iPhone App: TripView

The latest news is that Apple has exceeded 2 billion iPhone app downloads from the iTunes Store, and boasts more than 85,000 iPhone apps. Whoa. 85,000? Is that possible?

I’ve got about three and half pages of apps on my iPhone and I use fewer than five in any given week. Apple has done a great job of promoting and presenting its apps. At the App Store everything is colourful and enticing; but once you start buying, installing and trying apps, you realise there are very few you would actually try again, or at least with any regularity.  I threw out the US Constitution app like a half eaten toffee. Sure, I would like to be more familiar with the document, but who reads the Constitution when they’re waiting for a bus?

I don’t include game apps in this assessment, as I haven’t got the gene that makes playing computer and video games fun. And though I wouldn’t use most apps with any regularity, many of them are cool and well designed. Exhibit A: iSteam. Exhibit B: Zippo. But the primary measure of an app’s appeal is undoubtedly its usefulness; and one of the most useful apps I have found is TripView – Sydney.

TripView – Sydney ($1.99) and TripView Sydney Lite (Free) are digital compilations of all Sydney bus, rail and ferry timetables. The app is extremely user friendly and aesthetically clean. You can save multiple bus, rail and ferry routes in the $1.99 version, and when you select a route it will tell you automatically, given the current time, which trips you missed, and which trips are ahead, and by how many minutes. You can even see a replica of the rail station screens, showing which stops will be included on the route.

For someone like me who heavily uses bus, rail and ferry, this app has changed my world. Well, it has at least eliminated the stress of wondering when the next bus or ferry will come, and the hassle of having to carry around multiple timetables.

4 out of 5 stars

iPic: A flying fox no more

You might find the occasional bat in an old house attic in my small town in Pennsylvania. Good luck seeing more than a small blur of black though.

And you would often hear a rustling in the trees that lined my Jerusalem neighborhood at night. But the noisemakers would never show their faces.

But Sydney -

This is the city of bats.

For me, the beginning of a Sydney summer is defined neither by the lengthening of days nor the blooming of the Jacaranda; but by the recommencing of the northern migration of the flying fox. Every summer day at dusk, the flying pack departs the Botanical Gardens to sweep across my window for northern parts unknown. I never see the return trip.

The poor fellow above seems to have fallen from a tree in the Eastern Suburbs. But this is the wrong season, the wrong setting, and the wrong outcome.  After last week’s red day of dust, I hope he doesn’t herald a deadly summer.

A Street Car Named Desire in Sydney

I had the pleasure of seeing the Sydney Theatre Company’s faithful performance of A Street Car Named Desire on Friday. Cate Blanchett is clearly serious about her craft and deserves respect for her commitment to advancing the reputation and quality of Australian theatre.

The show has enjoyed sold out performances for a reason: The set is a perfect replication of a suffocating two-bedroom apartment in a drab two-story, inner-city tenement. The performances of Cate Blanchett and Joel Edgerton in particular, were inspired, and their accents believable. Edgerton deserves particular praise for convincingly embodying the classic American character of Stanley Kowalski, with his barely-contained insecurity, sexual frustration and violence.

This is a play for the non-theatre-goer as much as the connoisseur.

It’s a happy coincidence that I saw the play during my psychiatry rotation. Blanche DuBois is a decidedly more sympathetic character to me today, than when I saw the film on VHS in Hawaii in the summer of 1994.

The Blanche DuBois of the play as depicted on Friday, appeared to me a genteel and gentle, fading Southern beauty. A product of her time and place, she certainly had her prejudices and pretensions, but it was her deep insecurity-driven vanity and mental fragility that defined her. She was, what the DSM-IV would call, histrionic, one of the Cluster B personality types.

Histrionic Personality Disorder is seen as a pattern of excessive emotional behavior and attention seeking approaches with others.  They are often uncomfortable if they are not the center of attention and may use physical appearance, such as a provocative manner of dress, or explicit sexuality as a means to gain this attention.  They often see relationships as more intimate than they really are and are seen as moving very quickly once they become involved with someone (e.g., they may see a person they just met as their best friend or a person they dated once or twice as their future spouse).

Blanche’s personality disorder was most likely the reason for her supposed nymphomania, and must have been comorbid with an affective disorder – most likely a generalized anxiety disorder (GAD). Her GAD most likely evolved from a post-traumatic stress disorder following her childhood fiance’s suicide, for which she felt responsible. It was this anxiety disorder that facilitated her nervous breakdown. It was her rape by Stanley on the eve of his first child’s birth that precipitated it.

Blanche’s persistent snobbery with respect to Stanley made him a sympathetic character in the first act – her disapprobation of her sister’s choice seeming shallow and bigoted. It was fascinating to watch the slow revealing of Stanley’s own antisocial personality disorder in the second act, as our sympathies shifted to Blanche. And in between these two larger-than-life characters with their respective personality disorders, was Stella, the character who never garnered our sympathy, and who though perfectly sane and appropriately behaved, proved to have the weakest mind.

4 out of 5 stars.

Are Republicans crazy?

Here’s a quote from an interesting post at Club Troppo on the seemingly “psychotic” collective behavior of nations and communities, as it relates to current American political culture:

Mainstream republicans are crazy – not all but many. And of those that are not, many have to cow tow to crazy people anyway.

The evidence presented includes beliefs such as creationism, the voluminous hate mail Obama receives, and the bizarre behavior of Tea Baggers.

Are mainstream Republicans crazy?  Of course not, and I’m a life-long Democrat and fervent Obama donor/supporter/voter/lover.

First a point on using the word “psychotic” to characterize Republicans…

As discussed in an earlier post in reference to schizophrenia, a psychosis is characterized by the presence of delusions – that is, distortions of belief. These beliefs are fixed and false according to what one’s culture holds to be true, and despite evidence to the contrary.

Republican Belief #1:  Obama was born in Kenya.

Obama was in fact born in Hawaii, as his birth certificate states and the local Hawaii paper announced at the time of his birth. However, there is a fake Kenyan birth certificate making the rounds through Republican circles. One could say that the persistent belief that Obama was born in Kenya constitutes a delusion, given the evidence to the contrary and given the great unlikelihood that a presidential candidate could deceive the press, the Department of Immigration, the state of Hawaii, and the Republican political establishment for the two-plus years he ran for president, before getting elected. But the Kenyan birth certificate throws a wrench in things, so this is more a case of people desperately wanting to believe the worst to justify their natural inclination to despise and distrust someone they consider in every way different from themselves. This isn’t psychosis. By the way, if you want a Kenyan birth certificate, go here.

UPDATE: TPM reports on a birther movement infomercial challenging Obama’s place of birth and the legitimacy of his presidency. It’s supposedly running in 7 southern states.

Republican Belief #2: Obama is the anti-Christ.

The belief in an anti-Christ is no more fantastical than the belief in a Christ or Messiah – a belief shared by millions of Christians as well as Jews (according to scripture anyway, though he has not materialized as yet in Jewish tradition). Christians are frequently inclined to believe that what is foretold in scripture will happen in their lifetimes, out of a natural desire to bear witness to great events. Someone has got to be the anti-Christ. Why not Obama? I mean it is quite odd – still – to see a half-African named Barack Hussein Obama as president and two little black girls in cornrows running around the White House grounds. I can scarcely believe it. So the persistent belief that Obama is the anti-Christ within the cultural context of fundamentalist Christianity is not a fixed, false belief. Thus, not a delusion. After all, there is no evidence to the contrary.

Republican Belief #3: Evolution is just a theory, carrying no more weight than creationism.

Evolution IS just a theory. Granted, it is the best one we’ve got, but still. The evidence we have largely supports this theory, but only so far, and short of making it fact. Carbon-dating however, indicates the world is much older than many fundamentalists insist, and is pretty strong evidence against creationist claims of a much younger earth.  But no one has yet produced evidence against the claim that God made animals and men as they exist today in a God-week. Animals now extinct may have similarly been made in such a fashion. More importantly, the belief in creationism is not false according to a culturally Christian background. Thus, not a delusion. (But just to be clear, I do believe in evolution.)

UPDATE: A new fossil skeleton has been found that further elucidates human origins.

UPDATE: The ladies of the View talk creationism.

Now the main point…

Many of the Republican beliefs currently in circulation and frequently contradicting themselves – Obama is a fascist, socialist, communist, Hitler, Muslim, welfare thug – are also not delusions. These are born, as so many extravagant minority views are – of mundane and very sane ignorance: ignorance of political history, of other cultures, of world affairs, and of evidence. Ignorance breeds suspicion and a reflexive distaste for the other. Obama is the very definition of “Other” to some white, small town, Christians, who know about as much about fascism, socialism and jihadism, as they know about Darwinism and carbon dating – which is to say, not much. Ignorance is the broth in which racism grows best. Once ignorance has generated beliefs couched in suspicion, distrust and prejudice, it is the natural human inclination to seek evidence of whatever reliability to confirm and reinforce those beliefs.

The problem with the Republican Party today is not that a significant number of its members are crazy – figuratively or by scientific definition. The Republican sickness is an intractable intellectual laziness, a chronic lack of intellectual curiosity, a cowardice to seek out or confront information that might challenge the most easily developed ideas. This last feature – cowardice – is not unique to Republicans. It’s universal.

So no, many Republicans are not crazy, but Republican politicians most certainly do cow tow to the crudest of ideas if the are espoused by the base. That’s purely an act of political survival. That’s human behavior.

P.S. More photos from the Tea Baggers D.C. protest here.

UPDATE: It’s come to this (hat tip to TPM). Psychosis is an inherently innocent – albeit potentially harmful – and treatable disease. The source of this kind of thinking, however, is a sinister and far more refractory affliction…

UPDATE: TPM reports that Newsmax has taken down the article, but TPM’s got the full text.

UPDATE: TPM is like a veritable goody bag of reports of Republican histrionics. Here’s the RNC Chairman, Michael Steele spreading his special words of wisdom.

UPDATE: Lindsey Graham weighs in to call the Birthers who claim Obama was not born in Hawaii “crazy”. Video here.

Smoking for your mental health

I wrote a post after I finished my first year of medicine about my struggles with quitting smoking. I’m in my 5th year of medicine now… and still smoking. I’m not a smoker however. I’m a nicotine addict.

I’ve been on nicotine replacement since before I applied to medical school – mainly nicotine gum, but this year that stopped working – worse – the gum began making me sick. So I have switched to nicotine mints, and boy are they great. The nicotine dissolves faster under the tongue, the breath stays fresh longer, and the mint is a perfectly awful thing to pop after you’ve had a cigarette.

They say withdrawal from nicotine only takes about 24 hours, which would suggest that smoking is primarily a psychological addiction. I’m not so sure about that. I’m equally addicted to nicotine replacement as I am to cigarettes, so it’s not just the act of whirling that delicate white phallus between your fingers that becomes a habit, or the drawing in of one’s cheeks. But there’s no denying that a cigarette or a nicotine mint does settle the mind.

Doctors hate smoking. They shake their hands and make “tut-tut” noises and produce deep sighs when they leave the bedside of a patient with end-stage emphysema on palliative care. They shrug when they leave the room of a smoker whose had his leg amputated or a leg ulcer redressed that hasn’t healed in three years. We smokers are masochists. We’ re idiots. We’re burdening the health system with our preventable peripheral vascular disease, our chronic obstructive pulmonary disease, our lung cancer, our bladder cancer, our mouth cancer, our [insert organ here] cancer, our heart attacks and our strokes. They have banned us from their hospital grounds and the sidewalks encircling them – though you wouldn’t know it from the cigarette butts that crunch under your feet on your way in.

I hide my smoking from doctors like the bad habit it is. I keep my cigarettes at home for morning and after-work relief, or I keep them in my car for a post-lunch digestif. I keep my nicotine mints in my work pants pocket, and on rounds surreptitiously place a white tablet under my tongue.

But then I started my psychiatry rotation, and so entered Bizarro World.

More than 70% of schizophrenics and other mentally ill persons smoke cigarettes, which is why they predominantly die – and die sooner – of cardiovascular disease. No one is quite sure why they smoke. There is a theory around, that smoking may actually aid concentration and other measures of cognitive function in long-term schizophrenics. Who knows.

As interesting, is the shocking percentage of mental health workers that smoke. In every hospital I’ve worked – with its smoking bans and anti-smoking doctor-crusaders, the mental health unit has been staffed by unapologetic smokers. This excludes the actual doctors – the psychiatrists – of course.

But here’s where things get very interesting…

Patients in the longer-stay mental health ward where I’m attached are allowed to smoke. I suppose any patient in any ward is allowed to smoke. They may have cigarettes in their side drawer and go outside to smoke if they’re healthy enough to get there. But it’s privately done and discouraged. The main hospital staff would prefer to dispense nicotine patches and encourage patients to break the habit. But in the long-stay mental health ward of one particular hospital, the patients’ packs are all kept at the nurses station in a drawer that makes me drool. Every ten minutes or so a patient approaches the nurses’ station requesting a cigarette, to which the nurse on duty replies “Sure thing Johnno, here ya go” or “Sorry Fran, you haven’t got any more”. Here’s one conversation that actually occurred:

Patient: Nurse I need some more of that pain medication. (NB: many patients have substance abuse problems and seek more pain-killers than is healthy or warranted.)

Nurse: Sorry hun, but I just gave you a dose less than one hour ago. I wish I could, but you can’t have any more for another three hours. How about a cigarette?

Patient: Yeah, okay.

Bizarro World.

Later that day, after the nurse had seen to various patients, dispensed medications, and recorded progress notes in files, she sat down to see to one particular patient’s needs, by rolling him his own cigarettes:

Nurse: This will get you through the day, hun.

I bet they didn’t teach that in nursing school.

Schizophrenia is a devastating illness, and is a major contributor to a nation’s burden of disease and years of life lost due to disability (YLD). When a patient is mentally incapacitated by the anxiety of persecutory delusions and nightmarish hallucinations, I’m not sure I would have the strength or determination to deny them the solace of a coffin nail.  Not when the shock of my first day on the psych ward drove me to the corner store.