60. Are Personality Disorders Permanent and Irreparable ? If so, Why ?

October 28, 2020

Having had several years of training regarding the architecture and function of the brain, although much about neuroscience remains obscure to us, as I understand it, experiential, neurobiological and neuropharmacological factors often force marked variations in the development of brain wiring, or neuroanatomy — changes that while they may have a profound affect upon thought, emotion and behavior, are usually not apparent from casual observation of individuals so afflicted.

For example, there are but subtle external physical signs, visible to physicians, of fetal alcohol syndrome. The condition is produced by heavy use of alcohol by the mother during pregnancy.  Its victims’ ears are set slightly lower, their eyes set slightly further apart, and the philtrum of the upper lip is flattened.  However, what is more startling is that in victims of severe fetal alcohol syndrome, due to interference with the normal developmental migration of brain cells, many of the brain’s midline structures are underdeveloped or absent, and about ten percent of cases, the largest single bundle of brain wires, the corpus callosum, a bundle of axons with an average cross section of about two square inches and connecting the entire left and right cerebral hemispheres, is entirely absent.  Thought it may affect bimanual coordination, planning, decision-making and abstract thought, this enormously important defect is usually not obvious through appearances, and may remain undiscovered unless, for some reason or other, there happens to be a Magnetic Resonant Image test, (MRI) performed during life or an autopsy performed after death.

Similarly, in a number of other conditions, there are very substantial individual differences in brain wiring that are not apparent unless revealed by extensive specialized testing during life or at autopsy after death.

The brain is organized into clusters of brain cells that relate to various general functions.  This functional organization of the adult brain’s billion cells, occurs between conception and the first couple of years after birth, by the migrations of groups of cells from one place in the brain to another.  As the cells migrate, they drag a long, myelin-insulated connecting wire (axon)  with them from their place of origin, and form other, usually multiple, connections where they end up.  At birth there are about two billion such cells, each connected in this way to many others.

Brain development is markedly influenced by relationships in the early months of life, and as someone noted, by the learning of language, through which ideas are not only expressed, but on the basis of which abstract ideas may actually be formed.  All of these things influence the locations to which cells migrate, what interconnections are formed and strengthened by use, and which half of the cells  and their possible connections will be atrophy and be lost through disuse.

By about the age of twenty, about 100 billion of the original 200 billion cells and connections have been pruned away, leaving those functions and circuits that the organism has found useful and necessary for living as a human being.

Since the architecture and function of the brain have depended for development upon the learning of language, music and our attachments to other humans, etc., all of which will have varied from culture to culture, the proposition that all humans, all cultures, all races, would give identical results to a complex process of testing of brain function, seems far less likely to me, despite our egalitarian sense of fairness, than that they would score differently through cultural drift.  

The changes to which I refer, by the way, happen in the course of a single life, whereas genetic drift evolves over generations of time.  As an example of an important difference between individuals, a significant fraction of the population demonstrably has no empathy towards others.  Moreover, those individuals, once formed, have no capacity for developing empathy, lacking the cells and wiring circuits in their brains that make empathy possible.

In one other seemingly unrelated observation there lies a further bit of evidence regarding the conclusion one can draw about the structure of the brain.  It has been known for many decades that in a child with amblyopia ex anopsia, so called “lazy eye”, where there is a marked weakness of one of the muscles that directs one of the eyes, the images presented by each eye to Broca’s areas 18 and 19 of the occipital (visual) cortex of the brain, are so completely different, that the brain cannot make fine corrections to superimpose and fuse them into one congruent, binocular image.  Therefore the brain selects the image from the eye that is directed straight ahead, and suppresses the other less relevant, less useful image.

The eye surgeon has a dilemma.  For various reasons it is better to wait until at least the age of six before subjecting the baby to surgery, but if one allows the brain to suppress the image of the “lazy” eye for six years, the parts of the cortex perceiving the image from that eye will have atrophied, and will never develop even if the eye’s aim is straightened.  This evidence suggests that the timing of brain development is crucial, and that some abnormalities in brain architecture can become permanent.

The eye surgeon’s solution in the case of amblyopia ex anopsia is to alternately patch one eye, and then the other, forcing the child to use each unpatched eye in turn and providing timely stimulation to the occipital cortex on both sides of the midline, so that visual perception develops bilaterally.  

Thus there is evidence that when there something causes an abnormal development in the cortex in the first few months and years of life, these changes, or defects, can become permanent.

In the case of the dysfunctional prototype attachments to others that we think are the cause of clusters of behaviors we refer to as personality disorders, we suspect that they indicate literal defects in brain wiring, and that those miswirings are effectively unfixable, except possibly by partial patches and work-arounds.


59. Have T V and Newspaper Purveyors of News Committed Socioeconomic Suicide ?

October 24 2020

This morning a member of an e-mail discussion group to which I belong circulated the following story: 

Washington Post public editor:  the powerful have realized they don’t need the Post

THIS MONTH we learned that Tesla, a $400 billion public company run by one of the richest people in the world, has done away with its media relations department—effectively formalizing an informal policy of ignoring reporters. …


For personal reasons, I found the source of this story, the Columbia Journalism  Review, as interesting as the story itself.

In 1949, when I was about fifteen, and living in the little town of Monroe, about 50 miles north of New York City, I attended tiny Monroe High School, where my English teacher, Miss Beal, whom we all believed was secretly dating a boy in the senior class who had been left back a couple of times, more or less told me that I was going to be the Editor-in-Chief of our school paper.  As I recall, it was less like an invitation than an instruction. 

In making that appointment, she initiated what have been a series of major effects upon my life.  This is all the more astonishing to me because Monroe High School was such a tiny institution.  There were only just over a dozen kids in my class, and the “newspaper” was merely a bimonthly, mimeographed publication.  

In a way, being its Editor-in-Chief was like being appointed “emperor” of somebody’s back yard.  Yet, I discovered nine years later, after college and two years of law school, when the Army drafted me and and made me a military journalist, layout is layout and the inverted triangle format of a news story is independent of the relative magnificence of the publication.  Expositional writing, the clear explanation and publication of information about what is going on around here, is an art that is scalable.

I am pretty sure Miss Beal gave me my editorial duties in an unsuccessful effort to keep me too busy to disrupt her English class with my clowning around, but for me the first unexpected consequence came a year later when she recommended that the school should send me to a week-long seminar of New York State high school editors at the Columbia University Graduate School of Journalism. 

It was my first exposure to the excitement of a big city university campus.  The conference alone was stimulating enough, but in addition, on the first day I met a grad student, Buddy Brehm, who stopped me to ask what our baby-faced crowd was up to at his school.  At the end of a half-hour chat he had to go to a psych class, and invited me to come along.  The class, given by a professor named Short, had to do with the design of academic tests.  Now, after 71 years, I still remember the main point of that class:  that if too many students fail a given test, the problem is with the test, not the students.  The test design will have failed to match the teaching.

This was all about a dozen years before the birth of the Columbia Journalism Review, and I have only a vague impression of the journalism conference itself, other than it was consistent with the professional standards of the day as they were reflected in the work of Edward R. Murrow and Walter Cronkite.

On the basis of that long perspective, I believe I spied another conclusion hidden in the words of the present article.

The author of the Review’s article, Hamilton Nolan, asserts that because the very rich possess extraordinary access to social media, they no longer need to provide once necessary access on the part of the traditional mass media, to their organizations and their lives.  The example cited in the article is that because Elon Musk has more than 40 million Twitter followers, Tesla no longer finds it necessary to have a media relations department, and for more than a year has not responded to any inquiries from what he calls, “critical and ethical outlets like the Washington Post”.

Nolan laments this loss of power by the further assertion that, “As journalists, we all view this as a horrifying assault on the public’s right to know, and on our own status as brave defenders of the public good.”  One wonders whether he is simply unaware of the delicious irony ingrained in this statement, or whether it is merely a cynical exercise of the egregious disinformation strategy for which the current media have become infamous.

First, modern reporters, mostly ignorant of the law and the constitution, have exaggerated the Constitution’s freedom of the press, which merely states that no law shall be made prohibiting it. Reporters have converted that right into a more global but imaginary public right to know.  In using the latter term, the press grants to itself a right and a power it does not actually have.

Secondly, if Nolan thinks that anyone still regards the press as, “brave defenders of the public good”,  he is delusional.  By foregoing the clear and truthful exposition of events as they have transpired, ( forgetting the legacy of Murrow and Cronkite), in favor of the role of  fomenting the on-screen or in-print acting-out of rage and anguish, they have reduced themselves to being parties to the chaos.  They are no longer disinterested reporters of the news when 98% of their content participates in the mêlée for the purpose of attracting viewers and readers and enhancing their own power,

Therefore, by its behavior the press, as it once was,  has committed journalistic suicide, and today the products of the media are consumed only by individuals who already know the various media prejudices and are intent only upon confirming their personal biases.

People who are invited to talk to reporters know that the product of the press is so devalued that it is no longer worth the price of dealing with any who are, or may be, antagonistic.  For the new strategy of ignoring the press you can thank the President, because he has proven that more people see his tweets than they do the content of any of the print or TV news outlets.  

For allowing their greed, rage and fear to corrupt their professional standards, modern journalists have earned the consequences of their bad behavior.


58. Russian Interference in the Election

October 23, 2020

On the eve of the 2020 election, in the final debate of the campaign season, the candidates of the two major political parties each spent a good deal of time claiming that the Russians have again been using the internet to rig the election in favor of his opponent.

Are they each so stupid that they don’t realize that their words actually help Putin achieve his stated goal, which is not to elect either one of them, but to cause Americans to lose faith in what is the cornerstone of any representative democracy:  the free, fair and honest process of election of its leaders and representatives in government?

The answer is, it appears that they are!

And if half the Americans again refuse to honor the result of the presidential election, as the Democrats have done since 2016, and if this time the peaceful transfer of power is actually disrupted by violence in addition to the passive-aggressive resistance on the part of the losers that we have already endured for four years, Putin will have succeeded beyond his wildest dreams in demonstrating that democracy is a flawed theory of government.

It appears to me that hope lies in whatever common sense resides in the lower echelons of the two major parties.  Given that their leadership is composed mostly of the more fanatical partisans among them.

The greater risk of violence, it seems to me, will  come from a very close election, impossible to count and to call for one side’s candidates or the other.  Therefore I am hoping for a landslide in one direction or the other.


57. Are there biological mechanisms that consistently determine the way people identify themselves sexually?

May 26, 2020

I take a conservative view of the question. The MedScape article  below is highly technical and I caution against over-interpretation of the meaning or importance of any single observation.

Much of the speculation regarding possible biological causation for gender dysphoria pertain only to very rare biological conditions, such as congenital adrenal hyperplasia.

In discussing brain differences, in many of the cases the evidence was not clear whether differences might not have been caused by hormonal treatments rather than inherent brain physiology.

The evidence was obtained mostly for transgender individuals and may have only limited application, or none, to the question of homosexual behavior.

Another thing not discussed is the huge effect upon brain architecture that early attachment experiences and parental relationships clearly have.  That is, some of the gender-related differences in the size of the collections of brain cells that embryologists and neuroanatomists call “nuclei”, may have been caused by childhood attachment-development rather than the nuclei having caused the specific gender identity.

Nevertheless, the article is a useful collection of information and provides a basis for interesting speculations.

With reference to the sixth paragraph, it is useful to know that in a certain very small number of babies, the genitalia are ambiguous and at one time were “corrected” surgically soon after birth to resolve the uncertainty.  The surgeons often went in the direction of what the genitals most resembled, which was sometimes not consistent with whether the baby was chromosomally XX (female) or XY (male).  The parents, not knowing the chromosomal gender raised the kid according to what the surgeons had decided. This may have led to a certain number of those children just never feeling right about their gender assignment, some of whom requested a reassignment in later life.

So with those warnings against thinking these matters are settled, here is a recent Medscape survey article on the topic.  I would have just given the URL, but you have to be a member to gain access.


All the rest is a report from MedScape, a medical magazine – sorry I have lost the name of the author(s) and the date of publication.


Objective: To review current literature that supports a biologic basis of gender identity.

Methods:   A traditional literature review.

Results Evidence that there is a biologic basis for gender identity primarily involves (1) data on gender identity in patients with disorders of sex development (DSDs, also known as differences of sex development) along with (2) neuroanatomical differences associated with gender identity.

Conclusions Although the mechanisms remain to be determined, there is strong support in the literature for a biologic basis [Ed. not the same as “cause”]  of gender identity.


Gender identity is a fundamental human attribute that has a profound impact on personal well-being. Transgender individuals are those whose lived and identified gender identity differs from their natal sex. Various etiologies for transgender identity have been proposed, but misconceptions that gender identity can be altered persist. However, clinical experience with treatment of transgender persons has clearly demonstrated that the best outcomes for these individuals are achieved with their requested hormone therapy and surgical sexual transition as opposed to psychiatric intervention alone.[1] In this review, we will discuss the data in support of a fixed, biologic basis for gender identity.


This traditional literature review was conducted using a search of PubMed and Google Scholar for the following key terms: gender identity, gender dysphoria, transsexual, transgender, transmen, and transwomen.


Disorders (or Differences) of Sex Development (DSDs)

A seminal study by Meyer-Bahlburg et al involving outcomes of XY individuals raised as females due to severe nonhormonal, anatomic abnormalities of sex development provided the most convincing evidence that gender identity is fixed.[2] These congenital abnormalities include penile agenesis, cloacal exstrophy, and penile ablation. For many years, female gender assignment along with surgical feminization was the dominant approach for these patients. In this study, 78% of all female-assigned 46 XY patients were living as females. While the majority of these patients did not initiate a gender change to male, none of the 15 male-raised 46 XY patients initiated a gender change to female. Thus, the risk of questioning gender identity was higher in those 46 XY subjects raised as females than in those raised as males. The same group examined the degree of satisfaction with surgical intervention reported by patients with 46 XY genotypes and found that those subjects raised as boys were considerably more comfortable with their gender identity.[3]

Another seminal study relevant to this topic was by Reiner and Gearhart.[4] In their review of 16 XY genotype subjects with cloacal exstrophy who underwent female gender reassignment surgery, 4 of the 14 individuals raised as girls announced they were male, and 4 later chose to live as boys when they became aware of their genotype. The 2 individuals who were raised as males identified as males throughout life. The sexual behavior and attitudes of all 16 subjects ultimately reflected strong masculine characteristics regardless of gender assignment. Thus, children who were born genetically and hormonally male identified as males despite being raised as females and undergoing feminizing genitoplasty at birth. Although the cohort sizes in these studies were small, the data provide the strongest evidence for the biologic underpinnings of gender identity.

In congenital adrenal hyperplasia (CAH), the adrenal glands produce excessive amounts of androgens, causing genital virilization with a spectrum of different phenotypes in 46 XX neonates. Dessens et al[5] reported that the prevalence of male gender identity in 46 XX female-raised subjects with CAH was higher than the prevalence of female-to-male (FTM) transgender individuals in the general population of chromosomal females. In this study, the large majority (95%) of 250 female-raised patients later maintained a female gender identity. However, 13 (5.2%) had serious problems with their gender identity. 

Deficiencies of 5 alpha-reductase-2 and 17-beta-hydroxy-steroid dehyrogenase-3 are similar conditions in which the synthesis and conversion of testosterone to dihydrotestosterone is inhibited, preventing the development of external male genitalia and resulting in potential genital ambiguity. As with CAH, affected individuals are often raised as females. In a study of affected subjects, gender role changes were reported in 56 to 63% of cases with 5 alpha-reductase-2 deficiency and 39 to 64% of cases with 17-beta-hydroxysteroid dehydrogenase-3 deficiency who were raised as girls.[6] These data support the concept that gender identity might be attributed to hormone milieu during intrauterine development.

Data from DSDs highlight the potential influence of abnormal hormone exposure on the development of transgender identity in some individuals. However, it is important to note that most transgender individuals develop a gender identity that cannot be explained by atypical sexual differentiation. It is possible for individuals with normal sexual differentiation to develop transgender identity later in life.

Neuroanatomical Differences. Many of the current hypotheses for the biologic origin of transgender identity are based on atypical sexual differentiation of the brain. The perception of one’s own gender is linked to sexual differentiation of the brain, which differs from the body phenotype in transgender individuals.[7] Swaab et al have proposed that this discrepancy could be due to the fact that sexual differentiation of the brain takes place only after sexual differentiation of the gonads in early fetal life.[8] Along these lines, the degree of genital masculinization may not reflect that of the brain.

The notion of transgender-specific cerebral phenotypes is further supported by postmortem brain studies investigating the underlying neuroanatomical correlates of gender identity.[9,10,12] The vast majority of these studies have compared particular regions of interest only in male-to-female (MTF) transgender individuals.[13–15] These studies support the hypothesis that atypical cerebral networks in transgender individuals have a neuroanatomical basis.

Gray Matter Studies. Studies of cerebral gray matter in transgender individuals have provided the strongest neuroanatomical case for transgender gender identity. Postmortem brain studies suggest that some subcortical structures are feminized in MTF individuals. One of the earliest and most influential studies in this area investigated the bed nucleus of the stria terminalis (BSTc), which was reported to be a sexually dimorphic nucleus in humans with a larger volume in males than in females. In 1995, Zhou et al reported that the size and number of neurons in the BSTc of 6 MTF estrogen-treated transgender individuals was typical for the size and neuron numbers generally found in control females.[9] The authors further reported that these findings could not be explained by differences in adult sex hormone levels.

A similar study by Kruijver et al provided further data supporting the role of the BSTc in transgender identity.[10] They examined tissue from the same 6 MTF estrogen-treated transgender persons studied by Zhou et al and found that the number of neurons in the BSTc was more similar to genetic XX female controls. BSTc neuron number was also in the male range in the 1 FTM androgen-treated transgender individual studied.

Most transgender individuals experience feelings of gender dysphoria that begin in childhood. However, in a study of BSTc volume in postmortem brains of 50 control subjects, Chung et al reported that sexual dimorphism in the BSTc did not develop until adulthood.[11] Yet, the same group remarked that changes in fetal hormone levels could have delayed effects on BSTc volume and neurons in adulthood, thereby suggesting a role for BSTc as a marker for gender identity. Still, delayed development of sexual dimorphism in the BSTc would not explain childhood development of gender dysphoria or gender identity discrepancy.

In 2008, Garcia-Falgueras and Swaab were the first to report a sex reversal in the uncinate nucleus. They examined the third interstitial nucleus of the anterior hypothalamus (INAH 3), which is a sexually dimorphic component of the uncinate nucleus, in relation to the brains of transgender individuals.[12] They reported that the mean INAH3 volume and neuron number in 11 MTF transgender subjects were in the female ranges.

The above studies are limited by the fact that they involved postmortem examinations of a small number of brains from MTF individuals, some of whom had either received hormone treatment or surgery. Therefore, the study findings may represent confounding effects from exogenous hormones in a small group of transgender individuals. Despite their small sample size, these studies provide valuable evidence that gender identity is linked to neuroanatomy.

Studies by Luders et al provided further evidence that transgender identity is associated with distinct cerebral patterns.[13,14] In 2009, the group analyzed magnetic resonance imaging (MRI) data of 24 MTF transgender individuals who had not yet begun hormone treatment. These subjects were shown to have a pattern that was more similar to control males. However, they also observed a significantly larger, more “feminized” volume of regional gray matter in the right putamen in these subjects. In 2012, the same group observed thicker cortices in 24 MTF transgender individuals who had not yet received exogenous hormones compared with 24 age-matched control males in a number of regions across the lateral and medial cortical surfaces. The data supported a dichotomy between MTF transgender individuals and gender congruent males with regard to brain structure.

Differences in brain volume and cerebral activation patterns have been proposed as potential explanations for transgender identity. In 2011, Savic et al examined brains of 24 living MTF transgender individuals and found significant volume reductions of the putamen in MTF transgender individuals and significant increases in gray matter volumes compared with male and female controls.[15] Although these findings differ from the findings of smaller, “feminized,” putamens in MTF transgender individuals, they still indicate that certain brain areas in the transgender group have characteristic structural features compared with controls.

The same group investigated 12 living MTF transgender individuals who smelled 2 steroidal compounds: the progesterone derivative 4,16-androstadien3-one (AND) and the estrogen-like compound estra-1,3,5,[10] 16-tetraen-3-ol (EST). These compounds have been reported to activate the hypothalamic networks in a sex-differentiated way. MTF transgender individuals who had not received hormone treatment were found to respond similarly to female controls, with AND activating the anterior hypothalamus.[16] Another study by Gizewski et al showed a similar cerebral activation in MTF transgender individuals relative to female controls while they viewed erotic stimuli.[17] While the above studies only involved MTF transgender individuals, they nonetheless provided evidence of neuroanatomical pathway alteration as an explanation for transgender identity.

The following 2 studies were unique from the aforementioned ones because they included both MTF and FTM transgender individuals who had not received hormone treatment. Zubiaurre et al reported that FTM transgender individuals showed evidence of subcortical gray matter masculinization in the right putamen, while MTF transgender individuals had feminized cortical thickness.[18] In 2013, Simon et al reported differences in gray matter in 17 living transgender subjects compared with controls.[19] Differences were seen in transgender patients in the cerebellum, angular gyrus, and parietal lobe compared with controls, independent of their biologic gender.

White Matter Studies. Although an early study by Emory et al[20] found no difference in the whole corpus callosum or splenium region between MTF and FTM transgender individuals, the following MRI studies of white matter brain characteristics of transgender individuals suggested a strong neuroanatomical explanation for transgender identity. Yokota et al reported that the pattern of corpus callosum shape in both FTM and MTF transgender individuals was closer to subjects with shared gender identities than to subjects who shared the same natal sex.[21] Among FTM transgender individuals who had not received hormone treatment, certain white matter fasciculi involved in higher cognitive functions were closer to the pattern of control males than to control females.[22] Among MTF transgender individuals who had not received treatment, diffusion tensor imaging revealed an intermediate white matter pattern that was between those of male and female controls.[23]

Genetic Factors and Exposures

Although limited in size and scope, the role of genetic factors in transgender identity is supported by small studies of gene abnormalities associated with steroid hormones, twin case studies, neuroproteins, and prenatal exposures.

Steroid Hormone Genetics. Select genes have been associated with transgender identity. Although these studies have been small, they are most convincing findings to date linking atypical genes with transgender identity in both MTF and FTM transgender individuals. The CYP17 gene encodes the 17-alpha hydroxylase enzyme and is associated with elevated serum levels of estradiol, progesterone, and testosterone. In a case-control study of 151 transgender individuals, Bentz et al reported a significant association between the CYP17 gene and FTM transgender individuals but not in MTF transgender individuals.[24] Another study by the same group examined a polymorphism in the gene coding for 5-alpha reductase and found no association in a sample of both MTF and FTM transgender individuals.[25]

Various groups have investigated steroid hormone receptor gene variants to determine if they confer risk of developing transgender identity. Steroid hormones exert profound influences on fetal sexual development and act via specific receptors. It is therefore plausible that abnormal sex hormone receptor function may predispose to transgender identity. However, the existing studies on this topic have been contradictory and require replication. Henningson et al found an association between MTF transgender individuals and a dinucleotide CA polymorphism in the estrogen receptor beta gene (ERb).[26] However, 2 subsequent studies by separate groups reported different results. Hare et al performed a larger study of MTF transgender individuals and found no relationship with the ERb, but they did find a significant association with an androgen receptor repeat.[27] In a similar study of 242 MTF and FTM transgender individuals, Ujike et al examined sex steroid receptor genes and found no association with transgender identity.[28]

There have been several small case reports of atypical sex chromosomes in transgender individuals. The most common association reported was with disomy-Y (47, XXY); however, no statistically significant association between particular genes has been described.[29] Two recent studies of MTF and FTM transgender individuals reported that aneuplodies are slightly more common in transgender individuals than in the general population, but neither was controlled. In the first, karyotype abnormalities were found in 2.5% of the 368 transgender individuals studied.[30] A second study of 302 transgender individuals also showed a low overall incidence (1.5%) of chromosomal abnormalities.[31]

Twin Studies. Twin literature supports the potential contribution of genetic factors to the development of transgender identity. In 2 separate retrospective studies of twin pairs, Bailey et al and Coolidge et al demonstrated a strong heritable component among twins with transgender identity.[32,33] Hylens et al performed a similar study of 23 monozygotic twin pairs and showed that 9 were concordant for transgender identity compared to no concordance among dizygotic twin pairs.[34] Two small studies[35,36] also demonstrated a higher concordance for transgender identity among monozygotic twins versus dizygotic twins. Nevertheless, the overall prevalence of monozygotic twins discordant for transgender identity still outnumbers those who are concordant.

Neuroproteins. Brain-derived neurotrophic factor (BDNF) is a member of the growth factor family involved in synaptic plasticity and neuronal development. Altered BDNF signaling is thought to be a contributor to psychiatric conditions. Fontanari et al[37] reported that serum BDNF levels were 15% lower in an uncontrolled study of 45 MTF transgender individuals. However, all study subjects were treated with hormones, and no female subjects were included.

Neurokinin B (NKB) is a potent regulator of gonadotropin-releasing hormone secretion, which is essential for reproductive function. A postmortem brain study of 4 MTF transgender individuals by Taziaux et al[38] showed a mean infundibular NKB volume similar to control females. The observed feminization may have been explained either by medical estrogen therapy or lack of androgens due to orchiectomy.

Prenatal Exposures. Dessens et al[39] reported that 3 prenatally anticonvulsant-exposed subjects were transgender individuals. For many years, researchers have been assessing the impact of prenatal exposure to the estrogenic antimiscarriage drug DES (diethylstilbestrol) on the development of gender dysphoria in affected offspring. While the vast majority of DES-exposed children have not developed transgender identity, a 5-year online study of DES-exposed sons by Kerlin et al reported at least 150 cases of moderate-to-severe gender dysphoria among 500 sons with confirmed or suspected prenatal DES exposure.[40]

Although no studies to date demonstrate mechanism, multiple studies have reported associations with gender identity that support it being a biologic phenomenon. Table 1 organizes areas studied by study type and lists the associations that have been made.


Current data suggest a biologic etiology for transgender identity. Studies of DSD (Disorders of Sex Development) patients and neuroanatomical studies provide the strongest evidence for the organic basis of transgender identity. Because the sample sizes of most studies on this subject were small, the conclusions must be interpreted with caution. Further research is required to assign specific biologic mechanisms for gender identity.


56. Big Irv

July 21, 2018

Today a friend recommended watching West Side Story and the video about the making of West Side Story.

By coincidence, last evening I spent an hour on the phone with a chum and roommate from my college days, Irwin (Irv) Kostal, who is living in Indio.

We met and were pals when I was on vacation from college and was working that summer at home in New Jersey.  Irv was then going to the local college in my home town and we met at the local ice cream shop.

I soon met his family on Long Island and learned that his father was the music director for several TV  variety shows, (Sid Caesar, Carol Burnett, Gary Moore).   During several visits I got to know his dad, who had the same name as his son and was known as “Big Irv.  My pal was “Little Irv”, which was pretty funny since they were both several inches over six feet tall.   Irv transferred to the University of Chicago and we became roommates in an off-campus apartment.

At some point in those early months of our friendship, Big Irv began working with Leonard Bernstein as the orchestrator for his new broadway musical then in production, West Side Story.  Later, when West Side Story was made into a movie, Big Irv went to Hollywood and began a career as musical director, making movies that included, Mary Poppins, Sound of Music, Charlotte’s Web,  and Chitty Chitty Bang Bang.  His Oscar, as I recall was for Mary Poppins but I could be wrong about that.

In the early days when they were working on the stage version of West Side Story I was hearing Big Irv at the piano working on the music arrangements at their home, which was an ordinary suburban home to which a previous owner who was a dance teacher had attached a 30 by 40-foot dance studio.  That studio became a living-room/work room with a Steinway grand piano and a huge hi-fi system (before “stereo” came along).

Big Irv died in the early 1990’s, and Little Irv lost his second wife a few weeks ago, but my glancing exposure in 1953 to the entertainment world, and music at that level of brilliance seems as if it happened only yesterday.

One other connection.  Though it had always been an open secret in the movie world, most people weren’t aware of the fact that leading ladies often had their singing voices dubbed by vocalists well known in the industry, but who never got a line in the credits.  Such a one was Marni Nixon, who sang for Natalie Wood in West Side Story, and for Audrey Hepburn in My Fair Lady (another one of Big Irv’s films).  I last exchanged e-mails with Ms Nixon a few years ago, when she was still performing in clubs.  

On one weekend visit, I had taken two of my favorite records over to Long Island to share them with Big Irv.  I wanted him to hear two unknown singers I thought were great.  One was Julie Andrews, a young British understudy who had brought “The Boyfriend” to New York when the London star didn’t want to risk it flopping in America.  Big Irv didn’t like the ’20’s “flapper” music.  And the other was singing on a kids record called “The Mother McGoo Suite”, featuring the Mister McGoo cartoon character.  Big Irv scoffed that anyone could sound good using an echo chamber and brought out his example of a great singer, on a record of tone poems by Arnold Schoenberg, with whom he had once studied.  His singer was hitting each note perfectly in sequences of impossibly difficult intervals.

I was impressed, and the voice began to sound familiar to me.  We checked the records.  It was Marni Nixon singing on both of them.

Of course he later worked with both those women in wildly famous films, and, years later, pretended not to remember how he resisted listening to them that day.


55. Gwen, and Robert Moses’ Daughters

October 23, 2019

I didn’t know the man myself, but as a child I often heard his name mentioned by the sturdy but lumpy woman who looked after his daughters, Barbara and Jane, every summer for several years.

Robert Moses was, for half a century, arguably the most powerful man in the city of New York, the planner and so-called “master builder” responsible for its development in the early and mid-20th Century, and for huge projects on Long Island, and in Rockland and Westchester Counties as well.


Before and during World War II, in order to escape the swelter that was New York City, every summer, Moses and his family moved to their place at “The Lake”, where they hired a local woman, Gwen Larlham, to look after their children.   

Gwen was the second-oldest of the five girls and four boys of a woman widowed in 1923, when a drunk driver killed her contractor husband as he stepped off a trolly near a hotel lobby renovation job in neighboring New Jersey. 

After his death, Della had supported her brood by turning their large home, built with his own hands by their husband and father, into a boarding house.  Like the others of her siblings in their turn, Gwennie had gone to work early in order to add her salary to the income from the boarders, and help support her mother and the younger children.

Unlike her eight brothers and sisters who were all extremely bright, Gwen was slower to understand some things than the average person, moved with an awkward, plodding gait, lacked animation, and wore glasses as thick as the bottom of a Coke bottle.  Peering through her glasses her magnified eyes always made her seem like she didn’t quite comprehend what was going on, which wasn’t strictly true.  Her plain face rarely held a smile.  It was as if everyone else had gotten the joke and she didn’t. That was true.  She never got a joke until it was explained.  It was as if she was a few beats behind, trying to catch up with whatever was going on. Still, no one in the family teased her or treated her unkindly.  She in turn, was a friendly and loving person towards others, if seeming a little out of touch and and tentative.

The other eight did very well in high school.  The boys went off to be iron workers and craftsmen in the building trades, one girl became a beautician with her own shop, another an executive secretary. One ran off to Toronto with a handsome Canadian, and another married a tall, shy fellow who could fix anything, was a talented photographer, and made his living as a postman carrying the mail in Hackensack. Gwen, however, remained at home with her mother and worked as a domestic — which is presumably how she happened to be hired the first time to look after the Moses girls.

After which her inclination to treat children as her equal, which in some ways they were, must have helped her form a bond with them that their parents found they could trust and rely upon.

At home, Gwen often talked about Mister-Moses-this and Mister-Moses-that.  With a bit more enthusiasm than one might expect to hear from an employee. But again, it was as if her simplicity had resulted in a trusting loyalty towards Robert Moses and his family.  She often said that he was a very important man.  On the other hand her tone carried no implication of celebrity worship — and in any case, he was not that kind of celebrity.  Most local people had no idea what power he wielded.  Even later, most people didn’t know that it was because he wouldn’t build them a new stadium that the Dodgers left Brooklyn.

Towards the end of the war Gwen met and married George Schafer, a corpulent laborer of normal intelligence,  who had a florid complexion, and who loved her and treated her well.  Rather than Gwen leaving her mother’s home, he moved in with them.  Which turned out to be fortuitous, because a couple of years later George, who was epileptic, had a seizure while digging a ditch on a road project.  He was alone when he fell face down, and drowned in three inches of water in the bottom of the ditch before others found him.

Gwen remained with her mother until Della died in her nineties, then moved in with a niece and lived to a similar age, helping with household chores and with the niece’s children. 

This story is told from the perspective of the ten-year-old that I was when I formed these impressions and I may have mis-imagined some of the facts.  Now, with 75 years of hindsight and a medical degree, I’d guess Gwennie was on the mild end of the autism spectrum and would now be diagnosed with Asperger’s syndrome.  Gwen Larlham was my mother’s older sister and my Aunt Gwen when these events transpired, in Greenwood Lake, New York in the early 1940s.


54. Some Specific Facts About the Federal Court Injunction Sheriff Arpaio Violated — And the Background Context Surrounding the Present Case

January 6, 2018

Deep Background:  The overarching question is whether a nation has a right to decide who may enter through its borders.  Under the principle of national sovereignty established by the Treaty of Westphalia in 1648, one of the powers that characterizes a nation is that only it may decide who enters and who may not.  On the other hand, there are people who assert the argument, on its face utterly absurd, that national borders should be open to any who want to cross them.  

Though they do not often say it out loud, the open borders position is the one taken by many “globalist” liberals and by most immigrant advocates and organizations.  One way they imply this position is by avoiding the term “illegal immigrant” and referring to those who have sneaked across the border as “immigrants” or at most, “undocumented” people, as if permission to enter a sovereign state were not required.

So the first question we need to consider, if only briefly, is, is there still a reason to have nations (with borders) in this present-day world.  A person’s answer to that question will influence how he or she views the rest of the events in this controversy.

Because of its position on the Mexican border, this controversy has played out in Arizona for many years. Under the Obama administration in the most recent decade, the policy of the federal government was that, by executive order from the president, it would not enforce immigration laws.  Under his Attorney General Eric Holder, Obama’s Department of Justice went even further, asserting that it was not the business of the States — in particular, Arizona — to enforce Federal immigration laws.

One further background element:  When Obama ran for president and some questioned whether he was born in the U.S. as is required of a presidential candidate, the AZ Secretary of State — in charge of elections — asked the Sheriff to investigate whether Obama was eligible to be placed on the ballot.  Arpaio’s investigators found that the birth certificate published by the White House was probably altered in Photoshop and contained some errors suggesting it may have been forged.  Many Arizonans, possibly a majority, have felt that later DOJ investigations of the Sheriff were in retaliation for his investigation of Obama’s birth certificate.

An Attempt to Describe and Clarify the Specific Issues in Sheriff Arpaio’s Case

Specific Background: of the criminal contempt of court for which the Sheriff was just pardoned by the President.

After being told that Arizona could not enforce federal immigration laws even though it is one of only four Mexican border states and is heavily impacted by illegal immigration, the state legislature passed two state laws, criminal statutes 13-2008 and 13-2009, making it a Class 4 or Class 3 felony to steal the identity of another person in order to defraud them or to obtain employment — which can mess up the victim’s social security, unemployment or worker’s compensation accounts.  The laws were also amended to make it a felony under the Legal Arizona Workers Act to assume the identity of a fictitious person to obtain employment.

One effect of these laws was to bring anyone who violated them, including illegal immigrants, under the jurisdiction of Arizona law enforcement officials, including Sheriff Arpaio.



A Phoenix-based immigrant rights group (that is careful never to distinguish between legal and illegal immigrants and essentially pretends they are the same thing), filed a class action law suit on June 18, 2014, in the Federal District Court in Arizona, against the Sheriff, the County Attorney and the Director of AZ Public Safety (the state police), challenging the two laws.


Ignoring the identity theft aspect, the suit framed the issue in terms of Arizona intending to criminally punish individuals “who do not have federal authorization to work” (because they have entered the country illegally and have stolen someone else’s identity) simply for the act of securing employment.  The suit says the laws were favored by “Arizona nativists”, meaning legal citizens, “to make life difficult for immigrants coming from Mexico and Latin America”.  (Again, the suit seeks to conflate illegal immigrants with legal immigrants.)

The suit alleged that portions of Arizona Statute 13-2008 and 13-2009 are preempted by federal law and violate the Equal Protection Clause of the U.S. Constitution.

Preemption means that if a government, like a state, makes a law, then no lower jurisdiction, like a county or city, can also make a law covering the same subject matter.

The Equal Protection Clause of the 14th Amendment to the Constitution says: “…nor shall any State deprive any person of life, liberty or property without due process of law; nor deny to any person within its jurisdiction the equal protection of the laws.”

 In this lawsuit the judge agrees that on the face of it as written, the law applies to citizens as well as immigrants and illegal aliens.  On page 20 of the 48 page decision he says that, however, in a case where federal preemption is in question, the court may look at the intent of the statute in question, and that in this case there is an arguable likelihood that there was an “intent” for it to be applied mostly to illegal aliens, who would almost exclusively be the ones needing to use a false or stolen identity in order to get work.   (Not, as I understand it, that this court will decide the equal protection issue in this hearing, but the judge may have used this reasoning to satisfy one requirement for a “pre-trial” injunction: that the maker of the motion for injunction is likely to win on the Constitutional issue when the trial is finally held.   This is called “a likelihood of success on the merits”. )

The judge also decided that there was a likelihood and not just a mere possibility that the various plaintiffs would suffer irreparable harm if the court did not prevent the enforcement of the law while awaiting the later decision as to whether it was constitutional.

Finally, the court found that pubic interest favored an injunction.  Therefore in January of 2015 it granted the plaintiff’s request and enjoined the Defendants “from enforcing ARS section 13-2009(A)(3) and the portion of ARS section 13-2008(A) that addressed the actions committed ‘with the intent to obtain or continue employment’.”

To see thefull text of the Judgement granting injunction:

In this decision the court was not deciding the equal protection issue, but did consider that issue because it was deciding various motions, e.g. motions to dismiss the charges by the defendants and motions by prospective plaintiffs to be a part of the case.  He found the plaintiffs’ allegations plausible, but was not hearing the case in chief, and not, of course, hearing all the evidence that would later be presented.

[On the matter of the equal protection clause of the 14th Amendment of the Constitution, the Plaintiff’s argument might be said to be analogous to an argument that since 96% of murders committed in the inner city are done by black people, laws making murder illegal violate the Equal Protection clause because they will be enforced largely against black people.  The absurdity of such an argument in that context may be used to support the Constitutionality of the Arizona law against stealing identity or creating a fictional one in order to work illegally, even though that crime would usually be committed by illegal aliens.   The Plaingtiff’s argument may be reframed thusly:  Laws against criminal behavior violate the Equal Protection clause because they fail to protect criminals as much as they do those who are innocent.  This is a bizarre case of circular reasoning that will surely fail when the Constitutional issue is tried and appealed. ]

It was the injunction of the court trying only the motion to enjoin that the Sheriff violated, by continuing to enforce the Arizona laws.

When someone violates a court order or refuses to do what a judge says, he or she is said to be holding that court’s order in contempt and is said to be, “in contempt of court”.  

In many cases the court may find that person in “civil contempt” which is defined as follows:  

Civil contempt generally involves the failure to perform an act that is ordered by a court as a means to enforce the rights of individuals or to secure remedies for parties in a civil action.

However this judge found Arpaio guilty of criminal contempt:

Criminal contempt involves behavior that assaults the dignity of the court or impairs the ability of the court to conduct its work. Criminal contempt can occur within a civil or criminal case. For example, criminal contempt occurs when a witness or spectator shouts or insults the judge during a trial. A civil contempt usually is a violation of the rights of one person, whereas a criminal contempt is an offense against society. Courts use civil contempt as a coercive power, wielding it only to ask that the contemnor comply with the courts’ actions. Criminal contempt is punitive; courts use it to punish parties who have impaired the courts’ functioning or bruised their dignity.

Therefore, he was facing jail time until he received a pardon from the president.  A pardon means that he is declared innocent and the crime is not part of his record.  Every president pardons a dozen or two people, many of them on his last day in office, all of them having been convicted of crimes and many of them while serving their sentences.  These pardons are virtually always “political” in nature.

Though pardoned and declared innocent, Sheriff Arpaio was left with hundreds of thousands of dollars of legal fees, for which to this day he seeks contributions from his many supporters.


53. When they started calling doctors “providers”

August 2, 2019

As a once-upon-a-time journalist, and to some extent a propagandist,  I was very sensitive to and suspicious of this linguistic trick when it was first applied by those in government who favored Kaiser’s HMO model, what, forty years ago ?  Sure enough, within a year, insurers began encouraging and covering visits to “providers” with training one or two orders of magnitude less intense and extensive than that of physicians.

It has been the frog in the pot-of-water-heated-gradually ever since.  Physician-control over “health care” (which used to be called “medicine”, remember ?) was taken over by stealth, and the standards, methods and means of rendering medical care was relinquished by doctors themselves into the hands of the business class.

Keep in mind that Business Ethics is the prototype oxymoron.

When I worked for a large airline as the director of one of its busy regional medical departments, I had a decade to ponder the question of who, in a business hierarchy, it the “boss”.  After about 30 years in private practice, and the last 20 as a solo practitioner, I was able to conclude that the person who tells you how you will spend your working hours and can hire and fire you is the boss, no matter how exalted your title.

Not too many decades ago it was illegal in my state for a corporation to practice medicine.  A good call, because if a patient walked into my office with the personality characteristics displayed by the average corporation, I would, as was suggested by a famous Canadian film documentary, diagnose him or her as sociopathic.

Those who coveted the control of doctors over medical care have followed a clever strategy, because by gradual encroachments they have avoided provoking doctors into a direct confrontation of powers, in which they would have lost.  And they have trained a generation of doctors in the submissiveness that will prevent them from ever reclaiming what was once their profession.  By preferring to concentrate on the technological aspects of medicine and the satisfactions of patient care, physicians have now become incapable even of understanding the concept of a profession, much less of being able to reclaim their own.  Because, as people who have always tried to please their parents and their teachers, they are constitutionally incapable of doing anything that would incur the displeasure of patients or authorities – or virtually anyone.

Someone once said that other than direct force, which I do not advocate, the only power we have over others is to withhold ourselves from them.  It is because of this that the STRIKE has been the driving force of the union movement.  But thus far, physicians have been unwilling, except in very isolated cases, to strike in order to resume control over how they spend their time and to what standards of care they will respond.  As a consequence, 60% of their time is consumed proving to people who are incapable of understanding their explanations, that they have reasons for what they do.

Ironically, because doctors are forced to waste that time, they no longer have time to spend with the patient, listening, thinking, and explaining what is going on and what needs to be done.

We have become the “providers” they wanted us to be, and now we provide CONSUMERS with the products of the limited imaginations of our bone-ignorant bosses.  We provide what THEY, totally untrained in medicine, THOUGHT medicine was providing.  And we have given up what was, unbeknownst to them, the essence of our professional value, the healing relationship we had with our patients, and the unbending adherence to our professional standards of care.


52. A Jump-Rope Song

September 27, 2020

One of the mysteries of life is what our brains are doing when we are asleep.  We now know it is not simply a matter of recharging their energies, and that the brain is, for instance, actively processing and forming memories.  And that problems we pondered before going to sleep are often resolved when we emerge from sleep.  But our knowledge of the brain asleep is still very sketchy.

This morning I stumbled out of bed, peed and washed my hands and face.  As I placed the sliver of soap back in the dish, a bubble dome, about an inch in diameter, formed on top of it, and instantly, in the sing-song voices of little girls, a fragment of the words of an old jump-rope song, not heard in 80 years, came into my head:  “the next day he died with a bubble in his throat”.

A few minutes later I found on line, and immediately recognized, the rest of the song.

Lulu had a baby, 

his name was Tiny Tim; 

she put him in the bathtub 

to teach him how to swim.

He drank all the water, 

he ate all the soap, 

the next day he died with a bubble in his throat.

Now I am wondering about jump-rope and the songs from children’s games.  I remember learning that “Ring around the rosie;  Pocket full of posies;  Ashes, ashes; all fall down”, is from the time of the bubonic plague, when flowers were used to ward off contagion, and perhaps the smell of death, and the bodies and belongings of the dead were burned to ashes to stop the spread.

So how did I know then, and why was it so, that girls were expected to jump rope and boys could not, except on the occasional dare from the girls?  I think I took the dare once, maybe twice, but knew it couldn’t be a regular thing.

Ah, well, I spent a pleasant hour just now browsing through the metaphorical and allegorical meanings of jump-rope songs and nursery rhymes.

How does this connect to recent conversations here?  Well, in many cases the true political meanings were concealed in nursery rhymes because adults were not free to speak of them.   To speak against the king resulted in severe punishment, just as today, speaking against the established mob, (the one that designates itself as the arbiter of political rectitude), results in threats to, and assaults upon those who dare it. 

Whereas centuries ago in Europe it would have resulted in actual decapitation, now that is still true only in existing islamic theocracies or among those who aspire to establish them.


6. Tulsa County Deputy Mistakenly Grabs Gun Not Taser…

June 21, 2020

[Ed. Previously published April 16, 2015.]

There are some things about which I know very little. This is not one of them.

As many in the press have been too quick to proclaim, this case does point out a serious problem with the policies that govern the behavior of the police in this country. But the press, impelled by the desire to be the first to sensationalize an event and fan the lucrative flames of racial hatred and civil discord, have it ass backwards. 

They immediately raised the alarm because the Tulsa County deputy was a 73-year-old man and a volunteer who also donates a lot of money and equipment to the department.

“Wealthy donor… who pays to play cop” is the way the RAWSTORY blog put it, and every other news outlet including CNN questions whether his age was a factor. 

NBC news referred to the usual “unarmed black man”, ignoring the fact that the man, a drug and gun dealer on PCP, was fleeing from the scene of a sting wherein he was recorded selling a pistol to an undercover cop. Caught after a chase, he was struggling with police, pinned prone on the ground. Under the circumstances the only safe assumption was that he was still armed, given that he had one hand under him in his waistband and was refusing to take it out to be handcuffed.

Yet the media story became about a volunteer deputy, “playing” cop, who was assumed to be untrained and incompetent, who grabbed the wrong tool and shot the “black man” who proved, after the fact, to be “unarmed”.

First let‘s stop and recall that the exact same scene played out in Oakland, California a few years ago. There, a Bay Area Rapid Transit (BART) cop tried to tase a black teen, resisting on the train platform as cops, pinning him on his belly, struggled to arrest him during a manhunt for several black youths who had immediately previously been using a pistol to intimidate train passengers. At the time his department foolishly didn’t specify that the service pistol and the taser were to be worn on opposite sides of the duty belt. In the heat of the struggle, the officer grabbed the wrong one and shot the teen in the back thinking he was tasing him.

In that case the narrative advanced by the press and the black community included the implication that the cop was young, inexperienced and likely undertrained. There was also, as there will surely be in this case, the assertion that he was careless because, to him, black lives did not matter. Never mind that this latter allegation was completely contrary to anything anyone knew or learned about the officer before or after the incident. When he was found guilty of involuntary manslaughter and not intentional murder, there was raging, rioting, looting, and arson in Oakland, resulting in the arrests of 80 people. 

Returning to the matter at hand, in the interest of full disclosure I must reveal that I have been a volunteer with the Sheriff’s Office for a few years each in two separate counties. I was a ham radio operator member of the Alameda County S.O. Communications Team, including the time of the Oakland shooting, and heard second-hand accounts on the very day of the incident from the deputies of the Special Response Unit (SRU) with whom I also volunteered on the Sheriff’s 85-foot, high-speed patrol boat. At the time I, too, was in my mid-seventies.

We ham operators who were part of the disaster and emergency communications team did not participate in any law enforcement duties, though it was a slightly different story on the patrol boat. That boat assisted the coast guard in dangerous cargo inspections of incoming freighters, including, on one occasion, escorting a captured Colombian drug ship carrying half a billion dollars worth of drugs. Because there were many similar port security circumstances in which our patrol boat and everyone on it could possibly have become engaged in a fire-fight, (think McHale’s Navy without the torpedoes, but with the machine guns). the civilian volunteer on the boat (that would be me) was required to have a Concealed Carry Weapon’s permit, rare as hen’s teeth in California and requiring eight hours of annual training in the classroom and at the pistol range. Moreover, in both counties in which I served, volunteers underwent the same F.B.I.-based background check as applicants for sworn deputy positions.

But the chance I would ever have to participate in combat in Alameda County was extremely remote, and my main duty, in addition to setting up and operating ham communications between the boat and the County Emergency Operations Center, was to help the chief engineer with engine maintenance and repairs.

Far different when I moved a few years later to the Phoenix area and joined the Maricopa County Sheriff’s Office Communications Posse. That county is larger (9,226 square miles) than five different states and the District of Columbia, while being home to just under four million people. The sheriff enforces the law with something under a thousand sworn deputies, augmented by a number of specialized “posses” totaling about 3500 men and women of all ages.

In Maricopa county there is an extensive training curriculum through which posse members can qualify to, for instance, direct traffic, use restraints, (cuffs), search and transport prisoners, and even carry and deploy tasers, pepper spray and firearms. It can take a couple of years to go through all the training. I know because I took about half the training: including engaging in hand-to-hand combat with criminals. That training was very illuminating to me, as I was at the time approaching 80, my age at the time of this writing. I was doing well enough on gym mats with classmates a third my age who were only engaging in mock combat with me. The only reason I didn’t complete the training and go on to the pistol range, where I am already more than proficient, is because there came a time when I had to repeat all the techniques I had just learned, but after being sprayed in the face with real pepper spray. That I could not allow. For one thing I’ve had both cataract and glaucoma surgery on both eyes. For another, I have extensive scarring in my lungs from a pneumonia I had ten years ago. I simply couldn’t allow myself to be sprayed in the face with and to breathe capsaicin. As it turned out, there was no possibility for a waiver, since a posse member’s life, and that of the deputy with whom he or she is working, might depend upon being able to fight and call on the radio for help after being sprayed with pepper spray. 

In Maricopa county a posse member may volunteer for patrol duties, riding with a deputy, or for transporting prisoners to jail from the point of arrest in cage-cars. Qualified, armed posse (QAP) members may volunteer to assist at DUI check-points or go out with task forces serving felony warrants.

I had a major epiphany as I underwent the training in the application of “less than lethal” force. Not only did I finally fully concede that I was a fat old man incapable of taking down a tattooed psychopath with muscles developed at a jailhouse “muscle beach”,  but it became clear to me at last what we actually ask our police men and women to do when they go to work each day. They are expected to chase down and wrestle physically with the scum of the underworld, without killing them or applying any force that some political activist sitting safe in an armchair with a permanent animosity towards cops will, after the fact, decide to call “unnecessary”.

In the back of my mind had been the illusion that it would be sufficient that while I might no longer be able to fight, I could still shoot the eye out of a gnat.

As a physician and surgeon, standing in the operating room for hours repairing actual consequences, I know that real fights are not like the movies or TV, where actors trade punches for several minutes, only suffering a smear of fake blood at the corner of the mouth when it is all over. In real fights a single punch can collapse the bones of the face like eggshells, resulting in several months of surgeries followed by only a partial restoration of function. Or a broken blood vessel in the brain can result in death within minutes. 

To me it is perfectly clear that someone who throws a simple punch at me is putting me in real danger of grievous bodily harm or death, justifying the use of deadly force in self- defense. But the segment of the public with inverted values doesn’t see it that way, and insists that the police who protect the community use, even at the risk of their own lives and in the heat of the moment, the least possible force, doing everything to avoid hurting the poor drugged out, drunk or insane psychopath coming at them. This bizarre combination of medical ignorance and belief in movie “fight mythology”, is compounded by racial politics when the criminal is black. 

In the black communities of the inner city the prevailing narrative has become that the police are to be mistrusted and reviled, and that black young men are “unarmed” and “innocent” even when engaged in serious crimes. It is as if many in the black community feel that on the basis of past mistreatment, blacks have “earned the right” to be criminals, and to flee from or fight with police when apprehended.

It seems reasonable to suspect that this inversion is somehow related to that which has been found in sociological studies in school systems. Whereas popularity seems to track along with academic accomplishment among white students, among black students popularity and esteem are bestowed in inverse proportion to academic ranking. Black students who do well in class and speak standard English become objects of contempt among other black students. Those who copy the speech, dress, behavior and values of their fathers and older brothers in street gangs and county lockup are the sub-cultural leaders. 

On the street in the inner cities, the cops are fair game and the cons are the folk heroes. According to my observation of what is reported in the media, this false narrative is shared, or at least exploited by anarchists, liberal activists, the media, academics and the liberal white establishment, who consistently minimize the significance of criminal values and behavior, and wildly exaggerate or wholly invent the misdeeds of the police. For the average street cop, most of whom, naturally, are assigned to patrol the areas of highest crime, the general adoption of this inversion of values, and concomitant restraints on police behavior has amounted to handicapping the good guys and giving the advantage to criminals. It is as if, “no good deed goes unpunished”.

In a world where one is expected to use Marquis of Queensbury rules while fighting with 250-pound street thugs, what of the aging officer, slower and fatter than when a youth? What of smaller officers? Outnumbered officers? What of women officers? Do we have the resources to pension police officers off like millionaire athletes when they begin to lose peak physical conditioning?  Or like movie stars when they begin to show a few wrinkles?

Now on the steepening downslope of senescence, when I was undergoing volunteer posse training I had little interest in elective courses in the use of pepper spray or tasers. Instinct told me that my only chance of surviving an assault by a younger, quicker, stronger attacker would be to shoot him dead. That, essentially, would be the “least possible force” I would be able to employ successfully.

Not a problem for me philosophically or morally. If some big guy comes at me with the expressed intent to throwing the old guy down and kicking him to death, he has just forfeited his right to live.

What my police training revealed to me, not in so many words but very clearly, was that shooting an attacker is not what the community expects of its police officers, and that in my present aged state I am not a good match for the job.
Even though I would not have volunteered for any of the overtly dangerous jobs, law enforcement volunteers in Maricopa County are advised that whenever they are wearing the uniform, indistinguishable for that of a sworn deputy save for the fine print on the shield, they should wear bulletproof vests, because the uniform is a target for bad guys. Predators seek out the defenseless. 

At 2 pm on New Year’s Eve in 2013, an Arizona police officer was in pursuit of several men fleeing in a car from the scene of an armed robbery. When they crashed at an intersection the officer jumped out of his car and approached the suspect vehicle. To prevent them from driving off again, he ordered the men witnesses said looked like NFL line-backers, out of the car. Immediately the men grappled with the officer, trying to get his gun.

A 63-year-old Sheriff’s volunteer posse member in civilian clothes, having been stopped in the intersection because of the collision, jumped from his truck and ran to assist the police officer, just as one robber gained control of the officer’s pistol. The felon shot first at the man running to help the officer, hitting him in the center of mass. The bullet exploded his stomach and fractured his liver and one kidney. Then the bad guy shot the officer. Both survived, but the posse member just barely. All but ruined financially by months of hospital bills, the posse volunteer was refused the usual workers compensation medical coverage because he was not under a deputy’s orders at the time he ran to help the city cop.

Was he too old to try to help?

In my own late seventies I had decided even before my training that I would never volunteer for duties that involved backing up a deputy on patrol. Bad enough if I were not able to assist him or her fully. It would have been even worse, I reasoned, if in a dangerous situation the deputy, in addition to everything else, also had to worry about my safety. It would defeat the whole purpose of volunteering. My original intention in joining the posse was to help my community by using ham communications to back up county radios during time of disaster or emergency.  As I mentioned, I only took the more advanced training because I would only have felt safe while wearing the required deputy’s uniform if I had been armed. 

Regardless: when did it become acceptable for a criminal to attack any deputy, regardless of age? When did we turn our sympathies and our support upside down, and give them to the criminal instead of the lawman? This is an idea so absurd and indefensible that the only way to argue for it is with racial demagoguery and rioting. It is because there is no reasonable argument to be made that supporters of a false narrative turn to bullying and intimidation. 

The outcome I fear is that there will an outcry by the usual advocates of racial anarchy, one of whom, in 2015 at the time of this writing, is an advisor on racial policy to the President. Moreover, I expect an inquiry may be pursued by the federal Department of Justice under its racially biased leadership, to attack the policy of using volunteers in local policing. While both the national and the local Tulsa County issues are worthy of close review, deliberations should not be contaminated by the present atmosphere of racist animosity against the police. In my experience, there is a lot more good about the institution of police volunteerism than there is bad.