The Passing of Henry Gustav Molaison

"He left a legacy in science that cannot be erased." - New York Times, December 5, 2008.

Known to the world as H.M., Molaison spent the better part of 50 years under the scrutiny of scientists. Thankfully, it was beyond his ability to remember the indignity of such an existence. Molaison suffered from a type of anterograde amnesia as the result of an experimental brain surgery in 1953, and was unable to create new long-term episodic memories.

Molaison's unique impairment fueled the development of the field of cognitive neuroscience. Unlike other patients with traumatic brain injury, Molaison's brain damage had been surgically induced in an attempt to alleviate seizures. The unexpected memory impairment he also suffered as a result of the surgery provided some of the first clues as to the neuroscience of memory, the different types of memory, and memory encoding and retrieval processes.

His impairment left him unable to hold a job, and following the surgery (at age 27) he did not or could not live alone. As Molaison was cut off from the one cognitive function that enables us to learn, reflect, grow and make judgments, it is hard to know exactly how he felt about his life as the object of intense research. Was it a life he would have chosen for himself had he the capacity to remember even a year of such an existence?

Caught in a perpetual 'now', Molaison was at the mercy of the intentions of others. What informed consent he was able to give for his participation in the ongoing series of studies was limited to his feelings and perceptions at the moment. While his participation is these studies undoubtedly made a profound contribution to the field of cognitive neuroscience, reading his obituary in the New York Times left me pondering what principles guided the decisions about his participation. Can any of us say we would have chosen his life if we retained the ability to remember each day as a test subject? Is the argument then that he did not suffer because he was unable to remember the endless series of tasks in which his role may have been more akin to that of a lab rat than an equal collaborative partner?

Molaison's obituary alternatively refers to him as 'Mr. Molaison' and 'H.M.', in roughly equal measure. 'H.M.' was his identity in the community of science. Myself a student of memory, I did not know his given name until today. Was his status as a person somehow diminished by the reduction of his attributes to a set of data that bore the label 'H.M.'? Was this level of impersonalization necessary for the scientific enterprise to operate in an unbiased manner, or did it create and fuel an atmosphere that permitted Molaison to be unnecessarily objectified?

We live in an era that is increasingly concerned with issues of cognitive liberty (and rightfully so), and we must make sure that cognitive differences become neither an excuse to dehumanize, nor exploit any individual. Sovereignty of self should not be limited by how a person thinks. When we choose what another should experience, or how they should spend their time, we are shaping the future state of their brain and mind. This is nowhere more apparent than in the experience of parenting, but it applies as well to those who bears the responsibility of care for a person who is cognitively impaired. The impact of a single event may be greatly reduced in a person with certain cognitive impairments, or it may be greatly exaggerated. Therefore there is no catch-all answer as to the best way to ensure that such a person's sovereignty is held in responsible trust by its guardians. As a society, we are beginning to make inroads in recognizing these issues, and they require our ongoing willingness to tackle questions about individual identity and autonomy, such as those faced by Molaison, and the larger questions about how we treat those whose internal experience we can only begin to understand.

The Perils of Maverickhood

(I'm cleaning out the files. As it is no longer election season, I can post this and still be politically neutral.)

Maverick: " ... a bullock or heifer that has not been branded, and is unclaimed or wild; -- said to be from Maverick, the name of a cattle owner in Texas who neglected to brand his cattle."

I used to like the word 'maverick'. "Has not been branded... unclaimed ... wild" has a mystique to it that's hard to beat. But it really just means 'fell through the cracks', and/or 'got away when no one was looking'. And while 'wild' and 'unclaimed' are now synonymous with 'rebel' and 'independent', the word 'maverick' doesn't mean that you are particularly good at anything, or that you are superior to those who didn't escape the branding process. It doesn't even mean that you had to fight to escape being branded.

But somewhere along the way the idea of a 'maverick' began to evoke connotations of competence and effectiveness, presumably because being outside/above/beyond 'the system' meant a greater freedom to act in a way that could accomplish the desired (presumably good) ends. This certainly seems to be what we are supposed to think when we hear certain persons self-label as 'mavericks'. But "a person who thinks independently; a lone dissenter; a non-conformist or rebel" must be able to function within any system s/he hopes to influence. This holds true for the systems of science, as well as those of politics. While both systems benefit from people who aren't afraid to voice a new or unpopular opinion, the mantle of maverickhood sets a person upon a perilous path.

The perils of maverickhood are these...

1) Using 'non-conformity' as a shield for ineptitude and/or failure to understand the mainstream positions, or simply as a strategy to win attention.

2) Thinking that when/if you win points for independent thinking, the game gets easier. In reality, it gets harder.

3) Assuming that validated independent thinking in one area means that your wisdom in all areas is superior.

4) Assuming that having been noticed for rogue thought or action means that all of your subsequent thoughts/actions must be equally rogue in nature. After all, you have a reputation to maintain.

5) Listening to people who, when you successfully rebel and accomplish one thing, often expect that you can accomplish many more things that fall outside of your area(s) of expertise. (If you're smart, you don't lose your perspective. If not...)

(Interestingly enough, the use of the word 'maverick' by certain high-profile persons dropped off sharply just after I wrote (but did not post) this. Perhaps the incredulity was more widespread...)

The next time you hear or are tempted to use the word 'maverick', remember that it really just means 'got away when no one was looking.' ;)

On Thankfulness

"All our discontents about what we want appeared to spring from the want of thankfulness for what we have."

It's difficult to find something new to say on this topic. So instead I'll tell this story...

Thanksgiving has been a 'portable' holiday for me for quite some years now. I've often been far from family at Thanksgiving, and unable to make it home for this holiday. Rather than forgo the celebration of Thanksgiving altogether, I've attempted to celebrate it with friends wherever I happen to be living. This has left me with a wonderful collection of memories.

It's a different celebration every year, depending on where I'm living and who is available. Occasionally I've been invited to spend Thanksgiving with a friend's family, but some of the best memories are those where a group of friends came together to create our own Thanksgiving. One year all the friends were travelling to be with family, so we held Practice Thanksgiving Dinner the weekend before Thanksgiving. Another year a different group of friends held Thanksgiving dinner at the apartment of a recently-divorced friend, and spent the latter part of Thanksgiving Day shopping for all new Christmas decorations for her. One of the best memories is from one of the first times I spent Thanksgiving away from family, and with my friend Jimmy. Neither of us had much experience making Thanksgiving dinner, but we went at it with much gusto, from shopping for the food to decorating the table, and had a wonderful time.

If it sounds like I'm missing the point about Thanksgiving, rest assured that thankfulness is multiplied when it is celebrated with others. Each of these events created stronger bonds of friendship for which I am still thankful, though over the years I've lost touch with some of these people. For a time we were important to each other, and we gave thanks and celebrated that together.

A few days ago I won a turkey, and though I already have plans for Thanksgiving Day, I couldn't help but try to use that turkey as an excuse to catalyze another group of friends to come together for a dinner. Not really enough notice to pull off a whole holiday dinner, but I had to try. So this year I think there will be a 'Meat and Greet' event wherein the cooking of the turkey and the distribution of the meat will be cause for a get-together.

And speaking of events, I'd better get moving! Happy Thanksgiving!

A Welfare Magnet

"[Our Fair State] is more attractive to low income individuals than high wage earners." - cited today in local newspaper.

Not long ago I ranted about people who take advantage of state-funded health insurance. Since that post, I have heard other stories that make me crazy in that special way I get crazy when I hear you say that it's someone else's responsibility to take care of you. If you don't pay for your own health insurance, food, and daycare, then you have no business spending money on cable and high-speed internet.

And now a recent study conducted at Princeton University pegs Our Fair State as a state where the people who fund such attractive (and, apparently, easily-obtainable) welfare programs (with substantially higher benefit levels than those of neighboring states) are leaving the state, while those who drain those resources are flocking to it. Apparently this isn't news, as a 'welfare migration' to our Our Fair State from Neighboring Large City was reported over a decade ago in the New York Times.

Our Fair State is also facing a $5 billion dollar budget deficit. So what is the solution?

1) Cut benefits. If you are able to work, then it is your responsibility to support yourself and your children. It won't necessarily be pleasant, but you are also entitled to start your own business doing whatever it is that you want to do. Non-custodial parents with child support obligations should be last on the list to receive certain benefits (or not on it at all) if they are able to work but simply choose not to do so. Unemployment or underemployment should not be attractive in any way to a person with children to support. If you have screwed around with your life and have a lousy employment history, then accept the fact that you will have to work at less than desirable jobs to repair that history until you can get hired for a more satisfactory position. You are not too good to work at McDonald's, and you are not too good to work two or more jobs at the same time.

I've heard people complain that if they make more money, their benefits go down and that money is gone anyway, or they end up with a net loss when the benefits are taken away. (Yes, that's you with the cable and high-speed internet.) The problem with that line of reasoning is that it's not the state's responsibility to feed your children, enable you to put them in daycare, and pay for your health insurance when you are perfectly capable of paying for these things yourself.

Our Fair State has higher benefit level than most of the neighboring states. We also have one of the highest rates of migration of lower-income individuals into our state. Whether the goal is to stop the influx of a potential drain on Our Fair State's resources, or to reduce the existing state budget deficit, it makes sense to bring our state's benefit levels in line with those of neighboring states with similar costs of living by cutting benefits.

2) Tighten residency restrictions on who is eligible for benefits. If there can be a two-year residency requirement (wherein you are not a student) in order to receive in-state tuition at public universities, then there can be a two-year residency requirement (wherein you are not unemployed) in order to qualify for certain welfare benefits, such as food stamps and state-sponsored health insurance.

We complain that Our Fair State loses too many of its best college graduates upon graduation. If retention of individuals who contribute more positively to the tax base is a goal, then perhaps in-state tuition at public universities could be traded for a residency requirement to be fulfilled after graduation.

3) Make working a more attractive option than not working.

Apparently Our Fair State has one of the most generous state earned income tax credit programs in the United States. This is a refundable tax credit that is available even to those who owe no taxes. The credit has three 'phases', which describe how the credit is calculated based on differing levels of qualifying incomes. One you hit a certain point within the qualifying income range, your tax credit begins to shrink. This tax credit can represent a significant amount of money, but it is not counted as income when judging eligibility for food stamps or low income housing. It is also possible to receive advance payments of your projected credit during the year.

So how about increasing EIC qualifying income ranges to allow the working taxpayer to take home more money, while decreasing the benefits available in programs, such as food stamps, that do not require or promote employment as a condition of assistance? How about adding new rules for obtaining EIC that stipulate higher payments and/or higher upper income limits for those who pay their own health care and daycare costs?

If handled correctly, these ideas might put barriers in place that stem the tide of welfare migrants (and their associated costs) into Our Fair State, and reform the existing system of payouts so that it's impossible to have so much 'assistance' that you can also afford to have cable and high-speed internet.

Democracy in Action

"The best weapon of a dictatorship is secrecy, but the best weapon of a democracy should be the weapon of openness."

Ow. Ow.

This is me, the day after I voted about a hundred times. Yep, I spent a good 13 hours yesterday going through the voting process again and again. And again.

In my assigned district, approximately one-third of the eligible voters chose to cast an absentee ballot. And all of those absentee ballots had to processed on Election Day, at the district polling place. So my job as a poll worker was to run the 'voting loop' processing those ballots. All day long, and for another hour after the polls closed.

Here's the 'voting loop' for absentee ballots...

1) Pick up voter number tickets. (From the guy at the head of the line of voters. People were quite generous to us polls workers who repeatedly held up various lines in order to process absentee ballots.)

2) Open and inspect absentee ballots. (Ballots that were filled out in crayon, for example, would need to be remade, as the optical scanners cannot read crayon.)

3) Stand in line to register absentee ballots in the books. (In case the voter tries to vote in person on Election Day. Actually, if the voter shows up in person before his/her absentee ballot is processed, s/he can vote in person and the absentee ballot will not be processed. If the absentee ballot has already been processed, the voter cannot vote again in person.)

4) Run ballots through tabulator. Turn in very precious voter number tickets. (Big headaches if voter number ticket is lost.)

The entire day went surprisingly smoothly. Props to the City Clerk! Props also to the judges in Our Fair State who threw out the lawsuit brought by Our Elected Official that could have made the day much more tense and chaotic. We had only one poll observer of note, whom I christened (in my head) Tightly Wound, and while he was a noticeable presence, he obeyed the rules governing poll observers. It was almost anticlimactic, but in a good way.

All in all I spent 15 1/2 hours at the polls yesterday. By the time I got home and took a shower, McCain was making his concession speech. By the time Obama gave his speech, I was asleep. (Sorry to have missed it, but didn't sleep much the night before and had to be back at work today.)

Here are a few other observations from yesterday...

• Our fearless section leader, Mr. Bob, rocks! A pleasure working with you, sir!
• Poll workers were almost entirely over the age of 55, excepting a small group of high school students. There were just a few of us between the ages of 18-55.
• A body in motion should stay in motion. Seriously, if you have been in motion for four hours, don't sit down for lunch (even for 15 minutes) if you are going to have to be in motion for another 9 hours.
• The fatigued brain is an amazing thing. The output can bear absolutely no resemblance to the input. (This is why we worked in pairs.)
• 'No Sleep Til Brooklyn' makes absolutely no sense, given the context, yet is readily adopted by the aforementioned fatigued brain as a mantra.
• Everybody worries that they are going to be the one to make some hideous mistake while working. (Including me. Hence the no sleep the night before.) I was amazed at how many of the poll workers were working for the first time, and confessed to being kept awake by this fear.

It was a great experience. I'm glad I did it. I'd gladly do it again.

Subsidizing Stupidity

Avert your eyes; I am about to rant.

Universal health care is one of those ideas that makes its supporters feel wonderfully egalitarian. Nice warm fuzzies all around. To be sure, it is perilous to be without health care in this country, and for those with genuine medical need, receiving competent medical care should not come only at the price of bankruptcy.

But health care is a responsibility, not a right. People who insist on treating it as a right instead of a responsibility are part of the reason why we have a broken health care system. I know some of these people, and the following rant is directed at one of them in particular.

I know you think otherwise, but guess what? You are not entitled to my tax dollars to pay for your emergency room visit if you...

1) think energy drinks, coffee, and doubleshot espressos are an adequate substitute for food, and

2) have previously had heart palpitations while on a diet heavy in the aforementioned liquids, and

3) are currently having heart palpitations while on a diet heavy in the aforementioned liquids.


You are entitled to...

1) modify your diet to exclude the offending beverages. (Ideally you would have done this the last time you had this problem. Or the time before that.)

2) lay down until your heart stops racing. (Breathe deeply while you're at it.)

3) pay for your own emergency room visit and extensive testing. (The end result? You have a sensitivity to caffeine. Shocking.)

You wouldn't presume to come to me and ask me for money for that emergency room visit. (Actually, knowing you, I take that back.) Yet somehow because my money was separated from me via the mysterious process called 'taxes', funnelled around by this thing called 'government' into something called 'state-sponsored health insurance for the uninsured', you feel entitled to run to the doctor at the drop of a hat.

Thankfully, I have private health insurance at the moment, though there were several years when I went without insurance altogether. As a participant in private health care, I realize that the number of doctor visits I clock in a year is reflected in the premiums that everyone who participates in my plan pays. Unfair though it may be, we all pay for the poor health choices of those with whom we share insurance. Sadly, this seems not to elicit a spirit of cooperation that would collectively lower our premiums, but rather a 'I'm gettin' mine' attitude. And now I have to watch this attitude suck up tax dollars.

I have watched you and yours run to urgent care centers simply because they are there and you could. My tax dollars paid for it. In most cases it was not medically necessary that the condition be treated immediately, rather than waiting for a regular doctor's appointment. If you had had to pay for the visit, you would have 1) known the difference in cost between an urgent care visit and a regular office visit, and 2) exercised some basic common sense before seeking medical treatment. But because insurance is paying for it (and possibly compounded by the fact that you are not paying for the insurance), all considerations of cost go out the window.

Our health care system is broken in part because we are not responsible medical consumers. We live much less healthy lives compared to the people in other countries where universal health care is provided, despite adequate education on health and nutrition. Sickness is something we flaunt to one another, perhaps because it gives permission for sympathy to be extended to us. An office visit with a doctor is no longer the option of last resort for many common ailments, but rather a 'necessary' validation of common sense. Of all the reasons I hear for the high cost of health care, the one thing I never hear discussed is excessive and unnecessary use of the system. Perhaps this isn't a large factor in the price of health care, but it's a damn annoying one to have to witness.

Health care is a responsibility that starts with the individual, not the doctor. As such, it is irresponsible to expect others to absorb the cost of your poor health choices. Here's an idea - If 9 out of 10 doctors would agree that your predicament/visit was 1) unnecessary, and/or 2) the result of blatant stupidity on your part, you shouldn't expect health insurance - private or public - to pay for it.

Hello Election Official

"Hundreds of thousands of Americans, working at polling places across the country, make elections happen. Theirs is not merely noble work. It is the essential work of democracy." - editorial in local paper

Okay, I'm preening just a little bit.

I got my official letter today for my assignment as a poll worker in the upcoming election. My curiosity has gotten the better of me yet again. For some dubious reason, Our Fair State has been targeted by "partisan operators... who seek to create confusion at polling places." The details of the shady tactic being employed at this late hour aren't completely clear to me, but experts agree that this action will create "unnecessary hardship and confusion at the polls, and at worst, the disenfranchisement of [Our Fair State] citizens with a clear and legitimate right to vote." Voting can be quite a time-consuming process as it is, especially when voter turnout is expected to exceed 90% in a national election. What justifies making this process harder for the average voter?

In addition to being curious, I'm also a bit irked. The more I look into this, the more it smacks of a politically-motivated, partisan action by an elected official who is supposed to serve the citizens of Our Fair State. You'll excuse me if I find it hard to believe that "the stakes are enormously high", as alleged by Our Elected Official. I likewise find it hard to believe that "properly qualified voters are at risk of having their votes diminished and diluted by the votes of unqualified, ineligible voters". One presumes that Our Elected Official would back up such an allegation with evidence of the possibility of such a 'dilution'. Surely there should be evidence that such a heinous thing might actually occur if one is planning to unleash chaos at the polls. The only cited statistic in the original petition is an alleged approximation of a 22% discrepancy rate that will be found in voter registration applications. Of those discrepancies, there is no mention of what percentage would indicate an ineligible voter who actually turns up and votes thereby diluting the votes of 'properly qualified voters'. No one reasonably suspects that this is a high percentage. Oh, and did I mention that Our Elected Official was/is a "co-chairman of Republican presidential candidate John McCain’s [Our Fair State] campaign." Do you hear a voice in your head screaming 'conflict of interest'? (Yeah, I'm probably not completely 'politically neutral' right about now, but this is about messing with the democratic process.)

I agree with my compatriots that the "ultimate protection for democracy comes... from the people, who the founders of this revolutionary republic entrusted to zealously defend the electoral processes... And the single best way to mount that defense is to become a poll worker." Where else would you want to be, if not the front lines?

We'll see if my zeal can make it through a 16+ hour day as a poll worker.