“A lie told often enough becomes the truth,” said Lenin.

But what happens to the truth when it’s repeated often enough?

The first time someone said, “Smile and the world smiles with you, cry and you cry alone,” the words must have had quite an impact. The freshness of the phrasing, the newness of the thought must have been profound, quite capable of inducing an epidemic of epiphanies.

But now, years later, the words have become worn and tired from overuse.

The internet, by its capacity to repeat lies often and loudly, catalyzes the transformation of lies into truth. But in some kind of reverse alchemy, the internet also transforms truth into cliche - profound statements transformed into blog posts, then viral emails, before finding their way into the mainstream media, and public consciousness, after which, it’s only a short ride into a hallmark card.

So, here it is then, Mr Lenin: “A truth told often enough becomes a cliché.”

The same place can look lively when you feel good, crowded when you are tired, hostile when you feel threatened, and welcoming when you are secure.

Our feelings about the world reveal as much about ourselves as they do about the world.

A post from my Medscape blog for psychiatrists:

I just read a story on MSNBC about grammar vigilantes. The story says that those who are sticklers about grammar, spelling, and punctuation, have become even more fastidious because of all the stress in their lives. ( Hope they are not reading this blog.)

The article is trying to be interesting and cool. I get that. After all how many stories of “the worsening economy is causing stress and depression” can one read?

But I was still irritated by the obligatory quote from a psychologist, a Paula Wallin: “Our brains are wired to notice what s different and when you re sure of the right way and the wrong way, you notice mistakes more, says Wallin. The article goes on to say, “(Wallin) admits to dropping out of an exercise class because the instructor kept misusing the word lay.”

Ms (Dr?) Wallin also adds, “Attribution theory comes into this as well.” (comes into this?)

Now, we all know that her statement about “our brains are wired” is just, how does one put it delicately, BS.

“Our brain is wired” misleadingly implies that the psychologist, or at least, her profession, or science as a whole, has a thorough understanding of the exact pathway that is responsible for the phenomenon in question. In addition, the statement, “Our brain is wired to ___” implies a false cause and effect relationship between neuroanatomy and behavior.

Her statement about “attribution theory” may be peripherally relevant, but it strikes me that this psychologist is struggling to come up with something germane and insightful to say.

This genre of story must be familiar to you. It is what I call “says a psychiatrist” ( I am open to new suggestions for the name).

The formula is straightforward.

1. Start with a novel, sensational premise. Accuracy is not as important as the novelty factor. Examples include, “The Economic recession causes increased baldness,” or “Why Some Men Find Older Women Attractive ( A story that I perused while at the local haberdashery earlier this afternoon.).

2. Interview a Psychiatrist or Psychologist.

3. Throw in a few stories of sufferers of that phenomenon.

4. Write a clever headline.

5. Voila! You ‘ave ze story, monseiur/madame.

Ms Wallin, by the way, is particularly skilled - she helps the journalist fulfil both steps 2 and 3 of the genre.

So how does the psychologist end up sounding like a lay subscriber to Psychology Today?

Here’s how it probably plays out. The interviewer calls up the psychologist who is flattered to be asked. Then they ask her something like “So what are the psychological factors that could be causing this to happen?”

She finds that she can’t bring herself to say, “We don’t really know, I mean I could speculate, but that’s all it is, just speculations and theory.”

So she says, “Our brain is wired to …”

Now you may think I am an exemplary fellow who could never make ill considered remarks like Wallin’s. But I have to confess that a year or so ago, I was interviewed on the radio. And the interviewer said, “Is the election making life more difficult for married couples?”

“Sure, I said. “When a couple does not agree on the candidate, they might have issues in their relationship, because they are disagreeing on something that might be as fundamentally important to them as religion.”

The interviewer didn’t look impressed, and, I, thinking that thousands might be listening, attempted to say something more insightful and informative.” People are always passionate about some things. It s the way human beings are” And then I added, “Our brains are wired to do that.”

“This patient has no responsibility,” the resident said.

Interesting, I thought. Responsibility. Not a word I heard often anymore, at least not since high school, when I was occasionally accused of lacking it.

So what did this young psychiatrist mean exactly - no “responsibility”? Depending on cultural norms, I suppose there could be 2 broad definitions of the word.

Definition 1. Responsibility: To “take ownership of your actions,” a phrase that has become tainted with its use by television psychologists and talk show hosts, and Britney Spears.

Definition 2. Responsibility: To fulfill one’s obligations and duties.

To fulfill one’s duties. Is that a sign of psychological health? After all, the existentialists would argue that duty and obligations are ultimately decided by family, community, and society; therefore to fulfill your duty is to give up your intrinsic freedom, to bow to external social forces and expectations.

By this logic, an irresponsible person would be considered more psychologically evolved than the responsible person.
Put another way: If duties are dictated by social structures, and responsibility means fulfilling your duties, then to be irresponsible is actually a sign of psychological health.

But that’s clearly not true: The irresponsible person - someone who endangers other people by his actions - is not completely healthy. And the responsible person - someone who fulfills his or her duty, who does only what society and culture and subculture expect - is not at the highest level of psychological functioning either.

So, what is healthy responsibility then? And how to define it so different psychiatrists can agree upon its absence or presence in a person?

Well, what if the definition of “duty” was expanded to include not just obligations to a few people, but to all people?

In other words, a responsible person looks out for his own, but also for those who are not, he knows that although he is an individual, he has a responsibility to the world, he thinks about immediate as well as long-term consequences of his actions. To paraphrase some great man, the responsible person acts locally and thinks globally.

“In what way does the patient have no responsibility?” I asked the resident, ready to launch into a lengthy discourse.

“She is not responsible to time, place, or person, not even responsible to painful stimuli,” the resident replied, with characteristic confidence. “The patient is unresponsible.”

“Oh, ” I said. “You mean, the patient is unresponsive.”

Disclaimer: A work of fiction. Any resemblance to anyone alive, or deceased is purely coincidental.

“If only there were evil people somewhere insidiously committing evil deeds and it were necessary only to separate them from the rest of us and destroy them. But the line dividing good and evil cuts through the heart of every human being. And who is willing to destroy a piece of his own heart?”

Aleksandr Solzhenitsyn

“Do what you like, it’s not going to make a difference. I will kill myself.”

“You sound determined.”

“Life’s not for me.”

“How do you mean?”

“I just don’t want it.”

“What’s a typical day like for you?”

“I wake up in the morning, then I walk 4 miles. That’s crazy, right, that I want to die but I want to stay healthy? Anyway, I watch some TV, get something to eat, maybe take a nap.”

“You watch a lot of TV?”

“The TV’s my friend. I come back home and the house is all empty, there’s nothing going on, then I turn it on and the whole room fills up.”

“How do you feel, most of the time?”

“You mean my mood? I feel alright.”

“Sad?”

“Not really.”

“Happy?”

“No. Just numb.”

“For how long?”

“Ever since I can remember. Look, I know you’re trying to figure out how to help me, but you’re wasting your time. Nothing you can do.”

“You just don’t want to live.”

“Right.”

“Why are you still alive?”

“You mean, why haven’t I succeeded in killing myself? Well, I thought about jumping out of a building but I’m scared of going that way. I want to take pills, but only barbiturates or sleeping pills and you can’t get that at the store and my doctor won’t give them to me. Thought about hanging myself, but I’ve read stuff about how it’s easy to screw that up.”

“How about a gun?”

“No, I knew someone who tried that and he’s a vegetable, living in a nursing home. Tried cutting my wrists, but I didn’t go deep enough, and that didn’t work either.”

“So what did you do last night?”

“You mean with my throat? I cut here and -”

“Did you use a knife?”

“No, a blade. I -”

“Were you in front of a mirror?”

“Yeah, I set it on my bed - my bed’s in the living room so I can watch TV lying down - and I sat down, got a towel on my lap…”

“What did you do then?”

“I made some cuts, slowly, just scratches, then I said I got to do it now, so I push the blade in. I get a lot of blood so I lay down and wait and the blood’s coming out and the towel’s soaked but I’m still awake and I start to think, ‘What if the blood to my brain stops and I wind up brain dead like that guy I know?’, so I called 911.”

“How long do you think before you try again?”

“Oh, I don’t know, it could be tomorrow, could be next year. You want to keep me in the hospital, you go ahead. But I’m telling you, it’s not going to help. I will kill myself someday.”

“It is always consoling to think of suicide: in that way one gets through many a bad night”
Nietzsche

This post is for serious election nerds only. (You know you’re obsessed with the elections, when you not only read an obscure news story but also feel compelled to write about it)

I just read this story by the AP. An anonymous source close to the Obama camp leaked a story to the AP reporters: Apparently, Obama might offer the chief of staff job to Rahm Emanuel, the Democratic congressman from Chicago.

The discipline of the Obama campaign is legendary, so when there’s a media leak from the Obama camp, it means the campaign wants the story to go out. Why would they want Emanuel’s name even more closely associated with Obama?

Because Rahm Emanuel’s no ordinary congressman. He’s the son of Benjamin M. Emanuel, an Israeli born, prior member of a Zionist paramilitary organization.

How’s that for some Florida conservative-jewish-voter street cred?

Of course, the McCain campaign bought right into Obama’s ploy by releasing this statement: “Reports that Obama wants Emanuel to be White House chief of staff undercut any claims to unity and bipartisanship, and should alarm every voter.”

The McCain campaign should’ve ignored the bait. The older jewish retirees in Florida will be delighted, not alarmed, by these reports. And if McCain attacks Emanuel too strongly, these voters will turn away from McCain, skittish as they already are because of Palin’s inclusion.

And so Florida falls.

Johnny Mac’s been outmaneuvered again.

“So, I hear you are going back to India?” asked Dr A, a physician who’s been in the US for more than 3 decades.

“April next year,” I said. “You ever think of going back to India?”

He shook his head, smiled, and shrugged. Why would I ever want to go back? it seemed to suggest.

“You know, the outsourcing will stop, and the Indian economy will suffer,” he said. “The infrastructure is bad, more than 70% of the people still not educated, going to schools that don’t even have a roof, so much poverty still.”

I didn’t argue the point, didn’t correct his statistics. It’s easier to leave home behind, if you think of it as a terrible place.

Just saw this video of a McCain rally.

Check it out. A funny senior moment, but there’s more to this video.

Notice how McCain says, “Senator Obama’s supporters have been saying some pretty nasty things about Western Pennsylvania recently.”

He says it with feigned anger, then pauses and smiles. Not to to get all Freudian on you, but it’s a little boy’s smile, like he’s just been caught with his hand in the cookie jar.

Meanwhile, Cindy McCain reacts with a nod and a wry half smile, looking like an indulgent school teacher who is listening to another complaint about a naughty but somewhat adorable child.

The girl on McCain’s right has the grace to look solemn initially, but when the crowd reacts with polite good natured booing, she breaks into a smile.

All this even before McCain says he agrees with the Obama supporter.

No wonder he forgot his lines. Now consider this: If McCain had appeared genuinely angry about “those nasty comments”. If his posture, his demeanor, his face, his eyes, and his voice, resonated with genuine anger on behalf of these much maligned Western Pennsylvania populace, no one would have been smiling.

If he radiated authentic anger, the crowds would have felt angry.

But as it was, the whole thing had the air of a circus sideshow.

McCain’s negative attacks on Obama, with few exceptions, have rarely seemed genuine. McCain does not seem to emotionally connect with his own words. The psychic conflict is obvious - McCain grimacing, or smiling inappropriately, betraying a deep discomfort about the words that he is uttering.

I guess what I’m saying is that McCain’s authenticity mojo is way down. If I were his campaign manager, here’s what I would say to McCain.

“John,” I would tell him after watching him struggle through another debate or speech.

“Say it if you feel it. Feel it if you say it.”

It’s the oldest oak tree in the neighbourhood, or so the previous owner told me and I have no reason to doubt him. It stands 50 feet high, and like the iron pillar of New Delhi, so wide that you cannot put your arms around it.

But it wasn’t looking too healthy, and so i called an arborist ( Apparently, that is what the tree removal guys are officially called) to see about getting the tree taken out.
He introduced himself. “Jack.”
“Shyam,” I said, shaking his hand.
“Sean?”
“Shyam”
“How do you spell that?”
I spelled it for him, knowing that the spelling wouldn’t really help him with the pronunciation.
He gamely tried again,”Sham,” and then asked me, a bit irritably I thought, “Where are you from?”
I was tempted to say, “From Peoria,” just for the heck of it. Instead I replied, “From India.”
“India?”
I nodded, and we stood there for a moment, nodding and smiling.
That was the conclusion of that part of the conversation and we turned to look at the tree in the front yard.
“What do you think?” I asked, hoping that he would inform me that all my neighbors were wrong, that the tree was, in fact, on the threshold of a major revival.

He looked at the tree, his right hand shielding him from the sun. I saw a squirrel fluttering on a high branch. Squirrels in America are huge, I thought, not for the first time. The other day, I’d surprised a squirrel that had found its way to the garage. It looked me in the eyes and made a barking sound. I was, I have to tell you, a bit intimidated.

The expression on the tree man’s face was not very reassuring. “It’s dying,” he said, flatly.

I pointed to the green leaves, a bit like a patient’s relative, pointing to the heart monitor hoping that the blips are a harbinger of the patient’s recovery. But the arborist shook his head, “Those are just suckers, they happen when the tree is dying.”

How much? I asked. To remove the tree.

He looked at it. Stood back and looked at it some more.

“About $2400,” he said.

“$2400,” I repeated. I had long ago stopped converting dollars to rupees in my head, but still did it occasionally when I wanted to experience a sense of mild shock. Imagine that, I thought. 100,000 rupees to get this tree out. Unbelievable!

When I first left India, and moved to England, to take their licensing exam so I could work there, I happened to run into B one of my classmates from bangalore medical college. He was beaming broadly, looking on the verge of some ecstatic experience. Guy must’ve passed his exam, I thought to myself.

“Hey, watsup?”

“Man,” he said gesturing with his chin to his hands. He was carrying some heavy looking shopping bags. “Got 2 pints of milk for 40 p,” he said.

Soon I was finding similar joys in the supermarket. What? Fish fingers for 10p today? Baked beans for 15 p? And could that be just 5p? It was canned tomatoes, but I could put it to use.

Most of us had a budget of 40 pounds a week. Every penny (50 paisa in Indian currency) counted.

So it was a measure of progress, I suppose, that 10 years later I stood here outside my house in America, wondering whether I should get rid of the tree at 100,000 rupees a pop.

“You could leave the stump in,” Arborist Jack was saying. “There are guys who will come here, carve something out of it. You know animals, bears and stuff like that.

Or,” he suggested, “they could make you a totem pole.”

“I am not that kind of Indian,” I replied.