floured countertop again and repeat the folding. Return it to the covered bowl or measuring cup and refrigerate overnight.
Remove the dough from the refrigerator and gently stretch, roll, or pat the dough into a disk about 7 to 8 inches in diameter and about a quarter-inch thick. Place this disk on a baking sheet covered with lightly-oiled parchment paper. Return this to the refrigerator or freezer until chilled firm, giving the dough time to rest. Using two cutters, one about three inches in diameter and another about one inch in diameter, cut out the doughnuts. The excess can be bunched together and re-rolled. The doughnuts or doughnut holes cut from this dough will not be as attractive, but they’ll taste just as good. Let the dough rise for about an hour or until puffy.
Heat about an inch of oil in a pot or Dutch oven to about 325 for pale, soft doughnuts or 350 for more brown and crisp doughnuts. Fry for about thirty seconds, flip, fry for another 45 seconds, flip again, and then fry until they have achieved the desired color. If making doughnuts without holes that will be filled, cook for several more minutes, up to five.
Toss the doughnuts in white sugar, cinnamon sugar, powdered sugar, or coat with a glaze. Doughnuts and doughnut holes are best served hot from the oil with the exception of filled doughnuts, which should be allowed to cool before filling and topping with powdered sugar or a glaze.
100% all-purpose flour
2% instant yeast
1% vanilla extract
Our six-year-old daughter on our way home from a family Christmas gathering:
“Daddy, imagine if Darth Vader gave you a Christmas present. And imagine if his eight tiny reindeer pulled a Death Star.”
When it comes to good parenting, the proof is in the pudding.
Back in high school, I was a Star Wars superfan.
I’ve mentioned before that I grew up in a Star Trek household, but when it came time for the inevitable “Trek vs. Wars” debate, I always took up the Lucasfilm gauntlet. Why? The fantasy and mythology resonated with me in my youth. Return of the Jedi is one of the first films I clearly remember watching in theaters. Also, I could smile and nod, but never completely bought Star Trek’s utopian underpinnings. Star Wars’ Force seemed far more “real” to me.
Oh yeah. And laser swords. Star Wars won the “rule of cool” award hands down even if I didn’t know there was such a rule as a teenager.
I gobbled up every Expanded Universe story I could get my hands on. Tales of the Jedi. Dark Empire. Pretty much every novel from Heir to the Empire to the Black Fleet Crisis. I even bought the RPG sourcebooks even though I didn’t actually play the RPG. I poured over the vehicle schematics; the Alliance and Imperial military hierarchy; the alien races.
After a couple of years, I burned out on it all. It annoyed me when I found contradictory diagrams of the Millennium Falcon’s layout. It bugged the snot out of me when I felt the core characters were out of character. I still love Star Wars, but my passion for the series is more smolder than raging fire.
That’s where I was when I approached Ian Douescher’s William Shakepeare’s Star Wars. It was a gift from my wife. If she weren’t as big a geek as me, we would have problems.
At first glance, it struck me as too much of a gimmick. I never jumped on the Pride and Prejudice and Zombies bandwagon. Then I actually read this lovely book and decided it’s got to be one of the greatest feats of Star Wars fandom ever accomplished.
First off, hardly any action or dialogue is omitted. It’s Star Wars, in iambic pentameter. With authentic Shakesearean archaisms. With terse stage directions and a chorus describing all of the action. Seriously. My favorite stage direction:
Enter PRINCESS LEIA, in beam projected by R2-D2.
And we mustn’t forget asides and soliloquys:
HAN [to Luke]: I say, what a charming girl thou here hast found!
Either I shall destroy her or, perhaps,
I may in time begin to like the wench!
LUKE [aside]: Nay, executioner or lover, both
Are far too great a role for thee to play.
The book provides a few diversions into camp and parody. In a way, not unlike its source. In one groanable passage, Luke Skywalker gazes upon his helmet and laments, “Alas, poor stormtrooper.” There’s also a clever “who shot first” diversion in Mos Eisley. But for the most part, the book plays it straight, to its own benefit. And truthfully (verily?) its shockingly Shakespearean. The transition is remarkably sharp. Han Solo’s one-liners translate into surprisingly eloquent verse, as in here, aboard the Millennium Falcon:
A pilgrim, truly said! For I have gone
From galaxy to galaxy and more,
Yet never hath this faithful worshipper
Found aught to recommend that strange belief–
A singe Force that binds the universe.
True ’tis, no power mystical controls
Han Solo’ yet unfinish’d destiny.
And so I preach the one and only faith:
My simple, merry tricks are all my gods,
And nonsense is the only testament.
I worship at the shrine of my own will.
I haven’t read much Shakespeare since my English major days and this book reminded me of all sorts of stylistic quirks I’d forgotten. Rhyming verse to conclude scenes? Check. The ubiquitous chorus? Check. Expository asides that totally state the obvious? Yes, I’m looking at you Obi-Wan. And furthermore, the book’s iambic pentameter is really solid–using some of Shakespeare’s cheats (abbreviating words and fusing lines of dialogue) to make it work.
And now I’ll write the rest of this review,
In ‘glorious’ iambic pentameter.
See, that shit’s hard.
Beyond mimicking Shakespeare’s style, however, there really is something Shakespearean about this undertaking. Shakespeare wrote in a time when originality was not highly prized. Before becoming plays, his stories existed in legend, lore, or the zeitgeist. He didn’t invent Hamlet. He didn’t invent Romeo and Juliet. But he made them popular. It was okay to be derivative as long as one was entertainining.
Critics of Star Wars could always, fairly, argue its sci-fi setting is inconsequential. It doesn’t do anything with its plot you couldn’t do as a western or fantasy epic. I have a feeling Shakespeare would have shrugged at that criticism (after, you know, puzzling out what “sci-fi” actually is).
Lately, I’ve noticed a flood of Star Wars properties, whether Origami Yoda or Vader’s Little Princess. As a popular culture, we seem to be putting more value than ever in the nostalgic and derivative. That was Shakespeare’s forte. Hell, if Star Wars were around during the reign of Elizabeth he probably would have written his own version of the story.
But then, if you ask me, Goffrey Chaucer’s Star Wars would have been so much cooler. More ironic, more sublime, and more metamodern. Shakespeare’s fine and all. Just a tad overrated.
We finally watched Disney’s Frozen on Black Friday. Going into the film, we had no idea what to expect. Here’s why: by midsummer, we could only find two trailers. First, the international trailer–available in an assortment of languages, none of which being English. I’m linking the Japanese because Japanese voice actors and actresses are the world’s most badass. Prove me wrong.
Totally flippin’ sweet! If you can read Japanese, you’ll note it’s titled Anna and the Snow Queen. What about an English language trailer though? Well, it would be a while before one of those came out. We could find only this:
So, I’m thinking, this is the same movie, right? It would be a while before the full English trailer arrived, but even then, we went into the movie cold (so to speak).
So which trailer came closest? Well, both and neither. Adding a hearty dose of Broadway comes a little closer to the true picture. Wikipedia classifies Frozen as a “computer animated epic musical fantasy comedy film.” I’m not even sure what that means. To paraphrase Douglas Adams, it was clear from the beginning the movie would be almost, but not quite, entirely unlike anything Hans Christian Anderson would have ever written. But really, what is it?
And that’s my big quibble with the film, which isn’t really a quibble at all. It’s hard to pigeon-hole Frozen: beautiful, thrilling, and goofy, but surprising. Yes, there’s a largely-unnecessary comic-relief side-kick. Yes, there’s an unevenness of tone that’s typical Disney. At the same time, it breaks the mold in a lot of ways a spoiler-free review can’t describe. Hans Christian Anderson’s Snow Queen is a two-dimensional villainess–a Luciferian temptress in the tradition of Milton. Frozen‘s “Snow Queen,” Elsa, is easily one of Disney’s most complex characters. If you’ve seen enough Disney films, you kind of know the basic plot. That holds true here as well, but even then a few moments had me earnestly wondering where they were going with this thing.
Frozen is one of the most nuanced and subversive films Disney has ever created. This is the film for anyone who’s ever wondered why Disney heroines can be princesses, but never queens. For anyone who’s wondered, “Hey, where are the siblings?” Or why, in 2013, is the Bechdel test still so hard for a company that markets its films to girls and young women? Or why do Disney couples shop for the wedding ring on their second dates?
I’m being vague because I really don’t want to give anything away. It’s that unique. See it or yourself.
One of my goals in establishing this blog was to share some of my favorite recipes. I never knew it would be so goddamn hard.
To be clear, the blogging itself isn’t so difficult. The tough part, I find, is capturing what I do in nice, neat stages. Case in point from a few months ago:
Case in point 2–my wife and I ended up in a AAA 5-diamond restaurant a few months ago. As I’ve said before, I’m not big on the “food porn” sub-genre of blogging, but thought since it’s rare for us to eat out in the first place, I may as well document it.
So this is how I started…
… And after a couple of courses of nearly forgetting to take a picture, this ended up happening.
In a nutshell that’s why I’m so bad at blogging my culinary adventures. I’m just too damn eager to eat them.
Luckily, I had a little more patience with a grand foray over the last couple of weeks into dry aged, cold-smoked bacon.
I started with two and a half pounds of local, pastured pork belly from Whole Foods and the basic pancetta recipe and method laid out in Ruhlman and Polcyn’s Charcuterie.
The cure consisted of about 1/4 cup salt, 2 tablespoons brown sugar, and half a teaspoon of pink salt. Add to that a teaspoon of nutmeg, tablespoon of crushed bay leaf, and 2 tablespoons coarsely-crushed black pepper. I rubbed the pork belly all over and put it in a gallon bag for shy of a week, turning occasionally. Afterwards, I rinsed it, patted it dry, wrapped it in cheese cloth, and hung it in a part-open cooler for about a week and a half. You know. So the cats don’t get to it.
I probably should have photographed this. Meh.
I’d never cold-smoked before, so this was something of an experiment. I have a Chargriller with an offset smoke box and dumped just a couple of barely-lit hardwood coals into the box. I added the bacon to the main compartment on top of a nice, clean wire rack. Nearby, I placed a tray of ice cubes to keep the heat in the chamber down. I added a handful of hickory chips to the barely-smoldering coals about every fifteen minutes, or until it had stopped smoking. The vents spent most of the smoking time closed or barely-cracked–I didn’t want it to get hot enough to cook. It was a relatively cool summer day and I managed to keep the smoking chamber at about 100 degrees F.
Here’s the result at about the half-way point.
It could have smoked a little longer, but I wanted a delicate smoke flavor and decreed it done after about two and a half hours of moderate to heavy smoke. The end result: one of the best BLTs I’ve ever had.
I consider that there’s a picture at all to be a sign of a modest improvement.
So a lot’s been going on. There are so many things I could say about so much. Instead I’d like to talk for a moment about biscuits.
Our family went to Disney World in Florida. It was a lot of fun and I don’t think I’ll ever forget the look on our daughter’s face when she saw Cinderella’s Castle for the first time. Of course then she realized it’s basically just a restaurant. Thankfully there was enough else to see and do it was no big deal. Since returning home, we’ve been busy beyond busy. On top of that, I’m unlikely to get around to seeing Superman or Pacific Rim. They haven’t gotten great reviews, but dammit, I don’t care. I’d just be in it for the geek-out factor.
Back to the biscuits. They’re always going to be there for you come hell or high water. I grew up on biscuits made in the Southern U.S. tradition–wonderful dollops of dirtbag that they are. they’re a special treat. Especially for someone who loves to cook.
Preheat an oven to 450 degrees F.
Start with 2 cups of flour. You need a soft winter wheat “short patent” bleached flour for best results. White Lilly is the sentimental favorite for me and many others, but it’s getting harder to find. But do go out of your way to find a specialized flour for biscuits. I’ve made biscuits many times with national-brand all-purpose flour and trust me–they won’t yield exceptional results. Biscuits are almost entirely wheat flour, so if you’re not using the right one for the job, why bother? That’s what Pillsbury Grands are for. Incidentally, I find short patent flour makes the best roux. It creates much smoother sauces–almost the consistency of corn starch.
Mix in a teaspoon of salt–I use fine sea salt. Then mix in one tablespoon of baking powder. Sift them together–short patent flour tends to clump more in my experience. I also like to add a tablespoon of sugar. Some don’t. I find it balances the slight chalky taste of bleached flour. Next, cut in a third cup of butter. You could use less, but why not indulge? These really should be a “sometimes food.” Some people prefer shortening or lard, which produce a lighter consistency. Buttered biscuits are denser, but have a superior flavor, in my opinion. Lard is supremely light, but can pass on a gamey flavor and won’t get you much vegetarian cred. I cut the butter into half-inch chunks and then knead them into the flour mixture with my fingers. Once they become pea-sized clumps, I take a pastry cutter and blend them in until the clumps are the size of coarse crumbs. This way, some of the butter is blended in well with the flour, tenderizing the crumb while leaving a few bigger spots. Form a well in the center and stir in about 3/4 cup cold milk (I use plain milk instead of buttermilk). Knead slightly until all of the flour mixture is moistened. Do not overwork the dough. You want them to hold together enough to cut, but the more you knead, the tougher the finished biscuit will become.
Lightly flour a counter and pat the dough down into a round or oval a half inch thick. Cut out the biscuits and arrange them in a circle inside a cold 9 or 10-inch cast-iron skillet so that they barely touch each other. This contact will help them rise straight up instead of outwards.
Bake for 10-15 minutes, or until the dough is dry and just beginning to turn pale golden brown in spots. Brush the tops with about a tablespoon of melted butter, if desired (DO IT).
Don’t eat them all in one place. Seriously. That’s a lot of fat.
It’s been a while since I’ve had so many mixed feelings. Our soon-to-be six-year-old daughter recently declared she’s a vegetarian. We’ve been told many times by many different people we’re screwed when she hits her teenage years.
So here’s my dilemma: I have the utmost respect for vegetarians. A vegetarian diet is one of the most healthy and ethical diets out there. Too bad, as I said in my first post, I really, really likes me some bacon!
I’m a big believer in the virtue of free-range and ethically-raised livestock and I’ve tried to extoll this to my daughter. At this point it would be fair to note that, though I’m a licensed mental health provider, I don’t generally work with kids and tend to miss nuances of developmental appropriateness. Because the more I’ve talked to my daughter about how important it is we treat our food animals well, the more it hammers home that… well… she’s eating once-living beings.
I’m trying to eat more vegetables and this has urged us in that direction. My goal is more “Meatless Mondays” and more dishes in which meat is a subordinate part of the meal.
I’m far from swearing off pork fat, but if there’s a positive to this, it may be I’ll finally get my daughter to finish her vegetables and at least try her beans. “Otherwise, you don’t get to be a vegetarian.”
So here’s an attempt at compromise. For an early Father’s Day meal, I made grilled grass-fed steak with a spinach puree inspired in equal parts by Indian saag curries and chimichurri. I find herbacious, olive oil based sauces tend to compliment grass-fed beef more than buttery ones such as bearnaise or bordelaise. Those are great sauces, but they tend to stifle the delicate flavor of its natural fat. Enjoy!
12 oz. spinach leaves
1 small tomato
2 cloves garlic
2 tablespoons good quality extra-vigin olive oil
1 teaspoon lemon juice (or to taste)
Cayenne pepper, to taste
Salt, to taste
Bring one gallon of water to a boil. Cut an X into the bottom of the tomato skin and trim off the stem area. Blanch the spinach and tomato for about a minute, until the spinach is wilted and the tomato skin is loosened. Drain and shock both in an ice water bath.
Peel and seed the tomato. Squeeze the spinach into a clump until dry. Pulse all ingredients in a food processor until they form a paste. Thin out with more olive oil if a looser consistency is desired. Season to taste with salt, pepper, cayenne, and lemon juice. Serve as a condiment with grilled meat.
The American Psychiatric Association (APA) is rolling out the fifth edition of its DSM, the Diagnostic and Statistical Manual of Mental Disorders, this month. Like Game of Thrones‘ Stannis Baratheon, it’s the rightful heir, but no one wants it. As I’ve mentioned in previous posts, I’m a mental health social worker by trade. DSM 5 was a work in progress when I was in grad school eight years ago and it hasn’t earned a lot of positive early reviews so far. Furthermore, as it falls under HIPAA, my agency will switch to ICD-10 anyhow.
Arguably most damning, the National Institute of Mental Health recently released a statement that it will be “re-orienting its research away from DSM categories.” Its rational is long, technical, and for the most part, makes a lot of sense. Here’s the gist of it (and the emphasis is mine):
The goal of this new manual, as with all previous editions, is to provide a common language for describing psychopathology. While DSM has been described as a “Bible” for the field, it is, at best, a dictionary, creating a set of labels and defining each. The strength of each of the editions of DSM has been “reliability” – each edition has ensured that clinicians use the same terms in the same ways. The weakness is its lack of validity. Unlike our definitions of ischemic heart disease, lymphoma, or AIDS, the DSM diagnoses are based on a consensus about clusters of clinical symptoms, not any objective laboratory measure. In the rest of medicine, this would be equivalent to creating diagnostic systems based on the nature of chest pain or the quality of fever. Indeed, symptom-based diagnosis, once common in other areas of medicine, has been largely replaced in the past half century as we have understood that symptoms alone rarely indicate the best choice of treatment.
To summarize, unlike other fields of medicine, psychiatric disorders are classified by symptom (like persistent cough and sore throat) rather than etiology (like streptococcal infection). I should note the DSM’s creators’ goal was to create a purely descriptive diagnostic system that looked at “symptom clusters” without inferring underlying cause.
Of course, a lot has changed about our understanding of the mind since 1952. Schizophrenia was once though to result from poor parenting. Not only is that patently false, we can now detect apparent differences in brain activity in unsymptomatic children with a genetic predisposition for schizophrenia.
Daniel Amen is an American psychiatrist known for his reliance on brain scans, not just as a research tool, but for diagnosis. Last year, the Washington Post published a compelling article about him:
“Psychiatry is broken,” he is given to say, and psychiatrists “remain the only medical specialists that rarely look at the organ they treat.” He scoffs that diagnostic methods have scarcely progressed since “the days of Abe Lincoln.”
So you may think at this point think I’m a critic of DSM and advocate for advances in brain imaging technology. You’d be wrong. Let me tell you for what I’m advocating…
That’s right. Bring back the witch doctor. Because I believe in my heart that’s all a great psychiatrist really is. A witch doctor learned in the scientific method and perhaps heavily indebted to higher education, but a witch doctor nonetheless.
Here’s where I take issue with Dr. Amen: he claims psychiatrists “remain the only medical specialists that rarely look at the organ they treat.” He’s right in they rarely look at what they treat and wrong in that it’ an organ. A psychiatrist is not strictly a doctor of the brain. That’s a neurologist. The word, psychiatry is derived from the Ancient Greek “psykhe,” meaning “the soul.”
A psychiatrist is a doctor of the soul.
And what’s the difference? Can we even say such a thing as a soul exists? No. It’s by its very nature radically unknowable.
As much faith as Dr. Amen has in brain scans, the fact of the matter is, there are no widely-accepted diagnostic criteria based on brain scan markers. Though scans can show a difference in brain activity with someone impaired by a severe thought disorder, they can’t for many other debilitating mental illnesses. Furthermore, how could you ever tell the difference between, say people with obsessive compulsive traits that cause severe dysfunction in everyday life and people with obsessive compulsive traits that make them really organized and good at their jobs? Mental illness is a continuum we all fall within somewhere. You see a lot of lists of famous people who have struggled with mental illness. In some cases, they’ve not only overcome symptoms, but channeled traits such as compulsion or mania or depression into insight and organization and creation.
The fact of the matter is, modern psychiatry isn’t that different from folk-medicine. “Take one of these for a week. Tell me if you feel better. Experience says you will, but we don’t know for sure. We don’t know why it might make you feel better either.” I’m oversimplifying obviously. We have clinical trials and quantifiable rather than anecdotal evidence of efficacy. We also have mounting research about the brain/cognition link. The mechanism by which most psychotropic medication works is still theoretical, however. Drugs are created and tested to mimic existing drugs or speculated properties. Trial and error. Like the witchdoctor and the salve.
In my job at a community mental health center, I don’t think in terms of “what would be this person’s diagnosis per a SPECT?” I think, “how does this person need help?” And that’s the strength of the psychiatrist. She or he befriends the unknowable; the “how do you feel?”; the “who are you?”
Don’t get me wrong. I’m cynical about DSM5–especially the ways in which its writers have generally loosened diagnostic criteria, which could lead to over-diagnosis and over-medication. I can also believe assertions that its diagnoses lack validity and internal consistency. But the latter I chalk up to the DSM pretending to be something which its not–which is a dictionary of disorders that actually have validity and internal consistency. If you ask me, the DSM should imitate the holy book of Vonnegut’s Cats Cradle and preface itself with the following:
“All of the true things I’m about to tell you are shameless lies.”
I like the idea of a psychiatry that’s a fellowship of witch doctors and like the witch doctors of old, one that answers to its communities (plural). These include the general public, mental health peer/consumer/survivors, advocacy groups and yes even the least among them, NIMH. There’s something audacious about saying a psychiatrist treats the intangible. That yes, psychiatry cannot be removed from its cultural context; can manifest as social control, but that’s the baby’s bath wash. We can be okay with that because to accept psychiatry as such is a victory for the individual who doesn’t meet a machine’s dubious diagnostic criteria. It’s a victory for the power of the subjective.