Lies, damned lies, and statistics

by David Laing Dawson

Mark Twain said that long before we had computers and a few dozen algorithms we could apply to random numbers to find ‘meaningful’ patterns.

Data mining and scientific studies that find nothing or negative results seldom get published. So it behooves all academics to find something. To find at least an association that can be inflated by the manner the data is reported. Then it will get published, and the press might even pick it up if it is startling enough.

I am writing this because an article on the front page of our local paper tells us that people who take antidepressants are at risk of premature death. This is based on a local academic’s data mining and meta-analysis. The figure quoted is 33% higher risk of premature death and 14% more likelihood of death from cardiovascular disease. They also have to explain away the fact that if you have previous cardiovascular disease the use of antidepressants does not increase risk.

First, these are associations, not cause and effect. Secondly the variables are numerous. And the first variable that comes to mind is that the people who take antidepressants probably suffered from anxiety and depression, undoubtedly felt unwell, and did ask their physicians for help. The people who never took antidepressants did not. The only way these figures can be clarified would be to take 10,000 people who attend doctors complaining of anxiety, OCD, and depression and give antidepressants to 5000, and nothing to the other 5000, (randomly selected) and follow over 20 or 30 or 50 years.

Then we have the startling 33%. Well, if 3 people out of 1000 die in one group and 4 in the second group, that is a 33% increase, looking at it one way, but really a 0.1% difference looking at it in a real life way. These kinds of statistics are often misused in the press. When the actual risk (sorry, not actually RISK, just different finding) of contracting something increases from 1 in a million in one study to 2 in a million in another study that can be reported as a 100% increase.

I am sure antidepressants are both underused and overused. Underused in the rush of clinical practice when severe depression is not recognized or not reported, underused when the person is already self-medicating with marijuana, alcohol or opioids, underused when the dosages used are too small for severe depression – and overused as the go-to-drug for angst and unhappiness.

I am also sure any drug should be avoided if it can be. That goes for anti-hypertensives, statins, antibiotics, and aspirin.

So I did a little data mining of my own. It turns out that the people of Australia, Iceland, and Sweden rank in longevity 2, 3, and 4 in the world. Canada and New Zealand follow closely. Japan holds the number one spot but antidepressant data (for interesting cultural reasons) can’t be found so I have excluded Japan. On average the people in spots numbers 2,3, and 4 live between 82.4 and 82.8 years. Let’s average that to 82.6 years of life expectancy. Iceland, Australia, and Sweden also rank as the highest antidepressant users, ranking one, two, and four. (Denmark is number three)

Among the lowest antidepressant users (where data for life expectancy and antidepressant use can be accurately determined) are Estonia, Turkey and Slovakia.The life expectancy for the people of those countries averages 76. So by simple association we find that the longest lived people in the world consume the greatest number of antidepressant pills per person.

Applying my own meta analysis to this data I can arrive at the conclusion that high average consumption of antidepressants prolongs (oops, is associated with an increase in) life expectancy by 6.6 years, or almost 9%. The headline this could generate would be: Prozac increases life expectancy by 9%

But, academics have an ethical duty to explain the limitations of associations found in population studies and meta-analysis, and the true meaning of various statistical analyses in real life terms.

Reporters should have an ethical duty to avoid golly gee whiz headlines in health matters. (probably in a few other matters as well)

And medical historians should point out the dramatic change in the number of home and hospital beds utilized by moribund patients suffering from severe depression pre 1960 and today.

A curious side note: On the same Google page for Health news there is a report of a British teen dying from “eating her own hair”. They go on to discuss Rapunzel syndrome, and trichophagia. But such a compulsive behaviour is just that. A compulsion. A serious symptom of OCD. And easily treated today with one of those antidepressants maligned in the other article, along with some counseling of course.

 

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Some Thoughts on Parenting and Parent Blaming.

By Dr David Laing Dawson

I read R. D. Laing years ago. He was a good writer, a poet, and unfortunately good writing can hide a bad argument. At the time I thought there was one glaring problem with his thesis, and that was, that if we are to believe that the parenting style, the behaviour of the parents, especially the mother, was entirely to blame for the child’s woes, or even schizophrenia, and therefore was BAD, as in “she is a bad mother”, then logically we could trace her badness to the behaviour of her parents, and then to their parents and on through the lineage.

So with that logic, if it were true that all of one generation’s woes can be traced to the behaviour of the parents, there was no blame to be assigned, except perhaps to Adam and Eve. And as I recall, with every theory of motherly behaviour causing schizophrenia being discussed in our study groups, (Laing’s conspiracies, double bind, skew and schism, the schizophrenogenic mother) someone would say, “Don’t all mothers do that?” And we would laugh at this obvious truth. For to be a parent means to be sometimes overprotective, sometimes a bit neglectful, sometimes too preoccupied, sometimes angry, sometimes demanding, sometimes in disagreement, sometimes short tempered, sometimes too tolerant, sometimes offering conflicting advice, sometimes playing on guilt, sometimes encouraging, sometimes discouraging, sometimes right and sometimes wrong.

On the other hand there is nothing to stop brutal, immature, even sociopathic teens and adults from having children. Some terrible things do happen to children. In this part of the world we have imperfect systems in place to discover this, to intervene, and to apprehend if necessary. The worst of these situations often go undetected for years, for by their very nature, they are secretive, antisocial, and sometimes very mobile. And the children who suffer through this are often scarred for life.

The systems to protect children will continue to be imperfect, for to perfect them would require a level of state surveillance and interference our society would not tolerate. But we can continue to do our best, discuss it, adjust our laws and processes, rescue many, and try to help others recover.

Professional Parenting advice changes with every decade, as often as other fads and fancies. It often follows the zeitgeist of the time, and usually echoes the current advice or wisdom found within other human endeavours, such as best management practices in the new information industries. Fortunately most parents ignore this formal advice and seek the guidance of their own common sense, knowledge of child and teen behaviour and development, and the wisdom of their own parents, aunts and uncles. And most parents struggle to find the right balance, the right expectations, the right levels of support, love, acceptance, control and discipline.

But I don’t think we are biologically programmed to thrive, at least after age 3 or 4, within a cocoon of family perfection and complete safety. We need some challenge and adversity; we need some things to overcome, some fears to conquer, some skills to acquire. We need some adversity in our childhoods and adolescence. We need to experience failure, at least once or twice. We need to experience the death of a pet, perhaps a grandparent. We need to skin our knees, get lost and find our way home. We need to do some things that cause us anxiety. We need to experience disappointment. We do not need perfect parents.

But one child’s adversity may leave scars while another child’s proves to be the cauldron for a very successful life. Barack Obama is only one of several US presidents who lost their fathers by death or abandonment in childhood.

To paraphrase an actor/comedian who gave the Commencement address at his Alma Mater, The University of Western Australia: “You are all very lucky to be here. Some of you because you were lucky enough to have stable, wealthy parents, who guided you, inspired you, and paid your tuition. The rest of you because you were born with the genetic makeup to overcome whatever obstacles were in your way and get here on your own.”

Mark Vonnegut, Schizophrenia and Mother Blaming

By Dr David Laing Dawson

Mark Vonnegut, the son of Kurt, had (has) a psychotic illness. In his autobiographical novel he explained delusions in this way: if you were being chased by a pack of wild dogs, wouldn’t you rather think that somewhere there was a hound master who could call them off if he chose to do so?

I have always thought he was right, at least with respect to delusions. They are explanations for experiences that, in the case of mania, cannot be explained within the accepted laws of physics; in the case of schizophrenia, cannot be explained by a diminished social perceptual and information processing system; and, in the case of dementia, cannot be explained by a diminished cognitive apparatus.

The invented explanations are usually quite simple and usually involve blame in either a positive sense (God has granted me…) or a negative sense (the CIA is…). The target for blame (or perceived source) in a delusion is always standard fare. The source of extraordinary power and well being is God; the causes of failure, constraint, weakness, control, are parents, the police, a disease, or Aliens. The methods are always contemporary:  in pre-industrial  cultures, by curses, spells, hexes, and evil eyes, through the 20th century by radar and radio waves, and now through a variety of electronic devices, bugs, and micro implants. And as per the topic of a recent blog, note that parents make that list.

But beyond an explanation of delusions, this wish for a hound master who could, if he chooses, call off the dogs of hell, is really quite universal. Historically we have used, or fallen into, just such an explanation for every sin, illness, climatic event, and tragedy that befell us. And, almost always, we have been wrong.

But this need, this psychological human brain imperative, continues. The value of this trait of the human brain (mapping, organizing, understanding) lies in the advancements of science. We want to understand why things happen as they happen. The downside to this need, this wish, is the continuing enthrall of astrology, a myriad other nonsense fads and conspiracy theories, and the wish to find someone to blame  for schizophrenia.

More on Trauma in Youth and Schizophrenia

By David Laing Dawson

This blog is in response to a comment made on an earlier blog called As For Trauma Causing Schizophrenia: No! No! No! 

The comment was how do you account for this study? And how can you claim that trauma cannot be causative of schizophrenia? https://www.sciencedaily.com/releases/2012/04/120419102440.htm

This is the answer:

There is no doubt severe trauma in childhood can have long lasting effects. But can trauma be a specifically causative element in the development of the full illness schizophrenia? And is it either a necessary causative element or a contributing factor?

Data mining and surveys come up with many associations, some weak, some strong. Fair enough. But we have to examine the definitions of each and every term and understand that association is not necessarily causative. And in this situation we must be very careful what we publicize because any association between trauma and schizophrenia provides support for parent blaming.

I am back to eating butter after something like 20 years of favouring margarine. This because for many years data mining found associations with butter and other animal fats and cardiovascular disease, and only recently further data mining and studies have shown that, au contraire, we need fat, and margarine may be worse than butter. Now I slather butter on my corn and biscuits without guilt. As someone else has pointed out, there is a very strong association between major road accidents and the presence of ambulances.

The word paranoia is used in many of those studies. I don’t know how they define it or determine it. Adolescents suffering from anxiety often experience what they call ‘paranoia’ but we refer to as ‘ideas of reference’. They feel their peers are always talking about them, judging them. Some avoid school because of this. Sometimes this feeling becomes a conviction and then it may be prodromal of a psychotic illness.

Bullying is interesting. I have 30 years of experience dealing with families in which a child is reported as being bullied by his peers. There are some distinct subcategories in this: In one subset, when the details are elicited, it turns out the boy in question is as much a perpetrator as a recipient. They taunt one another. But this particular boy tells his mother that Jason called him a “…..” in order to get a reaction from his mother, or to avoid something, or simply to get in front of the call that is going to come from Jason’s mother or the school.

A second subset is the Asperger/ASD child. They are common targets for bullying, precisely because of the way they react to unfairness, teasing, slights, and taunts. It is not kind and it is not good but they have become targets for bullying precisely because of the social deficits they already exhibit. My own survey reported on this site indicates that at least a third to a half of people diagnosed with schizophrenia have had autistic symptoms since infancy. So I would definitely expect a higher proportion of bullied children to develop a psychotic illness. The bullying is not causative, but the prodromal symptoms of the illness “invite” bullying.

Auditory hallucinations are not, in and of themselves, schizophrenia. People, girls, who have suffered prolonged sexual abuse report a higher incidence of auditory hallucinations. This certainly could be understood as persistent trauma of a particularly disorienting kind causing impairment in the brain’s otherwise quite miraculous ability to (usually) locate the locus of a thought or feeling, as well as causing all the other symptoms of PTSD as well.

On the other hand preteen and teen girls with ASD or prodromal symptoms of schizophrenia are vulnerable to predators within a family and neighborhood.

In sum, there are weak associations, though all suffer from our poor definitions and lack of clarity of diagnosis. None are strong enough to be considered causative. And if this were an association between salt intake and hypertension, to publish early causes little harm. (although even here we now have the problem of some people having too little salt in their diet, and other studies showing high salt intake may have nothing to do with hypertension).

But because this overall weak association with all its definition and cause/effect problems could support the existing serious prejudice of parent blaming for schizophrenia, I have to stick with my simple, “No. Neither psychological trauma nor poor parenting cause the serious illness we call schizophrenia.”

Though, of course, either could make it worse.

The Women on the Right

By Dr David Laing Dawson

I am not puzzled by the heavy-set blowhard males who espouse the views of Briebart, Fox News, and the Alt right. I know them. I remember them. They were always loud, obnoxious, dripping with hostility, overcompensating for something: Didn’t make the cut for the football team, passed over for Prom king, snubbed by the prettiest girl in the school, not dumb but certainly not first in the class, never cast in the lead of the school play.

But I have been puzzled by the females espousing the same views. The Ann Coulters of our television. But then I think, maybe I’m being sexist. Maybe I expect women to all be kind, empathetic, generous, inclusive, self-effacing. There is no reason a woman cannot be as selfish and short sighted and loud as a man. After all, their bible was written by a woman, one Ayn Rand.

Okay, adjust your thinking David. A woman has just as much right as a man to be a Roger Ailes, a Sean Hannity, a Glenn Beck, a Bill O’Reilly. Women can be loud, obnoxious, and right wing too.

But my puzzlement has returned, for yet another Fox News commentator has been suspended for “lewd photos sent to female colleagues.”

My puzzlement is not about these men behaving socially and sexually as if their development was arrested at age 14. That goes with the territory. That is where they are.

It is all one and the same. Their sense of white male privilege extends to being lord of the jungle, having ownership of all they survey, and that includes the women folk. And their notion of courtship has always been to display plumage and induce fear.

But why don’t the women recognize this? They are not and will never be equal partners in this right wing endeavor. Hand maids, concubines, and incubators, yes. But not equals.

So I remain puzzled by the women. Unless, of course, they have a plan to get rid of all the blowhard males and take over themselves.

Neo-nazis, thugs, and little boys.

By Dr David Laing Dawson

In our history psychiatry overplayed its hand. As the theories of Freud, Jung, Adler and others caught on, some psychiatrists and psychologists thought we might have something to offer society as a whole. Perhaps psychological intervention could reduce violence generally, and even prevent war and promote peace.

This was overreach. And we are all aware now, I think, that the tools of psychiatry/psychology are more apt to be misused by the state (The Soviet Union), the CIA, Casinos, and by marketing, or building a better soldier, creating brand loyalty, selling junk food to kids, keeping a scholar or athlete focused.

For the most part the profession of psychiatry retreated to being a medical specialty engaged in the treatment of mental illness.

I was thinking of this while watching neo-nazi Christopher Cantwell on his Youtube video. He was an organizer and marcher in Charlottesville, and then a social media hit when he alternately ranted and sobbed on a self-produced video, after hearing there might be a warrant for his arrest.

Why any young and not-so-young American (or German or Canadian for that matter) might proclaim himself a Nazi today is a puzzle. As has been pointed out, they did not grow up watching their fathers lynch Negros or blame Jews for a recession. Where on earth does this come from?

But watching the performance of Christopher Cantwell it occurred to me that I had seen this many times before.

Troubled boys between age 14 and 17. Some ADHD, some labile emotions, and some developmental/cognitive immaturity. Within a half hour they might talk prison talk full of expletive laden revenge, need for respect, blame, threaten, and then cry, weep, apologize to me and their mothers. There is a frightened little boy inside that would-be thug.

They are trapped developmentally, still children dependent on adults, angry their needs are not immediately satisfied, experimenting with male roles of toughness, power, strength, (often borrowed from gang, drug, and prison cultures), ultimately terrified of adulthood and its demands for skills and responsibility.

Most get through this. Good parenting, time for the brain to develop and mature, some boundaries and structures that promote skill building and confidence, more self-reliance, less blaming of others. Sometimes pills for either ADHD or anxiety or both are required.

That is where Chris Cantwell is. I don’t know how much he truly believes what he says, but he is still, developmentally, 14 to 17, at once angry, blaming, playing a macho role, labile and fearful.

So yes, good parenting, some accessible mental health services, the right school system, opportunities to develop skills and confidence, could reduce the number of young men who become neo-nazis, or terrorists for that matter.

When the Mental Health System Refuses to Listen

By  Maria Lorenzoni With Marvin Ross

Much of my writing on mental illness and the flawed system that we have to endure deals with privacy and the absurdity of keeping family and mostly parents in the dark about their loved ones diagnosis, treatment and progress. Maria Lorenzoni recently  gave this  edited presentation this past August to the Service Coordination Council on Mental Health and Addictions of the Central Ontario Local Health Integration Network (LHIN). The LHINs co-ordinate services in geographic areas.

She describes her families experiences with the secrecy of the treating officials and the impact that had on her family. Here is what she had to say:

Every serious sickness is stressful for family members, but caregivers of people with severe mental illness face challenges that are unique in some ways. Imagine for a moment that someone you love has been stricken with a devastating stroke and is in the hospital and can’t communicate, at least for the moment. Now imagine the doctors treating him or her and not giving you details of the diagnosis, prognosis, the exact information in their reports, or the treatment plan. Or just leaving you out of the picture completely. And then imagine the patient slowly recovering, but still not cognitively able to function properly, and perhaps unhappy that they are in hospital, and then being visited by a patient advocate to be informed that he or she doesn’t have to stay in hospital if they don’t want to.

You would argue that this is absurd.

According to a statement from the College of Physicians and Surgeons of Ontario, physicians can share information with others involved within the patient’s circle of care without asking for the patient’s consent if the doctor has no reason to assume that the patient would object.

Sadly, this does not apply to mental health!

In my case, it was only after three hospitalizations that I was able to press the family doctor to give me the diagnosis of my loved one. We finally got our son  into the Centre for Addiction and Mental Health and we were desperately trying to find the right meds and treatment plan. He doesn’t have insight into his illness, he doesn’t think he needs meds, so it took some hard work to get him to cooperate. And then, this vulnerable person that is in serious need of care is visited by advocates who tell him he doesn’t have to stay there.

Then what?

The onus is entirely on the family to persuade the person to stay in treatment. As a family member, you try to cooperate as best you can, BUT, you are not allowed to have any private discussions with the doctor unless the patient is in the room. Being spontaneous and giving some helpful comments is tricky when the person is right there. The doctors, therefore, make all their decisions based on communication with a patient who’s confused and will not share much because they don’t think they are sick.

He finally went to a Home for Special Care and was put under a team.  While we acknowledge the good work they did, there were a lot of misunderstandings and frustration due to a lack of communication.  No one is perfect, and families need to listen to constructive comments without being made to feel that they are just part of the problem.  In the time that he was there, we had three short meetings with the team , there were serious problems with reactions to meds, but we were not given input.  In fact, when I asked a question, I was told quite clearly…”look, you be the mother and we’ll be the treatment team.”  My family was shunned and made to feel that we were not cooperating, and in fact, we were discouraged from even visiting.

SO, POINT NUMBER ONE – family caregivers need to be able to give and receive information (unless there is a very clear reason not to), be given a diagnosis and prognosis, and consulted on a plan of action for the future.

SECONDLY, we definitely need a media campaign to focus on the obstacles faced by people with “hard core” mental illness. Sadly, the current campaign to destigmatize mentally ill is aimed at the people who have a more socially acceptable emotional problem like depression and who are in a position to ask for help. People are under the mistaken notion that everyone with a mental illness has easy access to good, consistent, hands on care. I’ve spoken to some in the health field who have asked me why my loved one isn’t in one of those residences that provide “professional rehabilitation”, and another health professional who recommended that I access a support group that helps caregivers with the tremendous grieving process that comes with caring for someone with serious mentally ill. They didn’t realize that there are no residences with professional staff, and while some support groups are good, none of them have a counsellor to help caregivers, and actually some of them are nothing more than lectures with information that you’ve read from a book a dozen times.

SO, POINT NUMBER TWO – we need to promote public awareness that people with illnesses like schizophrenia exist – that they are from every walk of life, they are people just like everybody else, they are not the dangerous individuals you imagine them to be and CONTRARY to popular opinion, they do not have easy access to services. Caregivers also need counseling as well to be able to deal with living with their loved ones on a day to day basis

NOW, THE THIRD POINT, and the most difficult, is the problem of housing. There are far too few residences and the ones that are available are overcrowded. A few are decent, others have low standards, and the people who live there are not in a position to stand up for themselves.

People with very serious mentally ill are most in need of supportive housing, yet they are the least likely to obtain it. They DO NOT GET MEDIA ATTENTION, AND DO NOT HAVE A VOICE. There is no easy solution, but with SOME BRAINSTORMING AND SOME PROPER REDIRECTING OF FUNDS, some pilot projects can begin to appear. Families would be delighted to help in any way they could, and IN FACT, THEY NEED TO BE PART OF THE PROCESS, so that a proper support system could be implemented.

I know so well that parents of adult children with serious mental illness are very concerned about the future of their kids and want to see them living in a place where there is hope, dignity and support.

If the public becomes more aware, and less afraid of mental illness, if there is more communication with families on the part of health professionals, more guidance and support for families and the hope for proper supportive housing, the future can be much more promising.

 

Trump’s Great Service to Americans – But Time To Go

By Dr David Laing Dawson

The unraveling of Donald Trump is nigh. And if it happens soon, and if the reaction he has provoked has staying power, then, surprisingly, Donald Trump will have performed a great service for America. Perhaps the reaction to Donald will bring about a better America.

Donald has brought to light the simmering racism, the unholy divide, and the hypocrisy that is America. It has always been there of course, addressed politely from time to time, but recently not so overtly, so publicly that it could not be ignored by others.

To be fair though, the credit probably goes equally to Barack Obama, for it may be this unusual sequence of a first black president, and a very good one, followed by a Donald Trump that so ignited the fires of white supremacists and then lifted the fog of denial from the eyes of liberals.

All of them, the KKK, the Nazis and neo-nazis, the white supremacists, they all quietly nursed their wounds and hatred during Obama’s eight years. Now Donald has set them free.

On Tuesday, August 15, off the teleprompter, peppered with questions, Donald Trump revealed Donald. He was of course full of himself, referring back to his successes, even to his riches, boasting of his holdings, taking credit for an improved economy, defending his first statement after the events in Charlottesville, even taking it from his pocket and reading it again, even shamelessly claiming he received praise from the mother of the woman killed.

He became combative with the press, calling them fake news, stating he is more attentive and truthful than they are.

But most of all this exchange revealed his brittle narcissism and the extent to which he cannot tolerate any criticism, any possibility that he may not be the smartest, the best, the most successful person in the room, that he may have been imperfect this one time. And it revealed how his ego overshadows any concept of country, democracy, history. Asked if he would visit Charlottesville he told us he owns a house and a golf course there, the biggest, thus demonstrating his confusion between being president of a democracy and the emperor of all he surveys.

And it gave us a hint of how mad (this word meant to be read both ways) he will become when he is finally cornered and dethroned.

Do it soon. Do it carefully. Do it with a safety net in place.

On Democracy

By Dr David Laing Dawson

In my childhood I took my birth certificate with me to sign up for a summer soccer league. Of course I lost it. There is a good chance I did not tell this to my parents. But three nights later we all responded to a knock on the door. Standing on the porch was a stocky man who proved to have a thick middle European accent and my birth certificate, a little grass stained.

I remember all this because he gave me a stern lecture about my birthright as a citizen in this democracy while I blushed under my father’s gaze. Although, in my defense it was either my father or my mother who allowed me to take this precious piece of paper on my bike ride to the soccer field in the first place.

Among many others I have been writing about the threat to democracy Donald Trump and his colleagues pose as they systematically undermine the Fourth Estate, the judiciary, instill unease in the citizens, point their fingers at immigrants, and undermine the people’s confidence in the electoral process.

But I did not think it would be so easy. Surely the very idea of free, regular, unfettered elections is sacrosanct in this American Democracy of which they are so proud.

Apparently not. A new poll finds that over 50 percent of Republicans would be quite happy to have the 2020 elections postponed if either Trump or the Republican Party suggested or requested this.

Wow. Should not their instinctive response be, “No way!”

So the groundwork has been laid. And apparently few Americans received the awakening I received in my childhood, a stern lecture from a man who escaped a tyranny, and who knew shortsightedness, indifference, and stupidity can lose a democracy but only bloodshed can regain it.

Fire and Fury

By Dr David Laing Dawson

Some years ago the person who oversaw both the men’s and women’s shelters in this city expressed his surprise that far more actual physical fights broke out in the women’s shelter than in the men’s.

But it did make perfect sense after we discussed it.

Some irritation would occur, expected when living on top of one another, and a man would verbally insult another man. Then a pattern of behaviour would unfold that was learned on the playgrounds of every public school, playing field and back alley, one that probably has genetic roots we can observe with our cousins, the apes and chimpanzees.

“Yeah, and who’s gonna make me?”

“You and who’s army?”

Chin thrust forward, the baring of teeth, the snarl, the threatened encroachment on the other’s space, insulting the other’s sexuality, his courage, his birth, his mother, name calling, dire threats for the future, the unfurling of plumage.

Other men (boys) would intervene pulling the two apart as they hurled their last insults at one another. Their assuaging words were always of the order of, “He ain’t worth it.”

This last part is important, for it is face saving for both antagonists. And an actual fight is averted. Life goes on.

In the women’s shelter, one would insult the other, and the recipient of the insult would hurl herself at the antagonist. They had not experienced the same playground socialization.

I am thinking about this because of Kim Jong Un and Donald Trump and the way war begins, and even those words of Tillerson and others, “It’s the only language Kim Jong Un understands.”

No. No. No.

Tillerson, your job is to put your arm around Donald Trump, pull him aside and say, “He ain’t worth it.”

Maybe no one can do that with Kim.

It doesn’t matter. All that matters is that one of the protagonists, these blustering would-be alpha males, especially the stronger of the two, gets pulled back.

“Donald, he ain’t worth it.”

Now if American leadership really was smart and confident, it could offer Kim some face saving device. “But we will look weak,” American leadership will scream. This despite the fact they have the capacity to destroy the world and we all know it.

Tillerson, you appear mostly sane to me, and a man who understands a few things. It is your job to pull Trump aside and tell him, “He ain’t worth it. You could take him easy, but it ain’t worth it.”

And would it kill you to promise Kim that you will stop flying B 52’s over North Korea and stop practicing war in South Korea if he stops testing A bombs?