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Archive for June 1st, 2019

It’s Time to Let the Five Stages of Grief Die

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The actual five stages of grief were derived by Elisabeth Kübler-Ross from observing patients who were diagnosed with a terminal illness: the five stages were what she saw in their process of dealing with the fact of a terminal illness. That I had not realized. Ada McVean writes for McGill Office for Science and Society:

Denial. Anger. Bargaining. Depression. Acceptance.

This group of terms has become so ingrained in our cultural consciousness that almost anyone could tell you what they are: the five stages of grief.

Introduced to the world in the 1969 book On Death and Dying by Elisabeth Kübler-Ross, the Kübler-Ross model (sometimes called the DABDA model) surmises that there are sequential stages of various emotions that a patient goes through when diagnosed with a terminal illness, starting with denial and ending with acceptance.

Wait, did you think that the five stages of grief were experienced by the loved ones of a recently deceased person? So did I until researching this article! In reality Kübler-Ross developed her stage model after interviewing many individuals with life-threatening illnesses. It was only the experiences of these patients that she attempted to model.

While she was a psychiatry resident in New York, Kübler-Ross realized how little attention was paid by hospital staff to terminally ill patients, and how little medical knowledge there was regarding the psychological aspects besetting patients facing death. She worked extensively with terminally ill patients throughout her medical school career and continued to study and teach about such topics when she became a professor at the Pritzker School of Medicine.

Using these experiences Kübler-Ross wrote her now famous book outlining the DABDA model, citing her contact with ‘‘over two hundred dying patients’” as its basis. Now, she did write in On Death and Dying that, “family members undergo different stages of adjustment similar to the ones described for our patients,” but having a loved one diagnosed with a terminal illness is not the same as losing said loved one to death. The five stages of grief were never meant for the bereaved. That’s just how they’ve been applied again and again.

Putting aside that this model has been seriously misappropriated throughout the last few decades, it’s important to realize that from its conception, the Kübler-Ross model of grief was not based on empirical or systematic investigations. It was essentially “a collection of case studies in the form of conversations with dying patients.”

I asked our OSS colleague, Dr. Christopher Labos, to define case studies in one sentence, and he sent me this: “It’s a description of what happened to a single patient. It’s an anecdote.” As we are hopefully all aware by now, anecdotes are the lowest form of evidence. They cannot stand on their own. Kübler-Ross saw many patients and gathered many anecdotes, and then used them to create a scientific model that simply is not based on good evidence.

Since the publication of On Death and Dying, a few studies have attempted to test the stage theory’s validity empirically. Most of the results have found it lacking. This 1981 study looked at 193 individuals who had been widowed for various lengths of time. Their results indicate that “the stresses of widowhood persist for years after the spouse’s death; they do not confirm the existence of separate stages of adaptation.” Work by Bonnano in 2002 looked at 205 individuals before and after their spouses’ death, and found that only 11% followed the grief trajectory assumed to be “normal”.

Many of the studies whose findings do support the existence of a stage theory of grief have suffered from serious methodological problems. Take for example this 2007 study that examined 233 bereaved individuals. After its publication, several letters to the editor critiqued its design and findings, and the authors later undermined their own conclusions by suggesting relabeling and reconceptualizing the stages of grief.

Despite the lack of evidence to back up the Kübler-Ross stage theory of grief, its original birthplace, On Death and Dying, has been cited 15 509 times on Google Scholar at the time of writing. It has been applied to everything from the grief processes of those diagnosed with diseases like COPD or HIV, to the grief experienced by caregivers of those with dementia; patients who have amputations due to diabetes; doctors who receive low patient satisfaction scores or go through reduced resident work hours; even (and I am not making this up) the grief experienced by consumers after the iPhone 5 was a disappointment.

Why are we, scientists and the general public alike, so eager to believe in this non-evidence-based model?

Having experienced the sudden and tragic loss of my mother only six weeks ago, I can personally attest to the time following a loved one’s death being confusing, overwhelming and desperate. During such a harrowing time, narratives like the five stages of grief can bring immense direction and comfort to your life. Emotions like anger or even acceptance can feel inappropriate and having an outside force like the Kübler-Ross model affirm and validate your experience can really help you cope with your feelings.

To put it another way, “we are pattern-seeking, storytelling primates trying to make sense of an often chaotic and unpredictable world.” The narrative of the Kübler-Ross model reminds us that whatever we’re feeling now isn’t permanent. It essentially guides us through a difficult time and assures us that eventually we will reach acceptance and be OK. Assuming your experience lines up well with the five stages, you’re given a sense that you are managing your grief in the “right” way. That you’re doing well. But that’s exactly the problem.

Not everyone experiences grief in the same way. But in addition to dealing with the loss of their loved one, those whose experiences do not follow the Kübler-Ross model must contend with the idea that there is a right way to grieve and that they’re not following it.

The five stages model was meant as descriptive but has become prescriptive. Bereaved individuals can feel like there are certain reactions they should be having, and that they are somehow grieving wrong by not having them. There is no set pattern of emotions that  . . .

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Written by LeisureGuy

1 June 2019 at 11:42 am

Association v. cause & effect

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Written by LeisureGuy

1 June 2019 at 11:22 am

Posted in Science, Video

Measles for the 1%

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Lisa Miller has an interesting if somewhat depressing article in The Cut:

On an unseasonably chilly morning in May, three dozen or so plaintiff-parents, most of them from the Green Meadow Waldorf School, showed up at the Rockland County Courthouse, looking, in their draped layers and comfortable shoes, like any PTA from Park Slope or Berkeley. They were virtually vibrating with expectation and stress. For four long months, on behalf of their kids, they had been on the phone, sending off bullet-point emails, arranging meetings, coordinating calendars, and taking time off work, in an endless battle that had so far cost them hours of lost income and created child-care hassles — and made them into national pariahs besides. Today’s proceedings, they hoped, would result in a decision that might enable them to move on with their lives.

When legal arguments began, small smiles appeared on the parents’ faces. The opposition’s lawyer came off as clumsy, like an oversize actor fumbling his lines. Their lawyer, on the other hand, exuded a smooth confidence bordering on arrogance, an attitude that seemed to swell as he approached the lectern. Michael Sussman, 65 years old and educated at Harvard Law, is the most prominent civil-rights crusader in the Hudson Valley, having made his mark at 30, while working for the NAACP, when he helped to desegregate the Yonkers public schools. Now Sussman, who happened to have sent his own seven children and stepchildren to Waldorf schools, was defending his clients against the intrusion of local politicians into their personal decisions and private lives.

As he stood before the judge, Sussman’s voice rose in a slow crescendo. Recent actions by Rockland County against his clients were “infuriating,” he said; they pandered to biased constituencies and were rooted in “fundamental hysteria.” And then he roared. “Executive authority has its limits!” The parents were as still as forest animals, riveted. Their lawyer was articulating what they fervently believed: that even amid the biggest outbreak of measles in the United States since 1994 — with 200 cases in Rockland County, their own backyard — it was their right as citizens not to vaccinate their kids. This conviction had become for them a matter of conscience and principle. Most had kept their kids out of school for almost half the year rather than take them to the pediatrician for a shot.

If you live among or near certain quarters of the progressive left, among the art and fashion and tech elites who shop at farmers’ markets and worry about toxins in the air and water and believe that hiring a doula may gentle today’s medical-industrial approach to giving birth, then you have probably heard of Waldorf schools. Perhaps you have friends whose children go to one, or perhaps you’ve yearned for such a community for your own, knowing that Waldorf signals a countercultural wholesomeness, a respite from the onslaught of modern forces you’re pretty sure aren’t good for kids: the wide-open access to violence, snark, and pornography available with every Wi-Fi connection; the birthday-party goody bags stuffed with plastic crap; the stress and anxiety you see on very young children already worried about how they’ll do on the test. If you are the kind of person who sees self-interested, app-driven American capitalism as a threat to the preciousness of childhood and to a durable, intimate family life, then you are, at least conceptually, in Waldorf’s prospective audience. Waldorf parents, many of whom are themselves deluged by busyness and stress, agree that they will expose their children to no technology — none, including television, movies, and recorded music, even on long car rides — until middle school. The parents who work at Apple, Google, and Hewlett-Packard and send their kids to the Waldorf School of the Peninsula, in Menlo Park, California, endorse these limits with psychic relief — they know too well what their kids need protection from.

Waldorf pioneered this off-piste approach to raising kids, but it does not have a monopoly on the many ways liberal parents try to circumvent the institutionalized options that dominate the public-school system: “free” schools; home-school collectives; schools boasting “child-centered learning”; mountain, backcountry, or farming schools. There are about 300 Waldorf and Waldorf-inspired institutions in the U.S. (and more than 3,000 worldwide). Each offers an arts-based curriculum in which children are encouraged to play outdoors, use their imaginations, and think for themselves. In Waldorf schools, children become proficient at knitting and sewing, gardening and painting. Waldorf kids know how to juggle at young ages and to bind books by hand as teenagers. No one wastes a precious minute prepping for or taking a standardized test, because everyone on a Waldorf campus agrees that children are far more than brains to be filled, unreflectively, with meaningless facts and that real learning happens when the body — and the soul — are engaged as well.

Overwhelmingly white, affluent, and well educated, Waldorf parents identify as cultural creatives and nonconformists. Satisfied families describe their Waldorf kids as puppyish, freewheeling Pippi Longstocking types who grow up into intellectually curious, competent, self-confident people who thrive, as Sussman boasts his own children have done, at Wesleyan and Swarthmore and Oxford, working as videographers, nature illustrators, and the builders of nonprofits. Eric Utne, founder of The Utne Reader, that alternative digest for the left, sent his four sons to Waldorf schools; when he stopped running his magazine in 2000, he became a Waldorf teacher himself. Utne loves Waldorf for its “unhurried” approach to childhood. The schools represent the progressive counterargument to the vaunted “early reading” programs of public schools, which start drilling kids on vowel sounds in pre-K. According to Waldorf’s pedagogy, kids don’t read until they’re 7 or 8 years old, and because they’re not forced or rushed into it, they embrace literature with natural interest and hunger, Utne told me. He has seen third-graders devouring Plato and the fantasy series Dune.

Across the country, in every state, great numbers of these specially nurtured children remain unvaccinated. Apart from certain religious or ethnic groups particular to certain geographic regions — pockets of the ultra-Orthodox in Brooklyn and Rockland, say, or pockets of the survivalist right — Waldorf kids have some of the lowest vaccination rates in America. In California, Waldorf schools, along with home schools, have some of the lowest vaccination rates — many as low as 20 or 30 percent, and some as low as 7 percent. The Brooklyn Waldorf school has the ninth-lowest vaccination rate in Kings County, and in Manhattan, the Rudolf Steiner Waldorf school is No. 7. At the start of the school year in 2018, Green Meadow had the third-lowest vaccination rate in Rockland County after two yeshivas in Monsey. “All the Waldorf schools are horrible,” says Peter Hotez, co-director of the Texas Children’s Hospital Center for Vaccine Development. “There are several in Texas I would not consider safe for children.”

All states require kids to prove they’ve received a full schedule of vaccinations before they enter school. But a large majority of them, 47, also offer exemptions to parents who say their religious or spiritual beliefs prohibit vaccination, granting them a kind of “conscientious objector” status. And 16 states offer a broader “philosophical” exemption to those who wish to refuse vaccines on secular but moral grounds. Objectors have typically been members of very conservative or fringe sects who believe, for example, in the healing power of prayer or, as in the case of Christian Science, the ability of the mind to resist disease. The Amish have often opposed vaccination, and certain Muslim groups, especially those originating in Nigeria, Pakistan, and Afghanistan but also the Nation of Islam, have regarded vaccination as a malevolent government conspiracy. Segments of the Dutch Reformed Church see vaccines as impeding a person’s divine destiny.

In recent years, the number of parents seeking religious and philosophical vaccine exemptions has grown, and it is increasing little by little every year. Jews, including ultra-Orthodox groups, have traditionally accepted vaccination, but as this year’s outbreak in and around New York City shows, that is changing. Fears of vaccines causing autism persist, but that is only one thread of the story. A second thread, Hotez believes, is predatory peddlers of disinformation targeting especially vulnerable communities in order to market alternative therapies. But the phenomenon is much more expansive than even that. In the 2017–18 school year, 7,044 kindergartners in Texas had nonmedical exemptions. There were 3,344 in Washington State; 3,427 in Oregon; 4,753 in Michigan; and approximately 2,000 each in New Jersey and New York. But the number of unvaccinated children in the U.S., though small, has risen significantly in the past year. According to the CDC, the percentage of unvaccinated children increased from 0.8 percent in 2016 to 1.1 percent in 2017. These three tiny decimal points represent a huge increase to about 63,555 unvaccinated kids a year. And vaccination refusal is a contagion, like the measles. People who don’t vaccinate their children tend to live among people who also don’t vaccinate their children.

How and when did liberal parents travel so far from Dr. Spock? The measles vaccine was approved in 1963, six years before Americans landed on the Moon, at a moment when technological progress was a joyride Americans took en masse. But in one generation, the kids of those Spock-raised kids have seemingly lost faith in progress and in the wisdom of the conventional wisdom, regarding every figure along that formerly congenial hierarchy — the scientists, the pharmaceutical companies, the government approvers, the politicians, even the wise and gentle pediatricians — as an object of suspicion and a plausible agent of the systemic harm that is being done, unconscionably, to kids. And in place of faith in experts, they have developed an alternative parenting culture built on anxiety about all the ills that might befall children (sickness, damage, death) and a sense that they, and only they, know how to protect the specialness, and purity, of their kids. To preserve that sanctity, parents have to begin to regard the material world — everything from movies to memes to vaccines — as contaminating. In some circles, at least, liberal American parents have evolved from emulating the Jetsons to emulating the Amish in one generation, always with the insistence that they’re doing it for the kids.

n almost every Waldorf kindergarten, the walls are pink. Not just a flat hardware-store pink but a dappled, translucent, rosy pink. Rudolf Steiner, the Austrian intellectual who started the first Waldorf school in Stuttgart in 1919, called the method of application Lasur, German for “glaze.” According to Steiner’s color theory (derived from Goethe, whom he admired), kindergarten walls ought to be comforting but not confining, so a child can feel that the boundary between indoors and outdoors is in some sense permeable. The décor in a Waldorf kindergarten is prescribed as well. It looks domestic but intentional, like Little House on the Prairie went to Stockholm on vacation. There are usually curtains, also pink or red, and a table where items from the natural world are displayed: a vase of flowers, a handful of seashells, leaves, rocks. There may be a kitchen. Housework — including sweeping, gardening, baking, and darning — is a regular part of every day.

Every toy in a Waldorf kindergarten is constructed from natural materials. The tea set, including the cups and saucers, is carved of wood, and the stuffed kitties are knitted wool. Waldorf cloth dolls, famously, wear no facial expression, so children can feel free to impose their own ideas of mood and character on their make-believe games instead of receiving cues from a mass manufacturer. A Waldorf kindergarten is also stocked with ordinary objects — blocks, scarves, bits of yarn — that children can use to build their imaginary worlds. “Anything can be anything” is what Waldorf teachers say.

“My son can knit, he can sew, he can light fires, he can forage,” says Susanne Madden, a small-business owner with a first-grader at Green Meadow. “If the zombie apocalypse were tomorrow, he will be fine, but the kid next door, who’s on his iPad all the time, he won’t. My child is not in the grind, he has no anxiety, he’s not being dragged from place to place. He’ll happily play with two sticks, two stones, and a hedge.”

Madden picked up a pamphlet advertising Green Meadow at a farmers’ market. She went to school in Ireland, and her husband is Irish, and when their child was born, they realized they wanted something more nurturing than a conventional public school. They visited Green Meadow and felt right at home. Although Waldorf schools have tried to adapt to the modern world, they retain an antiquated, mystical, European feel: With its low buildings and wooden bridges set in a grassy dell, Green Meadow looks as if its architects had been hobbits. In the early grades, kids are taught fables, myths, and fairy tales — often from the Brothers Grimm and other children’s stories popular in Steiner’s day — which they are expected to memorize. As soon as they are able, they copy the stories they’ve memorized into blank books in their best cursive writing, eventually using fountain pens, and illustrate them, so by the end of the year each child has made what amounts to an illuminated manuscript. Math is taught through games with little faceless gnome toys — like Smurfs or trolls, if they were made by hand and sold at craft fairs. Every Waldorf child learns to play a special wooden recorder, called a pentatonic flute, and, even in high school, to dance, in broad, careful motions, sometimes waving silk scarves or toy swords, according to a choreography Steiner invented called “eurythmy.” Each fall, most Waldorf communities gather to celebrate Michaelmas with a pageant that enacts the story of St. George slaying the dragon. In Waldorf performances, he merely “tames” it.

Steiner developed his belief system (which Waldorf people call “a spiritual philosophy”), known as “anthroposophy,” after having personal experiences in which he spoke with the dead and had visions in which he saw the plans of the gods. Although Waldorf schools say they’re secular and no teacher ever explicitly instructs children in the tenets of Steiner’s philosophy, this system does form the basis of Waldorf education, as the schools acknowledge: According to an FAQ on the website of the Association of Waldorf Schools in North America, “Waldorf education … has its foundations in anthroposophy.”

Of course, very few Green Meadow parents officially identify as anthroposophists. Indeed, most admit, laughing, that they can’t even pronounce the word, and while some dabble in the study groups offered by expert faculty after school, more of them say they’ve attempted to read Steiner and found him incomprehensible. But through osmosis or proximity almost all have come into contact with anthroposophy’s core belief, which they regard with varying degrees of skepticism: Reincarnation and karma are real, and each child is born to particular parents to fulfill a particular destiny.

When Steiner started his Waldorf school, vaccines for tetanus, diphtheria, and whooping cough were less than a decade away, and the mystic — watching scientific progress and the rise of industrial-era materialism with a wary eye — warned that vaccination could impede proper spiritual development and “make people lose any urge for a spiritual life.” Without the right interventions, Steiner thought, a person receiving a vaccine could sustain damage that would carry into a subsequent life.

The job of the teacher, then, is a sacred one: to guide children through the stages of childhood with wisdom and gentleness so that each child may attain the freedom, competence, and curiosity to fulfill his or her destiny. Steiner followers say children younger than 7 especially need a low-stress environment, marked by gentle, comforting domestic routines, because they are still partially connected to the spirit world. At age 7 (after they lose, in Waldorf parlance, their “milk teeth”), children come “awake,” which is why the third-grade classrooms are painted orange-yellow and why it’s the right time to teach the kids to read. Fourteen to 21 is a time of  . . .

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Written by LeisureGuy

1 June 2019 at 9:57 am

Shaving sequences series: 89, 90—and the apotheosis of the Edwin Jagger DE89

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This SOTD post goes out to Danny T, who (like me) has found Nancy Boy Signature Shave Cream to be wonderful—and (he writes) Nancy Boy Sandalwood Shave Cream (which I’ve not tried yet) may soon be accompanied by a Nancy Boy Sandalwood aftershave splash.

The little Maggard synthetic made a great lather from Nancy Boy Signature Shave Cream, which is not only my favorite shave cream but makes one of my favorite lathers. If you’ve not tried this, you should. Not, as they say, sold in stores and not even advertised save by word of mouth. You won’t regret it.

The razor is new: the RazoRock MJ-90A, which is CNC milled. I presume the “90” is because this is the next (higher) step after the Edwin Jagger DE89. Let me quote from the product description:

1) Materials: Instead of low-quality zinc-alloy (Zamak/pot metal), we used aircraft aluminum block for the head and 316L stainless steel rod for the handle.

2) Build: Instead of cheap, non-precise stamping/casting, we have built the razor using precision CNC milling, both for the head and handle. The tolerances are superior to the DE89.

3) Design: Instead of having the blade tabs exposed, we have milled the tolerances of the guideposts to precisely hold the blade with very little blade play, meaning the blade tabs can be covered, protecting your precious ear lobes 🙂

4) Longevity: The DE89 is well known for its threaded post snapping off. Why? Because it uses cheap pot metal and because it’s post is spot welded on. Drop it from 12-18 inches and the post breaks off into the handle rendering your $40-45 razor useless and ready for the landfill. We completely milled the top cap from a block of aircraft aluminum, meaning the top cap is one solid piece, no broken posts here!

5) Handle: Instead of using a hollow cheap handle, we have milled our handle from solid 316L marine-grade stainless steel and hand polished it. We have also milled in our RazoRock Halo rings for extreme grip and comfort!

6) Price: Even though we made all the necessary improvements above, it sells for only $29.99! How does this even make sense when the competition is selling a far inferior product for $35-60? I’ll leave that with you to ponder 🙂

Technology evolves quite rapidly, and this razor fits the mantra “Faster, Better, Cheaper” familiar from the computer industry. The handle is noticeably heavier than the head, but as you will remember from the Guide:

The rule for razor handles, I’ve discovered, is that a heavier handle generally improves the feel of the razor, but a lighter handle can make the razor feel top-heavy and awkward. For example, I tried an Edwin Jagger DE86bl (faux-ebony handle) handle with the Shavecraft #102 slant head, and it didn’t feel right at all. In contrast, with the #102 head a Maggard stainless steel handle or an iKon Bulldog or OSS handle works fine because the heavier handle balances the head nicely.

A heavy handle puts the center of mass down in the handle, and the razor feels agile; a light handle puts the center of mass toward (or even in) the head, making the razor feel unbalanced and head-heavy.

A UFO aluminum bronze handle, fairly hefty at 95g, was quite comfortable with the Standard head—the razor felt even better than with its original (Standard) handle, made of aluminum and weighing 31g.

As the title notes, this razor is indeed the apotheosis of the Edwin Jagger DE89. And it shaved superbly. It’s a keeper.

A splash of Floris No. 89 finished the job. What a great way to start the weekend!

 

Written by LeisureGuy

1 June 2019 at 8:22 am

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