Tuesday, September 21, 2021

You Will Be Hearing These Forever

One downside of badgering people into vaccinations is that they will associate any negative experience in the days following with the injection and blame it. There was a female popular singer who got a lot of attention recently because a friend's cousin (or a cousin's friend?) got the vaccination and two weeks later had something go wrong with his testicles. The best response I saw was a friend who passed on a tweet "My cousin's friend got the vaccine, and two weeks later he gotten bitten by a moose.  Do the research, people."

It is easy to sneer, but this happens all the time even with free choices. The brain seeks answers, and will settle on a bad one that fits its schema. That the explanation does not explain does not bother many people.  It is the lack of explanation that is unendurable.  They told me I had to get the shot in order to visit my grandmother and said it was safe, but now my immune system is worse and I get every cold and flu that comes along. The hard part is that these explanations will often never go away, remaining impervious to all reason.

I heard these all the time when taking social histories from patients or families about how this illness started. He was doing fine, had a job and was going to school part-time, and he moved in with this girl. She was a nice enough girl but she broke the relationship off and he went into a tailspin.  He started talking psychotic and taking drugs and he's never been the same.  He still talks about her. What is much more likely is that he was getting psychotic and taking more drugs, so the girl broke the relationship off. Cart/horse. Especially with our children, we make up these explanations for what went wrong based on the time association rather than a logical association.

Sometimes they are quite true.  A serious head injury can explain just about anything. When I first started reading CS Lewis I marveled that he was doing something like algebraic proofs with ideas instead of shapes and graphs. I was stunned to later learn that he was not good at math.  His mother took a math degree and taught it.  He occasionally handled scientific concepts in his examples that were largely founded on mathematical principles.  It seemed impossible. Only later did I learn that when he was at the school run by a certifiable and violent headmaster, he had that person as his maths instructor.  Students were beaten if they got the answer wrong.  They were also beaten if they got the answer right. That could interfere with learning.

Time association has largely driven the vaccine-autism fables. During the years when a child begins to interact with the world enough to display that something is wrong, he also gets lots of vaccinations.  Such symptoms do not show up with bang, usually.  It's not like a fever or neck pain where it was not there yesterday, but unquestionably here today. But once the idea is planted that this odd behavior in your child might be caused by vaccines, many parental minds are going to leap to "Hey, yeah, he did get a vaccine six weeks ago."

I think I have post brewing about Infection Control Nurses and the wheedling, badgering, suggesting, and insisting they do as a normal part of their job, trying to get employees to accept flu shots, or environmental services to ramp up its surface cleaning, or other infection prevention interventions. (Or maybe not.  The summary is pretty easy. 1. Mandating an intervention is part of that continuum, not some entirely separate thing out of the blue. We have "forced" families to comply with various levels of health precautions for years. 2. Sometimes the professionals can be wrong, as can the nutritionists or psychiatrists or anyone else in the system.  Just as in any profession.  But mostly, 90%+ of the resistance and refusal they get is based on the same dumb-ass stuff they hear every year, of people claiming the flu shot always gives them the flu, or droplet precautions can be ignored if you are just poking your head into the patient's room for a second to tell him his visitors are here or whatever.) But the key takeaway is that the more you do this, the more resentful people are going to blame any subsequent thing that goes wrong on the hospital/school/Big Pharma, whatever. 

Thus, I am big on avoiding that as much as possible. Over time it builds distrust of the whole system even when it is completely undeserved, because people don't like some explanations. Yet I also know that people cannot always be persuaded, and sometimes you have to put the hammer down. That's not just hospitals and health, it's your profession too.


Texan99 said...

Cause and effect is tricky stuff. It's not just in the vaccine hesitancy area, it's your ideas, too, and all of ours. We can decry "post hoc, ergo propter hoc" until we're blue in the face, but it's still our standard quick-and-dirty first approach, a lot of "it stands to reason" loose thinking.

It's not a terrible approach, either, considering that we can't always stop the world and wait a year or so for reliable RCT results. The big problem happens when we get mad at people who don't agree with our inescapably fuzzy conclusions. And yet we'll get mad at each other's conclusions a lot less if we stick to making our own decisions and let others make their own as much as possible.

I know "as much as possible" sometimes runs up against the public good and demands intervention by force. Still, the facts have to be awfully darn clear to justify the use of force when persuasion and consensus fail.

random observer said...

I'm getting exhausted by the whole vaccine issue for many of the same reasons you are, and have correspondingly appreciated your take.

I have not really understood the mindset- vaccination is to me normal, just a part of life. The standard 1970s ones were mandatory to go to school when I was a kid, I've had others for work travel, I probably will get the shingles one pretty soon. Still to discuss with my doctor, but although shingles won't kill me I'd rather not waste time being that debilitated. I appreciate at a layman's level why it was possible to produce the main COVID vaccines so relatively quickly, and know they have been given to tens of millions or more without incident, and many of those that were incidents were just routine side effects. So I got first Pfizer and then Moderna and the worst I had were a bit of trifling shoulder pain and some pseudo-fever [felt hot and weak for two days, never higher than 37.7 C]. I could feel like that in any given week without either a vaccination or an infection. Meh.

I admit I share some of the irritation that some people are treating COVID like the Black Death, and masks as shibboleths, I know people like that. This has led to some policy choices I think were wrong, even serious mistakes. And even some fear peddling that is over the top.

But while COVID may not be the Black Death- it IS Spanish Flu comparable and that's not nothing. So I'm not buying arguments that trivialize the danger. I especially can't buy arguments that accuse one side of peddling unwarranted fear and overstating the threat, and claiming for their own side superior courage while in turn peddling far more ridiculous fears about the vaccine.

And I think governments have inherent powers in national security, public safety, and public health, even quite traditional pre-socialism governments thought so, and I suspect the US Founders agreed, from my reading of them. So I'm not easily buying tyranny arguments. Sometimes there is a need for emergency powers. Do I entirely trust modern Western governments? No. They are basically servants of people I disagree with, driven by assumptions I don't share, and frequently incompetent at core functions. And yet most of what has been done has been consistent with legitimate government power in an emergency to my mind, and the restrictions on liberty modest. Beyond a certain point, restrictions on internal movements and even external ones cease to be a pragmatic need in emergency and become an unwarranted restriction on liberty. Perhaps they were imposed to easily, too biased toward the domestic as against the international, and on a basis of panic. I'm open to the idea they were poorly done and governed by panicky idiots. Yet the basic power is valid. We'd use it in a real plague, and be glad of it.

In part, my reaction to the arguments against COVID measures from liberty have been driven by how unserious and 21st century so many have seemed, the latter aspect irritating above all when made by conservatives whose forebears knew better. The principles might be sound, but the hills chosen to die on were often poor.

The ability to take a cruise, or to take a family road trip, are trifles not vital life interests. International vacations are a frippery- lovely to have, no one ever died for the lack. I want a world with restaurants, but the ability to eat out is not essential. Make a sandwich. Every night, if that's the best you can do. I've done it.

random observer said...

part deux

I admit I'm mentally predisposed to not care about family gatherings, but those are also trifles even if you do care, a lot. At least over a year or two. The mere fact of skipping Thanksgiving or Christmas gatherings won't kill you. Granted, some relative might die in the interim. They also might die if you spread COVID. And people lived this way for millennia, to the extent any left their home village at all. My mother moved across an ocean and didn't see her parents for 7 years, and that as recently as the 60s, and between two industrialized Western nations. Nor did my grandparents have a phone. Travel cost money, and in their country phones cost a lot of money. (For the record, I haven't seen my 80 year old parents since Christmas 2019, though they live only a few hundred miles away. We do have phones. Just voice. That's sufficient, every so often.) I admit, too, that I'm predisposed not to care much about social gatherings out with friends and colleagues. I enjoy them, I've done a few during lulls in lockdown and since vaccinations. They aren't essential. I don't really care. I could have foregone entirely for the whole pandemic and another year yet. Everyone doesn't have to be as cavalier about them as that, but I do expect grown men and women not to freak out because they can't go to a bar, or hold a birthday party for themselves. Not exactly the war, is it?

And there's one last that I'm not so sure about, though every time I see it I do think it's nuts- something Helen Lovejoy or Maude Flanders would say on the Simpsons while screeching "won't someone please think of the children?" And that's the argument that masking kids is child abuse. I don't know. I always thought kids were more resilient than this. On one hand, yeah, every little thing apparently traumatizes them in ways that work out decades later. On the other, they seem to take a lot in stride if their parents can keep it together, and to take a lot of things for granted if their parents just tell them to do it. And if they occasionally slip up, and lose the mask, maybe a caregiver can give them a new one and little chance COVID will pass or they will freak out.

Plus, all of these could be most likely eliminated if everyone just got the vaccine, so there's that.

random observer said...

On the related note about autism- I admit I've always wondered.

When I was a teen in the 80s I worked in a public library. The card catalogue (!) contained a subject card for autism, and no cards so no books on the subject. I don't know why, but that absence of information struck me, as did the fact that I didn't know what autism was. I wondered if it was a political ideology in support of autocracy. True story. Maybe I was mildly autistic.

But all the years since, whenever I see the topic, I wonder did autism suddenly get more prevalent, and if so why (environment, genetics, too little lead in the air after the 60s...), or did we just finally give a name to something in which the kids used to die or be put away with their problem unnamed? Or are both these things true in combination? As I never had kids in the end I didn't have to worry about it directly. But it looms so large in our culture now- as a threat, as a question, and apparently as a moral and cultural value driver, that I remain curious.

Assistant Village Idiot said...

@ Random Observer - three long comments, but valuable, and if you ever start a blog of your own I will plug it and come visit and comment, just to prime the pump. These reminded me of something else I was thinking of as well.

Anamaria said...

Hi. I have read this blog a lot and never posted. So first post! What made me say this was the comment about autism. I have it.
I wasn't diagnosed till my late twenties, then I was given Asperger, then autism sprectrum disorder. I was born in the early 80's. I was always seen as weird. My teachers from middle school on up told me to see a therapist. Even I knew I was not the norm, I looked for a lot of reasons for my differences like a weird version of schizoid personality disorder. Yes, I was into abnormal psych since I knew I had something.
My dad was also like me and he was born in the 1940's. We both had no friends. We both hated change with a passion. We hated being touched or hugged. We both had terrible social skills.
My younger brother was terrible shy. He also had sensory isssues like hating socks because of the seams. I also was like this with many more sensory problems. I don't know about my dad other then he hated being touched.
The autism is genetic in my family. We were just ignored. I was told my sensory and social problems weren't real. That I was faking it and doing it for the attention. So, yeah, I think people like me were around. We were just bullied and dismissed as the local weirdo. Think Boo Radley from To Kill a Mockingbird. The local freak who everybody ignores. Yeah, I'm bitter.
By the way, the diagnosis is accurate. Every therapist I have had, and I had a lot, have told me the same thing.

Assistant Village Idiot said...

Thank you Anamaria. You will be understood here as several here have children with spectrum disorders, and a few others are more than a bit Aspie. An I saw many professionally over my career. I had a young HFA friend who I considered was a possible schizoid PD, though I later decided against that, so I don't think you were far afield in considering that. You are right that what you describe is pretty classically autism, however. I do think that there will be further divisions in the diagnosis as we learn more, with some bleed over into OCD characteristics.

I am so sad to hear of your childhood loneliness and rejection. You would be the age of my children. It was harder for females, I think, as social expectations were heightened and there were fewer carve-outs for science/math/technology places in society for them. There still are fewer, I think, though it is certainly better.

Yes, they were certainly around in previous generations, just not recognised. I have a new daughter-in-law who is just now wondering if her mother, with whom she has always had strained relations, might be on the spectrum. Some of those called "idiot savants" and put in institutions fit a subcategory of autism.

Assistant Village Idiot said...

I am trying to think of a story of a person on the spectrum who was successfully fit into a community in the old days. I imagine there were some, but no examples occur to me. Most must have had very hard lives.

james said...

"Nobody minds Ben Gunn."

Grim said...

...sometimes you have to put the hammer down. That's not just hospitals and health, it's your profession too.

Yeah, it is. That's exactly why I have very firm standards about when it's allowed, and when it ought not to be.

Texan99 said...

Grim: I'm with you.

Anamaria: I'm somewhere on that spectrum for sure, as were both my parents. It took me a long, long time to realize that, to the extent I was ever going to enjoy much social contact, it would mostly be with other people on the spectrum. It's a relief sometimes, isn't it, to find that you're not the only one, that there are people you can interact with on terms that make sense to both of you, though they'd never make sense to an extrovert?

I used to think it was just that I had a taste for odd ducks, but there's more to it than that. It's not only disliking a lot of kinds of social contact that others take for granted, it's affirmatively enjoying sharing the way of looking at the world that comes with people like us: a sense of how much conventional contact is a pointless waste of time, and how pleasurable contact can be with people who approach things more the way we do. It's as if most conversations were occurring between two people who are sleep-walking, and then suddenly we have a conversation between two people who are wide awake.

random observer said...

Anamaria's comment suggests a world of tragedy, and I hope that things got better after diagnosis, at least given it meant some degree of understanding. I'm all the more disappointed since she was born in the 80s, and I had thought autism was, if not terribly well understood, at least a widely discussed and familiar topic in the media. Disappointing to know that doctors as well as family could be so unresponsive.

I wonder too about people "on the spectrum" who managed to function well in the past- the spectrum covers such a range of mental types and behaviors now that there must have been millions such, and it is interesting if probably fruitless to speculate on which known historical figures might have been so diagnosed if they were living now.

The Mad Soprano said...

National Geographic had a good article (for once!) on autism about a year or so ago. A scientist took CT scans of the brains of children between the ages of four months to two-years-old. What he found was that children who were later diagnosed with autism showed faster brain growth than those not on the spectrum.