Happiness

September 1st, 2010 by lost_wanderer

An abbreviated list of what makes people happy includes:  You have to find out what is true for you, so most happiness advice is only true most of the time.  Happiness is a way to travel, with a life filled with frequent, simple, small, positive experiences.  Happy people have reasonable status, are both technically and socially competent, and are successful.  They have low stress and feelings of guilt, get enough sleep, have good perceived health, access to nature, and a sense of control over their lives.  Community, spirituality, and good individual relationships are important for happiness.  Living under a good government is important.  It helps immensely if you love your work.  Happy people are optimistic and grateful.  Symbiotes can help.  For the rest of the details read below.  

The advice in this post should be used in the same way clinics often use psychological assessment tests.  (For examples, see Psychological testing – Wikipedia, Psychological Test List, and Neuropsych Tests)  A client comes in, and for the first few days he is given a whole battery of tests covering just about everything imaginable.  Then a counselor sits down with him, goes over the results, they narrow down where the problem areas are, and then they proceed from there.  Some of the advice in this post will be in tension with other advice in it.  For example, “You should delay gratification for greater rewards in the long run.” versus “Try to live in the moment, not in the past or future.”  The way to think about this is that there are many ways in which people can be less than fully functional.  So, you’ll need to tailor any advice to your life by reasonably applying it to your specific situation.  If you tend to worry excessively, you will need to try to worry less, and learn to take reasonable risks for the greater gains.  But if you’re a risk freak, then you might need to work at being more cautious.  The first step then is to take stock and ask yourself the question, “What in my life is causing me problems?” and tailor your approach accordingly.  Also, don’t fall into the trap of becoming a slave to any “happiness advice rules.”  Be flexible, generally act in moderation, and do what works for you.

What a person brings to life (their personality, likes and dislikes, abilities, temperament, skills, and habits) determines their happiness to a fair degree, and therefore to some degree our happiness is out of our control.  For example, our inborn degree of extroversion is an important variable in determining our happiness.  Relative to the current range of environmental variation (1), about 50% of people’s happiness depends on their genes.  But, this leaves us with the other 50% to work with, which allows a lot of room for improvement.  Approximately 10% of the total is a result of various identifiable life circumstances, such as health, SES, marital status, and income.  And 40% is some combination of unknown factors, along with the actions that individuals intentionally take to make themselves happier, or not.    

If you want to intentionally work at improving your happiness one thing you need to develop is a looking-down-on-yourself-as-a-subject metaperspective on your life.  So a good habit is to keep a happiness diary.  You need to figure out what’s true for you.  Because we often know our own nature better than others do, and often have our own interests more at heart, a good general rule is that people who set their own agendas in life are often happier than those who don’t or can’t.  This is one of the reasons why freedom and happiness correlate.  Another reason is that freedom implies status and respect in a community, because the fact that you can’t make choices to the same degree as your peers is often a sign of inferior status.  So you need to know yourself, and be able to act on that knowledge, to fashion a life that’s grounded in what’s best for you. (2)  But, having said this, unlimited freedom isn’t the ideal state either.  Routines are comfortable and familiar, and help us by limiting our choices.  Research shows that although people believe they want endless variety and choice, they’re actually happier with somewhat more limited options, otherwise they can become overwhelmed.  As with many things, freedom also needs to be in moderation.

However, there’s one problem with the plan of finding out what’s true for us.  As bad as other people are at running our lives, we aren’t necessarily very good either.  (It’s just that other people are generally even worse.)  It turns out that people are quite bad at predicting what will make them happy. (Stumbling on Happiness by Daniel Gilbert)  They consistently remember bad things in the past as worse than they were at the time, and they make the same mistakes over and over in predicting how various hypothetical circumstances will affect their happiness.  For example, when people are asked how happy would they be if they were paraplegic many people predict they would be miserable.  It turns out that, while parapaglics might be not quite as happy as before, they often aren’t miserable.  The reason they aren’t miserable is that we don’t react to the world as it is, but to how we perceive it, and we have some control over this.  People are very good at adapting to bad things by changing how they see the world, and our inability to account for this when given some hypothetical explains why our imaginations fail us.  One way to fight this tendency is to ask people who are actually in the hypothesized situation how happy they are.  This turns out to be a better predictor than a person’s introspection usually is.  So, even though people vary in what will make them happy, the average of other’s experience is still better than we can do in predicting how happy we will be in some situation we’ve never experienced.  This is why it’s important to try all sorts of things for ourselves, because through this process we find out who we are, and what works for us.  If you think about it, it shouldn’t be the least bit surprising that people are bad at knowing what will make them happy.  If people were actually good at this, then there wouldn’t be much point in doing happiness research.        

As many people have said, “Happiness is a way to travel, not a place to get to.”  Along these lines one key to happiness is setting up your life so that you generally have something good to look forward to.  Living in this way supports optimism, and also dovetails with the finding that happiness tends to grow out of small, frequent, regular, and dependable positive experiences,  which are habits that are part of a routine.  As such, a person’s happiness can often be best understood by looking at how their ongoing activities operate in their life.  A change in a person’s life that involves pursuing a goal or engaging in a new activity (joining a club, beginning a new hobby, learning a new skill, changing careers, making new friends) will usually change a person’s happiness for a long time, because they are now in a constantly changing environment that provides a series of novel happiness enhancing experiences.  By contrast, even an important change in a person’s material circumstances (getting a new house or new car) will usually result in only a temporary rise in happiness.  This is because people become acclimated to the static facts of their new lifestyle as they roughly have the same experience over and over.  (Why Are Some People Happier Than Others? by Sonja Lyubomirsky)  This contrast highlights the fact that happiness generally doesn’t grow out of possessing things, but out of doing things. (3)  Dr. Michael Fordyce summarizes the idea that happiness often grows out of a series of small positive doing-things experiences by employing what he calls the “Time Clock Theory of Happiness,” and argues that a person’s happiness is largely determined by the content of their thoughts over time. (Happiness Research Website)  What this suggests is that you should try to find simple pleasures you enjoy and distribute them throughout your day. (4)  (Savor the Little things – Zen Habits)  If a person regularly engages in activities such as having sex with someone they love, spending time with friends, relaxing, learning new and interesting things, challenging herself with new projects, and meditating (Meditation – Lost Wanderer) she will probably be happier.  And if she can limit distasteful activities, such as long commutes and boring or stressful work, it’s so much the better.

In addition to simple pleasures, there are a number of general factors that for many people tend to color their overall life satisfaction: regularly getting a good night’s sleep, having a low level of stress (since stress tends to maintain depression) (How NOT to Multitask – Work Simpler and Saner – Zen Habits), living in quiet surroundings (Stress and Noise - Resources for Science Learning – The Franklin Institute), having high self-perceived health (5), engaging with nature, and having respectable statusDepression tends to be associated with social rejection and emotional isolation (6), living in fear, unrelievable pain, and having a low sense of control over your life.  Dr. Steven Ilardi, in his book, “The Depression Cure,” argues that our transition from the hunter-gatherer lifestyle to modern civilization created a mismatch between our biology and the environment that reduced our happiness.  Some of his recommendations are that we should consume at least 1 gram/day of omega-3 fatty acid (because it’s anti-inflammatory)  (For example, see Natural Factors Omega-3 Pharmaceutical Grade Fish Oil – Lost Wanderer), get enough sleep (most people need 8 hours/day) (7) (Sleep Related Topics – Lost Wanderer and Sleeping Like a Hunter-Gatherer – Lost Wanderer), eat a healthy diet (The Paleolithic diet – Lost Wanderer), exercise (Move Natural Exercise – Lost Wanderer, Pole Dancing & Belly Dancing are Good Workouts – Lost Wanderer, Lifting Depression by Kelly Lambert – Lost Wanderer, RossTraining.com, and Conditioning Research), and get 30+ minutes of sunshine/day. (8)  Another very important factor I can add to his list is our natural biological symbiotes, such as various helminths and protozoa, which we need in order to function normally, and lost during our transition to modernity.  For example, the common soil bacterium Mycobacterium vaccae seems to have strong antidepressant effects, which might help explain why so many people enjoy gardening. (Is Dirt the New Prozac - Discover Magazine, See also, We Need Our Symbiotes – Lost Wanderer)  Johns Hopkins researchers have written that a majority of subjects in a 2006 experiment reported an increase in life satisfaction over a year after taking psilocybin a single time.  Many of the volunteers described the experience as an especially spiritually significant one.  (Magic Mushrooms – Lost Wanderer)  Another natural antidepressant of note might very well be semen. (Semen acts as an Anti-depressant – Lost Wanderer)  And some of the natural environmental stressors people used to be exposed to might also be very helpful.  (Adapted cold shower as a potential treatment for depression – Lost Wanderer)   

The evidence for the relationship between money and happiness is mixed, and sorting out all the confounding variables will take researchers some time.  National income has greatly risen in the last 50 years, but national happiness levels haven’t changed.  (I suspect that this is because if everyone is on average richer, then no one’s relative status has changed, and status is often the reason why having money is important for happiness.)  The happiest states are the poorest ones, and the least happy are the richest.  Yet, rich people are happier than poor people, (My guess is that this is mostly because rich people have higher status and they have a greater sense of accomplishment.) and rich countries are happier than poor ones. (Rich countries generally have more honest governments.  See below, “trust and confidence in their government.”)  What researchers can say right now about money is that having lots of it usually won’t make you happy, because it has rapidly diminishing returns past some point.  It seems that money helps if it can be used to access those things that increase happiness, and to reduce those things that lead to unhappiness.  So, if someone can use a raise to get enough sleep, eat a healthier diet, have a greater sense of personal freedom, etc., it might very well help.  And if that raise can be used to reduce or remove pain, stress, insecurity, anxiety, being trapped in a job you hate, not being able to get good health care, having low status/being looked down upon, being forced to interact with people you don’t like or trust, not having access to nature, etc., it would be likely to increase happiness.  Today in America, money’s effect tends to top out at about $50,000/year, and after that its returns drop.  As a dramatic demonstration of this, in a study of 22 people who won major lotteries, researchers found that after some time these people were no happier than matched controls who hadn’t won. (Lottery Winners and Accident Victims: Is Happiness Relative?)  (It also seems to be the case that earned money correlates with happiness far more than won money. (Can Money But Happiness? By Arthur C. Brooks) (9)  Money spent on acquiring things often doesn’t increase happiness, because trying to buy happiness puts you on what has been labeled the ”hedonic treadmill.”  The pattern is that a new possession will give you a temporary boost, but then you will fall back to your previous level, and you then need to buy something else to get another boost.  Since the tendency is to have to up the ante each time, it’s a race you can’t win.  From reading this post, you might reasonably conclude that it does make a lot of sense for someone to say, “I’ll be happier when I have an income of at least $50,000/year, a job I love, good friends, access to nature, etc.  But all too often what people are saying is something like, “I’ll be happy when I get that big raise or promotion.”  To fight this money trap one piece of advice is, instead of comparing yourself to others who have more than you, use downward comparisons.  Read stories about people going through catastrophes. (Recommended happiness reading – Memoirs of illness and catastropheThe Happiness Project)  Compare yourself with those who have less than you, who have gone through tragedy, and who are struggling.  Make a list of all the positive things in your life: friends, family, a job you love, good health, enough food, etc.  You might come to see that you are blessed.  And if your circumstances are very bad, stories where someone overcame incredible hardships inspire you to believe you can also.  It’s OK to have material goals, but you shouldn’t fall into the trap of thinking you’ll be happy when you reach some high material accomplishment. 

The same principle also applies to very high status.  Try to focus on that you have accomplished, not on what you haven’t.  It is certainly true that having high status helps happiness, but it too has diminishing returns.  And if your self-esteem comes out of a title, then losing your job is a catastrophe.  This explains why the loss of a job is very bad for happiness, since people lose self-respect and expect to be seen as a failure by family and friends. You need to remember that your job isn’t you, and avoid the status trap.  So don’t envy others’ great wealth or status, if you do you’re probably living an unbalanced life and targeting the wrong goals. (10) A good strategy to achieve maximal happiness is to invest your energy in a balanced way in most, if not all, of the various factors that contribute to happiness.  Once a category is above a certain level, you’re probably misallocating resources if you are trying to drive it to the sky.  Keep your priorities balanced, and practice moderation in most things.  Indulge yourself occasionally, but don’t make indulgence into part of your lifestyle.  Obviously, addictions and compulsions can ruin lives. 

The advice in this post is geared for those people who have enough to offer such that they can fit into some sort of reasonable community.  In short, you aren’t that toxic person everyone else is rejecting.  Living in a community requires a degree of honesty, and, like most things in life, honesty involves tradeoffs.  There are clear benefits to deception; otherwise our capability for it would never have evolved.  There are many circumstances such as war or negotiation, where unvarnished honesty would drive you from the field of battle.  Likewise, individuals with little to offer often end up in the unenviable situation of having problems they can’t ignore, and they can’t solve in any honest way.  While the compromises such people fashion might entail large costs, they also might be the best they can do given their limited resources and capabilities.  In addition to habitual dishonesty, a whole panoply of dysfunctional behavior patterns (drinking, engaging with prostitutes, habitual pornography, gambling, etc.) sometimes can be viewed as coping mechanisms used by those who have no better options.  If you aren’t in such an unfortunate situation, fitting into a community as a respected member can be the path to a happier life.  We need a place called home.  A community of people is a group who care about each other (which lowers the stress response), participate together in meaningful activities, who believe in the system, and are mutually invested in a common set of rules.  The nature of community makes it an ongoing enterprise.  Cooperation is fostered by shared fate, and the expectation that people will interact into the future.  In this way reciprocity and equality are encouraged, and cheaters are punished and driven out.  People often have common interests, a common background, propinquity, and support each others’ dreams & goals.  So, you should use the power of others to help achieve your goals, and listen to good advice from trustworthy friends.  (The Evolution of Despair by Robert Wright – Lost Wanderer, The Importance of Belonging and Community – Lost Wanderer, and The Uplift Program for Happiness - Lost Wanderer)  Having said all this, if you are so dysfunctional that you are toxic, you should look to other sources for happiness advice. (The Origins of Violence: Is Psychopathy an Adaptation? by Ian Pitchford

Good relationships are a very important determinant of happiness for almost everyone.  (Rejection Creates Resentment – Lost Wanderer)  One of the many reasons for this is people need motivated conversation.  We must feel needed.  Research indicates that it’s more important to worry about having around five good friends rather than a lot of them.  Extraverted people are happier, and if your social circle is lacking you should try to meet some new people.  (Succeed Socially.comGood family relations and a significant-other long-term loving relationship help a lot.  Married people are happier than the unmarried, and widowhood is bad for happiness.  (Although it isn’t clear what impact having children has on happiness.) (A Simple Statistical Method for Measuring how Life Events Affect Happiness, The Math of Love – Lost Wanderer, and For those who are Contemplating Marriage – Lost Wanderer) (11) 

But, this raises an obvious question, “Just what is a good relationship?”  In order to have good relationships we have to do our part.  To have good friends we have to be one.  One starting point is to remember that people don’t remember what you said so much as they remember how you made them feel.  The advice people give on the topic of friendship is commonsensical: 

  • Be polite, be fair and follow the rules. (12)
  • Don’t maliciously lie (lying to protect someone is more of a judgment call). 
  • Keep your wordpay your debts, take what’s yours, and be patient and flexible. 
  • Don’t react in anger.  (If you’re angry count to 10, and wait 24 hours before sending an angry email) 
  • Try to not hold grudges, and follow the golden rule. (13) 
  • Practice compassion by putting yourself in their shoes. (14) 
  • A good relationship will have: trust, respect, appreciation, and enthusiasm.  It will be transparent and have open communication with people able to, for the most part, freely express their needs and feelings while empathizing with one another.  (15)  You will be involved, accessible, engaged, reliable, and committed.  (A New Scale to Assess the Therapeutic Relationship in a Community Mental Health Care: STAR
  • Of course, it’s a two way street, and you should try to hang around with people who also do and are these thingsHappiness is a team sport.  In the end we should try to interact with people we like and who like us back, and be with the people we can count on when the chips are on the line.  (16)  (See also, Fighting Fair in Relationships - Lost Wanderer
  • Take responsibility for what you do. 
  • Happy people are emotionally stable and socially competent.
  • You should try to live your values, and know your moral bottom line
  • Keep it real.  Can you take what you say seriously? (17) (18)    

Stephen Pinker, in “How the Mind Works“, discusses two mechanisms that can contribute to creating strong friendships.  First, if people share a rare common interest they will often naturally generate positive externalities for each other.  For example, if two people both like an esoteric genre of music they can share advice about it, and they become more valuable to each other.  If two people are more valuable to each other this results in a positive feedback cycle, because each can more likely count on the other for aid.  Because each is not only a source of advice, but also aid, they see each other as still more valuable.  This process iterates in an upward spiral.  Second, in similar fashion, if John has a special area of expertise that Susan values, and can’t easily substitute for, then he becomes valuable to her.  He will know that he is valuable to her, which means that he knows he can more likely count on her for aid and support.  So as a result she now becomes more valuable to him.  She now knows that he thinks she is valuable to him, so she can now count on him for more support.  Again, the same upward spiral occurs.  These two mechanisms highlight the importance competency has.  Happy people are more competent people.  The more competent you are in general the more you have to offer.  Having more to offer, you will attract others who will also have more to offer.  So you should find the things you’re are good at and love to do, and develop these areas.  One strategy is to ask yourself, “What’s in short supply?”  Then try to make yourself an indispensible expert, and find those who will value most what you have to offer.  (The Evolution of Happiness by David M. Buss)  The idea is not that you are helping people in a bean counting tit-for-tat way, but if you can help generally, by being able to give to people what they can’t get from others, you can build friendships. (19)  Happy people want the best for those around them, they like other people, and help people when they can for their own sakes.  Help people problem solve, share their goals, help them find a silver lining, and be on their side/team. (20) (21)  All of this will create confidence in everyone involved.  Besides sounding nice, it turns out that it’s also in our own self-interest to increase the happiness of those around us, because people catch emotions from others.  Happiness spreads in society in waves, much like a viral infection, and your happiness somewhat depends on the happiness of people who are 3 degrees of separation from you.  (Happiness is Contagious – Lost Wanderer)   So try to do one thing every day to make someone else happy.  In marriage if one partner is happy the other also on average will be happier. 

We are a social species, as evidenced by the large number of social emotions we have for regulating our interactions with others: guilt, shame, self-righteousness, loneliness, jealously, love, modesty, resentment, contempt, gratitude, approval, pity, etc.  Humans evolved in small hunter gatherer groups of 50 to 200 individuals, and most of these were kin.  So continuous face time is the default setting, and it was the norm for 99% of human evolution.  In the hunter-gatherer days being in a tribe in which you trusted the collective decision making of the group would have been important for survival.  Because it would have entailed such a high a fitness cost, incompetent leadership became something that made people unhappy.  How would you have felt if you thought your tribal leaders were criminals, incompetent, or malicious; instead of honest, honorable, and competent? (22)  It only makes sense that this would be one of the determinates of happiness today, only now it’s good government that plays the role of the tribal council.  The happiest countries are small, stable, homogenous, democratic, protect human rights and liberty, they are efficiently run, and have honest courts.  People have trust and confidence in their government.  I don’t think I’m speculating too wildly when I suggest that if a country is stable this means you don’t have to deal with the anxiety that arises out of political turmoil.  A homogenous country generates less suspicion that various other factional interests are trying to take advantage of you (9), and you will be more likely to have a sense of belonging. (Trust in Communities and Ethnic Diversity – Lost Wanderer and Belonging versus Support – Lost Wanderer) (23)  If a country is democratic you have status as an equal citizen, and democracies imply the various rights and freedoms that allow you to tailor your life to achieve greater happiness.  An efficiently run country implies a good standard of living, and honest courts means that you can trust you won’t be legally cheated.  Northern European countries are the happiest: Denmark, the Netherlands, and the Scandinavian countries.  Other countries with high levels of happiness are Switzerland, Canada, and Costa Rica. (24) 

Spirituality is another aspect of human experience that’s important for happiness.  Spirituality exists when a person has an emotional connection to something larger than themselves.  This can be many things: their community or country, a cause, science, God, etc.  People have suggested that for an activity to be meaningful in the spiritual sense we must understand what it is and how to do it, and how it fits into the larger picture creating a benefit for that larger thing that is beyond ourselves.  Whatever the specific object of a person’s spirituality, it is characterized by four major affective components: a sense of gratitude (appreciation of benefits received), awe (an overwhelming feeling of deep respect, wonder, and fear), transcendence (a state of being or existence above and beyond the limits of material experience; lying beyond the ordinary range of perception, preeminent or supreme), and love.  Spirituality gives people a sense that they are needed, a belief/feeling that they have a higher purpose.  They believe they are living by a higher narrative.  Some defenders of the spirituality argue that if you think that it’s irrational to be spiritual, you should dare to be irrational, because you already are in so many ways.  Not infrequently spirituality involves religious beliefs about judgment and an afterlife, and this provides another reason why it creates happiness, because it helps happiness to believe in ultimate justice.  (Although a religion full of hate tends to drive out happiness.)  Durkheim argued that God ultimately refers in a metaphorical way to the clan or tribe.  (The Death of Animism, Community, and God – Lost Wanderer, Alienation and Animism – Lost Wanderer, and “Religion Explained: The Evolutionary Origins of Religious Thought” by Pascal Boyer – Lost Wanderer)  If this is so, then the purest form of spirituality would exist in relationship to a community, and the other forms (to science, a cause, etc.) would be in some sense substitutes. (25) (26) 

The old clich’e, “Do what you love and you’ll never work a day in your life.” leads directly to the important idea that if you can do what you love to do, and you are good at, you will live a much happier life.  (How to Find Your Passion – Stepcase Lifehack, Find and Follow Your Bliss, The Short but Powerful Guide to Finding Your Passion - Zen Habits)  When deciding which job to take, along with salary and benefits, the questions should be: how engaging and meaningful will this work be for you?   The opposite of work you love is toxic work, which is work that mentally exhausts you. (27)  Whenever I have heard a world champion, or anyone who is at the top of their field, interviewed, and the interviewer asks, “What is the secret of your success?” almost inevitably the first thing the person says is, “I love what I do.”  They are passionate about it, and when going to bed generally look forward to, or even can’t wait for, the next day.  They are mentally energized and thrilled by it.  For them work can even be joyful and gleeful.  I think this partly explains what Joseph Campbell meant when he said, “I don’t believe people are looking for the meaning of life as much as they are looking for the experience of being alive.”  Work is for them is what play is to a child.  Most people can think back to some period of their lives, frequently when they were children, when they woke up every day passionate about living.  If you love your work much of your life will be like this.  Csikszentmihalyi says that such work creates the experience of “Flow.” (28)  People are not focused on themselves, but absorbed and fascinated.  One acquaintance of mine once said that his father was a big strong guy, loved helping people, loved fire, and loved working in groups.  So he became – what else? - a fireman.  Other examples I’ve run across include: The Olympic gold medal winning wrestler Cael Sanderson, who had to work to not smile during matches, because he enjoyed them so much. Warren Buffett describes himself as “tap dancing to work every day.” And the mathematician David Hilbert, who while delivering a funeral eulogy lost track of the situation and started enthusiastically delivering a math lecture! (29) Even those of us can’t do something we love for a living should make a list of those things we love to do, and try to make time for them every day. (30) (31) (See also Mindset: The New Psychology of Success by Carol Dweck- Lost Wanderer

Our sense of ourselves, or how our thoughts and words relate to external reality, has real consequences.  So there are a number of habits you can cultivate that involve deliberately managing your thoughts and emotions to increase happiness:  Our attitudes somewhat determine who we are, which leads directly to the old idea of having a positive attitude.  A positive frame of reference flows out of what you pay attention to, how you interpret it, and how you remember it.  You might begin by keeping a journal each day, and fill it with entries that reflect on what went well in the last 24 hours.  When someone is negative you should try to think of two positives for each negative.  In general look for the silver lining, for beauty – which is always there in the world, and try to find some meaning in even the worst of things.  Spin it half full rather than half empty, and ask, “What did I learn, and what is better because of it?”  Make lemonade out of lemons by asking, ”How can I take advantage of this development?”   Think about how it could have been worse, and could always be worse.  If you don’t have any information at all (even probabilistic) guess positive until proven otherwise.  Expect happiness. 

However, while hope and optimism are essential for happiness, you should never confuse the general belief that you will overcome in the end with the expectation of success of any specific plans you have made.  You need to be confident, but not have unrealistic expectations.  In other words, believe in yourself, but not too much.  You should expect disappointment within an overall joyful life.  You need to also be realistic enough so your rose colored glasses don’t become blinders such that you only see the positive, and ignore some impending catastrophe.  So when making specific plans you might try imagining the worst case outcome, then imagine the best, and then imagine something in between.  The third one will generally be much more likely. 

Other habits of mind you need to be aware of include: If you worry a lot, give yourself a set time and place each day to worry, and then otherwise don’t.  Self-monitor and keep a score in a worry journal where you write them all down.  Don’t indulge pointless negative thoughts, but note them in your worry journal and then change the topic. You will probably find that most of the things you worry about either never come true, or they come true in a way no one could have anticipated or prevented.  Stress and tension are universal negatives, so the more you can eliminate them the better. (32)  Sometimes it is best to simply face our fears.  For example, you might think about, share, talk about, and deal with your fears of death, instead of letting them hang over you.  In general it turns out that the best way of dealing with negative thoughts isn’t to try to suppress them, or to vent them, but instead to change the subject and think about positive and productive things, such as, for example, what you are grateful for.  Being generally grateful is very important for happiness.  One technique people have suggested is to construct a “gratitude bomb” by making a detailed list of all the things other people have done for you over the course of your life.  It should run into thousands of items, and could be overwhelming.  Cultivate gratitude, make it into a habit, and incorporate it into your routine.  In this way you are recreating the experience of being in a tribe.  Along with gratitude, forgiveness has been called, “an essential ingredient for mental health,” (33) because anger and hate drive out love.  Try to think about your own faults before you beat up on others for theirs.

Still more advice includes: 

  • You might need to try to be more decisive.  When faced with an uncertain choice, make it and move on.  In studies where people were allowed to reconsider and change their choices they were on average less happy with them. 
  • Don’t dwell on what you can’t control, but focus on the positive things you can do to make things better. (34)  Don’t ignore what bothers you if you can change it.  Your aim should be to fix the problem, or at least make it better.  If you can’t do either, your last option is to try to focus on something else you can do something about.  You can’t control the past, so give yourself a break, don’t beat yourself up for mistakes, flush the guilt, don’t brood, learn from your errors, and move on and improve. 
  • You don’t have to be perfect.  You should strive to appreciate your strengths, root for yourself, give yourself credit for what you have to offer, accept your shortcomings and weaknesses, and thereby cultivate self-acceptance. (35)  Try daily self-affirmations.  Make a list of your positive characteristics.  Put them on index cards, hide them around your house, and every time you see one focus on it for a while.  Treat yourself the way you would treat a good friend, and in this way work on your self-esteem. 
  • Don’t set yourself up to fail by setting goals that are incompatible.  Don’t persist in clearly unwinnable conflicts, but recognize the situation and tactically retreat. (You’ve Gotta Know When to Fold ‘Em: Goal Disengagement and Systemic Inflammation in AdolescenceSet reasonable goals, both short term and long term, you can have success with in all areas of your life.  (See also Mystery Moods – Lost Wanderer)  The idea is to create a record of success, so that you can develop self-confidence in your abilities.  Happy people feel successful, and are satisfied with their lives. 
  • Practice being honest with yourself.  Don’t self-handicap in order to have an excuse ready if you don’t succeed. 
  • You might also have to learn to not care what certain people think of you (8 Best Ways to Deal with Detractors – Zen Habits); and, as harsh as it sounds, to flush toxic people at some point. (36) 
  • Work at failing fast and cheap.  That is, figure out if you can succeed at whatever you’re doing early on in the process, and if you can’t drop it. 
  • Try to see the humor and play in life. (37)  Look for books, films, and TV shows on DVD that you find funny. 
  • Remember that you always have choices, so you have some control, and aren’t helpless. 
  • You need to be open to new ideas, and try to learn something new every day.  Challenge and novelty are important elements of happiness.   
  • Being able to negotiate well is a general applicable and valuable skill. (38)  
  • You might need to learn to be appropriately assertive, to stand your ground, and speak up for yourself. (39) 
  • You might consider learning to play poker well.  Bill Gates, among many others, credits poker with teaching him a lot about how to run a business. (pp. 396-7, “Cowboys Full: The Story of Poker” by James McManus
  • Develop your problem solving skills. (40) 
  • More education can sometimes help, and a conscientious attitude (the tendency to be organized, and to think carefully and thoroughly before acting) is often a plus. 
  • You have to learn to take reasonable risks, so you can’t be too afraid of failure.  If you’re not occasionally failing you’re not taking enough chances.  It turns out that moderate, rational risk takers, who are from the 50th percentile to the 84th, are the happiest. (The Art of Living Dangerously by William Gurstelle)  “Courage is not the absence of fear, but rather the judgement that something else is more important than fear.” (Ambrose Redmoon).  So don’t feed the fear, feed the dream.  Think of solutions, instead of dwelling on worst case scenarios.
  • Things are rarely as good or as bad as they seem, so try to take a 3rd party perspective, and be somewhat detached and analytical when things go wrong.  This doesn’t mean you’re uninvolved, but instead it’s more likely your problem solving will be more productive. (Calm as a Monk: How Equanimity Can Save Your Sanity – Zen Habits
  • When you have to do unpleasant things do the worst things first, get them out of the way instead of having them hang over you head. 
  • People who plan for the future and delay gratification often come out ahead in the long run.  So, don’t take shortcuts that will hurt you in the long run. 
  • But, you also don’t want to end up only living in the future (or the past) but try to live in the present and enjoy it.  The past is to learn from, the present is to enjoy, and the future is to look forward to.  The goal is to keep them balanced and in their proper places. 
  • Try laughter yoga. 
  • If you have gone through emotional trauma try expressive writing for getting over it. Write down in detail what happened and your feelings about it.  Get it out of your head, and know your own mind.  See your flawed thoughts, be honest with yourself.  To remember it practice telling someone else. 
  • The book, “Nudge: Improving Decisions About Health, Wealth, and Happiness” argues that we should arrange our lives so that it’s easy to do the right things.  The authors argue that we have self-control problems because of limited time and the various mental shortcut heuristics we use to get along in the world.  (List of Cognitive Biases - Wikipedia)  So we should tilt the playing field in our favor by, for example, intentionally setting our default options. 
  • Control your desires. 
  • The simplicity movement argues that many people have their priorities confused, and we should simplify our lives and flush the clutter.  (Simple Living, Simple Living – Wikipedia)
  • You might try recording your night-time dreams and sharing them with others.  Some people report this can lead to lucid dreaming. (The Lucidity Institute
  • Some people find getting a pet helpful. (Happiness Is: Are Pet Owners Happier?
  • Create new challenges by starting a new hobby, joining an organization, or learning a new skill.  A general rule is to buy experiences rather than goods, because a good experience will tend to get better each time you remember it.  (”59 Seconds: Think a Little, Change a Lot“ and Richard Wiseman’s Online Webpage for his book “59 Seconds...) So go to a concert, movie, unusual place, or strange restaurant.  
  • One piece of happiness advice is to smile more often.  While it’s true that our emotional state helps determine whether we smile, it turns out that the lines of causation are a two way street, and if we smile we can actually make ourselves happier.  People are told to practice by putting a pencil between their teeth.  (“Just smile, you’ll feel better!” Will you? Really?
  • On her blog, The Happiness Project, Gretchen Rubin lists many suggested readings, and says that she found the 13 virtues of Franklin (41), The Rambler, The Life of Samuel Johnson, and St. Therese, Story of a Soul especially helpful to her. 
  • Fight procrastination. (42) 
  • It was John Wooden who said, “Don’t let what you cannot do interfere with what you can do.” 
  • Commit when appropriate, don’t hold back, and ignore the irrational messages/feelings that interfere with success
  • Finish the projects you start that are worth finishing.  If you have a winning hand, be stubborn and keep at it. 
  • Work at being lucky. (How to Be Lucky – Lost Wanderer
  • Compromise is sometimes wise, satisficers tend to be happier than maximizers, and the perfect can be the enemy of the good. 
  • Don’t be a slave to rules, but be flexible in means to a given end. (Predictors of Success for People with Learning Disabilities – Lost Wanderer
  • You have to learn to take constructive criticism.  Being in touch with reality is often painful, but (if you are willing to take the pain) you have to let the evidence guide you even if it hurts.  For many people, it is so painful to consider ideas/arguments they disagree with, or are outside their current world view, they shut them out. (43)
  • Wives are happier if they believe their husband is committed to the relationship
  • Vacations shouldn’t be thought of as a set of experiences, but as a celebration of family.
  • In general, it’s bad to be alone or watching a lot of TV.  It’s better to be listening to music or reading
  • Look for ways to be romantic. (Cheap but great dates – Zen Habits)  
  • Happy people aren’t too emotionally dependent on other’s approval.  Of course, it’s a balancing act between our need for others and our need to have a sense of control, independence, autonomy, and self-support. 
  • Happy people don’t experience many of the negative emotions that erode happiness: they have low tensions, stress, fear, guilt, resentments, regrets and worries.  Happy people like themselves.  People with high self-confidence see themselves as having many good qualities, positive traits and abilities.  They see themselves as likeable, attractive, and worthwhile. 
  • Many of the roots of the positive school of psychology stem from the humanistic school. (Positive psychology – Wikipedia and Humanistic psychology – Wikipedia)  Psychologists such Maslow focused on such topics as love, creativity, self-actualization or “fulfilling one’s highest potential”.  (FWIW, I’m not actually sure what they mean by ”self-actualization.”) 
  • Happiness is itself a resource that produces better relationships, longer life, health, wound healing, a lower chance of suicide, less depression, and less alcohol and drug abuse.    
  • Stop looking at virtually all mass media, and get rid of the TV.  Advertising is selling the myth that buying things will make us happier.  We are continually being invited to be seduced by the unhealthy cheap thrills of modern life.  (Superstimuli – Whole Health Source)  Because of the mass media we all now compete with the best in the world, and compare our lives with the fantasy ones we see on TV.  Beautiful people are constantly paraded across the screen, providing unhealthy upward comparisons.  We could be the best at something in the ancient tribe, but now envy, which used to motivate people within realistic settings, leads to depression, self-perceived failure, and frustration.  If an athlete wins a silver medal at the Olympics announcers will describe the second best in the world (by a hair) as having “lost.”  On top of all this, the news presents us with a depressing negatively distorted version of reality (see foot note 22).

(1) Any statement like this is always limited to the range of variation of the relevant variables that was present in the environments where the studies were done.  If some very important variables were highly range restricted then a statistic won’t generalize to another environment where these variable weren’t so restricted.  For example, if everyone in a population was deficient in a symbiotic bacterium that strongly affects happiness by changing serotonin levels, then the researcher’s statistical model predicting happiness would be incomplete, and its heritability estimate for other environments would be different.

(2) Having said this, while people do vary in what makes them happy, there’s also a fair degree of agreement among people about this, otherwise giving advice would be impossible beyond saying, “Follow your own heart.” 

(3) Since our hunter gatherer ancestors hardly owned anything, and they were generally happy, it makes a lot of sense that owning things wouldn’t create happiness for us either.  A caveat to this is that today a minimal level of possessions are often necessary as a signal of status, and status has always been correlated with happiness, both in the hunter gatherer time and today.

(4) The simple pleasures simply have to be enough to create happy lives.  Hunter-gatherers didn’t have trips to Europe, etc., yet they were happy with only their spears and skins.  We know they were happy both from anthropologists’ reports, and from the fact that evolutionary selection wouldn’t have fashioned an animal that was generally unhappy in its natural environment.  The fitness cost from the stress would have simply been too large.

(5) Unless the person is psychotic, I would think that at some point a person’s perception of their health would correlate with their actual health.  So, their actual health must also matter. 

(6) The lowest status in a community is to be socially rejected and shunned by everyone in that community.  For an exploration of what happens when you are on the very bottom of a society, see (Delusions as Strategic Deception – Lost Wanderer).  Being cast-out might be considered an even lower case, but then you are no longer inside the community.

(7) To help our sleeping Ilardi recommends we turn off the lights 1 hour before bedtime, and use only a soft lamp or candlelight with no overhead or computers.

(8) This last piece of advice stems from the fact that sunlight is about 100 times as bright as artificial light, and through specialized receptors in the back of our eyes it adjusts our body clocks, which regulate our sleep and hormones.  We also get vitamin D this way, and most people in modern society are deficient in this.  (Vitamin D Deficiency in Modern Society – Lost Wanderer)

(9) This distinction might help explain why affirmative action is so controversial.  Besides all the other objections (Affirmative Action: A Worldwide Disaster by Thomas Sowell), instead of redistributing only money, it is also attempting to redistribute status.  As such, it rearranges the social hierarchy, and more clearly attempts to redistribute happiness.

(10) You want to manage your relationship with money, and not let it manage you.  You should try to eliminate debt, and build an emergency fund (a major way to reduce stress and make you feel more secure).  If you can find less expensive ways to do things, control impulse spending, and learn to live with less you will likely be happier in the long run.  A good book to start thinking about this is, “Your Money or Your Life: 9 Steps to Transforming Your Relationship with Money and Achieving Financial Independence: Revised and Updated for the 21st Century.” by Vicki Robin et al.

(11) The general advice seems to be: Select a mate who is similar to you in mate-value & values, interests, politics, and personality.  A spouse should also be agreeable, emotionally stable, conscientious, and open to new experiences.

(12) The advice for good relationships overlaps with the advice for good sportsmanship, e.g., be polite and use appropriate language, don’t show off, respect your opponents, don’t argue with officials, don’t make up excuses when you lose – instead learn from it, cheer the other guy, don’t cheat, the team often comes first, etc.  Also, don’t engage in gamesmanship. (Gamesmanship – Wikipedia)

(13) Although, if you are ending a relationship, I could imagine circumstances where revenge could be an attractive option as a healing experience. 

(14) One exercise is to start by imagining the suffering of a loved one.  Try to see the world as they see it, so that you can understand their pain, their emotions, and why they would react the way they do.  By repeating this exercise, you are developing a skill that can be applied to everyone, so that you can better understand what they are going through.   

(15) In relationships you should practice active listening, which means that you: pay attention and respond, really try to understand the other person, make eye contact, don’t judge them, use touch, recognize their emotions and non-verbal cues. (For more, see The Art of Active Listening Tip Sheet and Active Listening Skills

(16) David Buss even recommends that we set up critical tests to see who we can really depend on, and thereby develop a greater sense of deep social connections. (The Evolution of Happiness by David M. Buss)   

(17) What makes for bad relationships is also common sense: People are angry, neurotically needy, condescending, destructively critical, reject and dislike one another.  They find each other annoying.  They are impatient, dishonest, and authoritarian.  They use pressure, engage in one-upmanship, and play manipulative games.  Other common practices include: not taking responsibility, changing the topic when they don’t want to talk about it, lying, playing dumb, withholding information, playing victim, feeling entitled, verbally minimizing the harm they’ve done, and basically not caring about others.  One test of whether or not a relationship is toxic for you is to ask yourself if you feel more energized or less after spending time with that person.  (Thinking Errors List and 15 Common Thinking Errors)

(18) The problem with this advice is that it is in some tension with the advice to be positive.  Imagine that you are, in fact, ugly (or even deformed), have a very low IQ, are a terrible athlete, naturally socially awkward, you can find nothing you enjoy in life, you are in bad health, in extreme poverty, everyone but mental cases and criminals reject you, and the only women interested in you are prostitutes.  Wouldn’t it be rational to be depressed?  Wouldn’t it be rational to see yourself in unflattering terms, because it’s true?  In short, the bottom 1% will be, of course by definition, in the bottom 1%.  Someone must be on the bottom of any competitive distribution, including a distribution of those things in life that make for happiness.  This highlights another of the tragedies of life, since good things tend to co-vary in populations (because of assortative mating, if nothing else), some people will end up on the bottom along many dimensions.  Their lives are the tragic and inevitable outcome of the logic of a competitive Malthusian type of world. (Malthusian catastrophe - Wikipedia and The Most IMPORTANT Video You’ll Ever See by Dr. Albert A. Bartlett)  Low self-confidence correlates with unhappiness, and people with low self-confidence see themselves as unattractive and as failures, feel inadequate and guilty, expect to be socially rejected, are shy, self-conscious, self-critical, and hyper-sensitive.  They doubt love, are jealous and possessive, are unsuccessful and dissatisfied with their inter-personal relationships, have difficulty accepting praise, and are cautions and fearful.  Those who are unhappy are more neurotic, have many unfulfilled aspirations, are anxious, rigid, and display low spontaneity.  They are dependent on others for their self-esteem, are over concerned with prestige and social approval, have dissatisfying family lives, and are self-abasing.  They feel inadequate and insecure, are pessimistic and suspicious, are more likely to have experienced a loss of love, are socially withdrawn, and worry excessively. They are less competent, are less organized, and have lower mastery of the skills necessary to achieve their goals.  All this can easily end in self-hatred.  Those on the bottom will be more likely to be only able to socialize with others on the bottom, and the reason these other people are on the bottom is that they too don’t have much to offer.  In such circumstances, when you are hanging around with others who are depressed, and you can’t trust and don’t like, it would be rational to be depressed yourself.  This perspective is partially supported by the phenomenon of depressive realism.  This is where people with depression have been found to have a more accurate perception of reality.  Although the picture is complicated, people who are happier tend to have illusions of superiority, control, and excessive optimism.  (Depressive Realism – Wikipedia)

(19) This distinction is important and can be perhaps clarified by recalling the song, I Hate Myself for Loving You.  The idea this song captures is that someone might know that at a calculating rational level it would be far better to not love someone.  But at a more primal level they simply do.  If a person were extraordinarily lucky none of their desires would ever be in conflict.  In terms of relationships it’s ideal if you both like helping someone, and it is also in your long-term rational self-interest to do so.  The problem is that if you help people, but don’t really like them, there is the risk they will sense the calculating nature of your help, and discount accordingly.  Of course, you also get far less out of this sort of relationship.  But, this raises an obvious objection:  I can choose to act in a certain way out of calculated self-interest.  But, I can’t choose to like/love someone.  So what do I do if I don’t?  The two pieces of advice that come to mind are to fake it until you hopefully do feel it.  And to set up the background conditions that will make such feeling likely to eventually occur, and hope that they do.   

(20) A person I know who went to an African country on business said that everyone there was desperately poor.  So everyone was constantly cheating everyone else every time they could to try to simply survive the day.  Of course, this created a downward spiral that no one could ever get out of, so they were all desperately poor.  This next story might be apocryphal, but perhaps will serve as a useful allegory:  I read that if you put one lobster in an aquarium it will often be able to crawl out.  But if you put two lobsters in the same sort of aquarium neither will ever get out, because as soon as one starts crawling up the other will instinctively come over and crawl up on it, pulling the first one back down.  So, if you want to get out of whatever trap you’re all in, find people you can trust, get behind them when they are trying to crawl out, and push.   

(21)  When giving advice it is usually best to suggest possibilities, but not to give instructions.  You should prioritize, and focus precisely on the most important points.  Also, avoid giving mixed messages, e.g., “It was fine, but you could improve it.”  And avoid making vague statements, e.g., “I don’t like it.” 

(22) I share the opinion of many of the most informed people I know that America as a corrupt society going to Hell.  The media, if not telling outright lies, through agenda setting, framing, the use of redefinition, and the careful taxonomic use of language categories supports an elite that rules by deception.  All this, along with a corrupt court system, both encourages and disguises the ongoing destruction of this society.  Those who speak out are pariahs, and considered either insane, fools, or far worse.  Those who are the relatively honest people in power all too often must, at the least, compromise their principles to stay there.  Morality is inverted, with honorable people called scum by dishonorable people who are in positions of power.  Our presidents tend to be of one of two types, either they don’t know the truth, or they are semi-psychopathic liars.  Seemingly, anyone who knows the truth, and tells it, has a very hard time get elected.  Think about two of our recent presidents: Clinton was credibly accused of rape, and Bush is a smirking fool who pushed for a war that killed hundreds of thousands, and will cost an estimated 3 trillion dollars.  Yet, both of them are now comfortably retired.  The worst part of this is that the ultimate source of the problem is the American people.  The population of this country can’t handle the truth, and instead prefers to be told comforting lies.  So, as we spiral down towards Hell, this the system can’t reform itself and, barring some miracle, this nation is doomed.  (As you might guess my perspective hasn’t done much for my happiness.) 

(23) In his book, Love and Survival, Dean Ornish also makes the point that in order to feel emotionally secure you need to have some sort of reasonably standardized rules.  You have the option of any number of different choices, but you should have some standard, so that you know when you are right with the tribe.  (Love and Survival by Dean Ornish – Lost Wanderer)

(24) Having said this, while it is much better to live in a country with good government than bad, I doubt that even the best modern state does as well as the tribal council often did.  If things were going well people once had the whole tribe for social support, with typically each person a valued member of an enduring social group.  As such they lived their whole lives enmeshed in a web of deep intimate contacts within an extended kin group.  Today, we have lost this social support network, and are often limited to the nuclear family.  In the Paleolithic your kin determined what the law was, now the law is complex and created by strangers.  And at work people often suffer a sense of powerlessness as worker bees in large companies.  In short, even in the best societies, today we live relatively socially isolated disempowered lives. (The Evolution of Despair by Robert Wright – Lost Wanderer)

(25) Along the lines of thinking about spirituality as a phenomenon that grows out of community, evolutionary psychologist David Sloan Wilson argues that religion evolved to allow groups to better cooperate, and that those groups that had religion out competed those that didn’t. (Darwin’s Cathedral: Evolution, Religion, and the Nature of Society by David Sloan Wilson)

(26) Jonathan Ellerby lists the various paths by which people have traditionally tried to achieve spiritual enlightenment through following specific practices.  These include: ceremony and ritual, sacred movement, sound and music, prayer, meditation, study, yoga, death practice, sacred service, and ascetic practice.  (Return to The Sacred: Ancient Pathways to Spiritual Awakening by Jonathan H. Ellerby)

(27) When you are mentally tired one of the best ways to recharge yourself is not to rest or sleep, but engage in something you find fascinating.  For example, you might read a great heart-pounding page-turner of a mystery story. 

(28) Being engaged in flow also prevents your brooding on negative thoughts.  When you brood your stress level goes up, driving your depression level up.  Brooding does have some initial benefit, because it allows us to think through why something went wrong and not make that mistake again.  But it has diminishing returns, and after the first hour or so past the first day of brooding you generally aren’t helping matters.  After that it is usually best to try to focus on something else, with several of the more engaging activities for most people being conversation and learning new interesting things.  If activities are intrinsically enjoyable people’s attention won’t be wandering.  They will not have to work to pay attention, they will be present, observing, and be breathing differently.  (Practical Tips to Practice Being Present)

(29) “David Hilbert was one of the great European mathematicians at the turn of the century. One of his students purchased an early automobile, and died in one of the first car accidents. Hilbert was asked to speak at the funeral. “Young Klaus,” he said, “was one of my finest students. He had an unusual gift for doing mathematics. He was interested in a great variety of problems, such as…” There was a short pause, followed by, “Consider the set of differentiable functions on the unit interval and take their closure in the …”" (Exactly Who and What is Your Instructor?)

(30) Jim Collins, the author of such books as, Good to Great, gives this career advice:  There is the set of all the things you are good at.  There is the set of all the things you love to do.  And there is the set of all the things you can make a living at.  Assuming these three sets intersect, pick from the intersect your choice of careers.  

(31) Csikszentmihalyi has argued that one common characteristic a flow type activity must have is that there must be an appropriate level of challenge in the activity.  Beyond this, it seems that much of what makes something into an experience of flow for a person depends on the particulars of the individual.  The most enjoyable for most people are unfortunately very hard to turn into jobs: sex with a loving partner, socializing with friends, relaxing, meditating or praying, eating, and sports.  Of course, these are all activities that we evolved to enjoy back in the hunter-gatherer days when hunting and gathering were our jobs.  One way evolution gets an animal to do what it needs to do to survive is to make those things enjoyable.  Unfortunately the rise of civilization created a mismatch between those things we instinctively like to do, and what we have to do to get along in today’s world.  So an animal that was designed to go out and pack-hunt down a large dangerous animal for dinner, in a kind of thrilling sporting event, might now be working turning bolts 8 hours a day on an assembly line.  No wonder comparatively few people say, “I passionately love what I do.”  The least enjoyable activities are things like commuting, working, and doing housework.  I once thought of this party-proof that no job is fun: Suppose an employer has a job which is actually fun for most people, and he is paying someone $20/hour to do it.  As soon as word gets out someone will show up at his door and say, “I will do it for $19/hour.”  The next day it will be $18, and so on, until people are paying the employer to do the job.  So any job that does pay anything at all can’t be that job.  So, no job is fun.  This ”proof” of course isn’t correct, because there can be barriers to entry, specialized abilities necessary to do the job, and someone might have unique tastes and preferences - enjoying a job few other people would, etc.  But what it does indicate is, all other things being equal, the more enjoyable a job is the less it will pay.  (See also Before the Fall, Evidence for a Golden Age by Steve Taylor – Lost Wanderer, The Worst Mistake In The History Of The Human Race by Jared Diamond – Lost Wanderer)

(32) I once had an instructor make the point that people wouldn’t want total certainty, because that would be boring.  (A Nice Place to Visit – Wikipedia)  People also don’t want total uncertainty, because that would be chaos.  What they want is to be in a state of reducing uncertainty.  An analogy seems in order:  A surfer doesn’t want to be on the shore.  He also doesn’t want to be out on the calm water.  He wants to be riding the wave into shore.  A happy life is then to be understood as action and process, to be in the middle of playing an enjoyable game, and not as a static place.  It also seems that the nature of the uncertainty matters.  Someone who buys fire insurance might still want to enjoy the thrill of a close basketball game.  So, some types of risks cause mostly unhealthy anxiety, and some cause mostly healthy thrill.  My belief is that good risks are those that dovetail with what would have been required activities in the Stone Age, and bad risks are those that don’t.   

(33) The current dominate narrative in America today tells us that revenge and retribution are shocking and beyond the pale.  This isn’t true in all cultures, and since many people are wired to enjoy retribution it might be just as healing.  I think our society’s rejection of retribution and revenge might be analogous to the Victorian society’s purported rejection of sexual pleasure.  While it is true that sexual gratification is potentially a dangerous and destructive thing, witness the AIDS epidemic, in its proper place it is also a wonderful thing.  Perhaps revenge works the same way.  In pastoral societies, where no effective central law exists, cultures of honor develop where justice is founded on the threat of violent retribution for wrongs done.  Under these circumstances vengeance is not only allowed, but required.  (Culture of Honor: The Psychology of Violence in the South by Richard E. Nisbett)  Today, norms in hard-core prisons work much the same way.  The only thing which protects you is your reputation.  The rule is, “You can lose every time, but you must fight every time.”  As bad as this is, the alternative can be worse.  I also don’t think that a culture of honor is necessarily philosophically morally inferior to a culture of law.  My suspicion is that most Americans would see it that way because they have been trained to.  For whatever political reasons, this is the current consensus.  But if we were to tote up the costs and benefits it isn’t clear to me that one system would clearly win out.     

(34)  In sports they put this way, “Control the controllables.”  For example, in tennis when receiving serve you can’t decide you will take it to your forehand side if he/she serves it to your backhand side.  You also can’t even directly control whether or not you will win the game.  That outcome depends also on what the other person/team does, and you have no control over that half of the equation.  But you can control how well you train.  So arrange your goals around what you can measure and influence.  All the rest of it will happen of its own accord.

(35) These pieces of advice are all attempting to combat low self-confidence.  To introduce a note of reality here, unfortunately lack of self-confidence might all too often arise from people’s accurate perceptions of themselves and their lives.  See foot note 17.

(36)  Repeating foot note 16, one test of whether or not a relationship is toxic for you is to ask yourself if you feel more energized or tired after spending time with that person.

(37) In a radio interview I heard, the speaker opined that a sense of humor can save your life.  For example, when Hitler was in power the Jews told many jokes about him:  “Two Jews noticed that every day Hitler would walk by their shop in the morning.  They devised a plan to get a big rock to drop on his head from the second story of their shop to kill him.  The next day they were waiting with the rock, but at his usual time of 8:00 a.m. he hadn’t come by.  At 9:00 he hadn’t come.  At 10:00 he hadn’t come.  Finally, one of them gets worried and says, “Gee, I hope he’s OK.” (One Life to Give by Andrew Bienkowski)

(38) Here are some random titles to get started: Getting to Yes: Negotiating Agreement Without Giving In, Influence: The Psychology of Persuasion, Secrets of Power Negotiating, How To Haggle: Professional Tricks For Saving Money On Just About Anything, Bare Knuckle Negotiating: Knockout Negotiation Tactics They Won’t Teach You At Business School, The Negotiation Toolkit: How to Get Exactly What You Want in Any Business or Personal Situation, Leverage: How to Get It and How to Keep It in Any Negotiation, Practical Negotiating: Tools, Tactics & Techniques, The Haggler’s Handbook: One Hour to Negotiating Power, National Negotiating Styles.

(39) You might start with: Don’t Say Yes When You Want to Say No: Making Life Right When It Feels All Wrong.

(40) Effective problem solving involves a large number of elements.  Here are but a tiny few:  Be proactive.  Don’t wait for a solution, but go out and find one.  Do your homework, and anticipate consequences.  Break the problem down into its sub-parts.  Look for someone else who has solved similar problems.  Look for analogies.  It is worthwhile to keep in mind that successful problem solving also often involves a large amount of domain specific knowledge.  (Talent Is Overrated: What Really Separates World-Class Performers from Everybody Else by Geoff Colvin In short, there’s often no substitute for really knowing what you’re talking about. (”The Complete Problem Solver” (1981 ed.)), “The Universal Traveler: A Soft-Systems Guide to: Creativity, Problem-Solving, and the Process of Reaching Goals“, Center for Creative Learning, The Myth of Creative Genius – Lost Wanderer, Problem solving – Wikipedia)  

(41) Franklin’s 13 virtues are: temperance, silence, order, resolution, frugality, industry, sincerity, justice, moderation, cleanliness, tranquility, chastity, and humility.   

(42) If you are having trouble getting started on a project one method is to just dive in to get going.   For example, if you are writing a paper put down everything you know, garbage and all, to get started.

(43) Of course it’s always a balance between being too close-minded for the wrong reasons, versus having no ability to filter out nonsense. (See, for example Deconstructionism is Horsesh*t – Lost Wanderer, Freudian Psychology is Horsesh*t – Lost Wanderer)  The only advice I can give in this regard is that there is no substitute for knowing a subject, and to let evidence and reason guide you in deciding what’s nonsense.

(Superme.com, “The Happiness Myth: The Historical Antidote to What Isn’t Working Today” by Jennifer Hecht, “100 Simple Secrets of Happy People: What Scientists Have Learned and How You Can Use It” by David Niven, “Happiness: Unlocking the Mysteries of Psychological Wealth” by Ed Diener, The Politics of Happiness: What Government Can Learn from the New Research on Well-Being by Derek Bok, The How of Happiness: A New Approach to Getting the Life You Want by Sonja Lyubomirsky)

Regarding Comments on Posts

August 6th, 2010 by lost_wanderer

Once a post is over a week old I’m now blocking comments on it.  I’ve gotten tired of the spam.

Fighting Fair in Relationships

July 28th, 2010 by lost_wanderer

There are many types of contentious verbal contests, such as philosophical discussions, academic and political debates, and courtroom arguments.  In each type of contest there are generally accepted rules of fairness, and what counts as a dishonest trick.  (See for example: List of Fallacies – Wikipedia, A List of Fallacious Arguments, Misuse of Statistics – Wikipedia, Propaganda and Debating Techniques by A. Orange, Conversational Terrorism: How Not to Talk! by Dean & Laura VanDruff, 38 Ways to Win an Argument by Scrivs)  My post isn’t about these sorts of contests, but instead is about fighting fair in intimate relationships.  For these sorts of arguments, if you are trying to maintain or strengthen the relationship, and not seeking to end it, here are some rules of thumb. (1)

To start with, discuss and agree to the rules of fair fighting with your partner before you ever get into a fight with them.  Get to know what your and their personal fighting style is.  Don’t let issues build up; discuss them when they come up.  Don’t surprise your partner out of the blue, but set aside a time you both agree on.   Treat the other person with respect and as an equal.  Listen to them, and try to really understand him/her.  Try paraphrasing what you hear them saying, and see it through his/her eyes.  Don’t assume or speculate about what they are thinking.  In other words, don’t pretend to be able to read their mind, or expect them to read yours.  Take responsibility for your feelings and actions by using “I” statements.  Be direct and honest about how you feel and what you want.  Try to limit your fighting to only one issue at a time.  Define its scope, state it clearly, and don’t bring in unrelated items or unrelated past mistakes.  Keep it real by dealing with the problem, and not merely a symptom of the problem.  Ask yourself what your real goal is before you begin, that is, what you really want.  Be specific about your complaints, and use examples.  Focus on solving the problem, rather than trying to simply win for its own sake.  That is, you should be trying to find a mutually satisfying win-win solution by attacking the issue, and not the other person.  You do this by negotiating, compromising, log rolling, and brainstorming solutions.  Propose solutions and ask your partner to also do so.  Discuss the pros and cons of each proposal. 

Don’t name-call or blame the other person with ”you” statements.  Don’t threaten violence, swear, denounce, curse, express contempt, engage in sarcasm, taunting, or character assassination.  Don’t hit below the belt by attacking the other person’s sensitive areas.  Try not to raise your voices.  If your partner breaks a fair fighting rule, don’t escalate.  Keep your intensity proportional to the size of the problem.  Ask questions that will clarify the situation, and not ones that will put the other person on the defensive.  Therefore, try to not ask questions that begin with, “Why?”  Avoid making comparisons to other people, and don’t belittle the other person’s accomplishments.  Don’t reduce your partner to a statistical generalization by stereotyping him/her as merely a member of a category.  Don’t exaggerate.  Don’t say you “always” or “never,” unless it is literally true (and it almost never is).  Avoid saying the words “you should”, “you must”, ”you ought”, “I told you so”, “When will you ever learn”, “How many times do I have to tell you?”  Give the other person equal time.  Don’t interrupt or talk over the other person.  Don’t use disrespectful non-verbals, such as eye rolling, harrumphing, sighing, smirking, yawning, etc.  Limit your fight to no more than 30 minutes, and if necessary schedule another round for later.  If things get too heated take a half hour time out.  Be careful about introducing other people’s opinions about the situation.  Don’t fight in front of the kids.

You need to give the other person the room to change their mind and save face, because you don’t want to end up merely trying to score points in a game of, “Now I’ve got you, you SOB.” (Transactional Analysis – Wikipedia)   That is, don’t play manipulative games. (2)  If you do set limits and promise consequences, be prepared to really carry them out.  Don’t talk about divorce unless you mean it.  Don’t demand to win coming in the door.  Apologize when you are wrong, but be careful that you aren’t the only one who ever apologizes.  Don’t quibble over trivial details.  Try not to just walk out of an argument.  However, you might need to do so if the situation is getting out of hand or isn’t productive.  Tell them why, and let them know when you will be back.  If it’s appropriate hold hands during your discussion.  If and when you reach an agreement, write it down and set a trial period for the new behavior.  At the end of this period see if you need to modify the agreement.  Finally, if nothing seems to work it might be time to bring in a trained counselor.

(1) For an earlier post that discusses similar interpersonal negotiation concepts you can take a look at, The Uplift Program for Happiness - Lost Wanderer, part of which reviews the book Creating Optimism.
(2) Again, from Transactional Analysis, Eric Burns documented a number of such games, for example, Poor Me, Silent Treatment, Martyr, Don’t Touch Me, Uproar, Kick Me, If it Weren’t for You, Yes - But, See What You Made Me Do, and If You Loved Me.  See also: Psychological Manipulation – Wikipedia

(37 Rules to Fighting Fair by Happy Lists, Fair Fighting Rules: A Formula for Resolving Conflict - divorcehelpforparents.com, Fair Fighting: Turning Arguments into Discussions by Mark Smith, Fair Fight Rules - Stayhappilymarried.com, Fair Fight Rules: From “Domestic Violence” by Barbara Corry, M.A. – Klamath Crisis Center, Fair Fighting Rules for Couples by Nathan Cobb, Ph.D.Cobb Counseling Inc., Fighting Rules: From the book “Men Don’t Listen” by Wayne Misner - Dr. Irene’s Verbal Abuse (Site)!, Some Rules for Fair FightingTexas Woman’s University Counseling Center, How to Fight Fair – Dr. Phil, Fighting Fair to Resolve Conflict, Fair Fighting Rules – Knapp Family Counseling)

Medical Mistakes

June 1st, 2010 by lost_wanderer

Estimates vary, but according to several sources, in the U.S., medical errors are roughly estimated to cause from 44,000 to 195,000 deaths and 1,000,000 injuries each year.  It’s also estimated that in hospitals in the U.S. adults receive only 55% of recommended care, that 30% of care might be unnecessary, that 14% of patient’s cases involve substandard decision making, and that 1% of hospital patients have adverse effects because of negligence. (Preventable Medical Errors: Nature and Extent – Wikipedia)

Contradicting a commonly held myth, one thing that does not appear to be a major source of error is incompetent health care providers.  Instead the core problem seems to be that medical care has become very complicated.  For example, it takes from 80 to 100 correctly executed steps to administer one dose of a single medication to a critically ill patient in an ICU.  Another misunderstanding is that every adverse event means a mistake occurred.  Patients need to be aware of the fact that an adverse event doesn’t necessarily mean an error happened, since some level of unavoidable risk is often involved with many health practices and procedures. (1)  I think that focusing on the human factors issues involved in providing medical care could be one of the most useful ways of significantly reducing the rate of mistakes.  Factors that can increase the odds of an error include: an inexperienced medical staff, the use of new procedures; prolonged, intensive, complex or urgent care; caregiver sleep deprivation (which can as much as triple the risk of mistakes), the emotional impact of past mistakes which can thereby cause future mistakes, the patient being either very young or old, poor communication (2), failure of follow-up, failure of informed consent, failure to follow advance directives, over-reliance on automated systems, caregiver depression and burnout, an unwillingness to share information (sometimes for fear of liability and loss of reputation) which impedes system improvement, cost cutting measures, poorly designed facilities and buildings, and caregivers being in denial about the very problem of medical errors itself.  In underdeveloped countries infrastructure failure (such as inadequate training and broken equipment) also frequently leads to substandard care.  One general cause of mistakes that encapsulates a number of the more specific causes just listed is likely to be the assembly line nature of much of modern medical practice.  Doctors see many patients for a brief time, and don’t have the luxury of spending time to get to know the patient, which increases the likelihood of oversights.  As a reaction to a system that both doctors and patients frequently hate, some doctors have been experimenting with alternative models.  (See, for example, Dr. Pamela Wible’s website: Community Ideal Medical Clinic and Create Your Own Clinic (3) (Patient Safety: Causes of Healthcare Error - Wikipedia, Medical Error: Risk Factors – Wikipedia, Preventable Medical Errors: Most Common Causes – Wikipedia)  

Some examples of medical errors include: misdiagnosis (4), giving the wrong medication (type, dose, route, combination, or at the wrong time), hospitalcaused infections,  an incorrect laboratory result, equipment malfunction, transplanting organs of the wrong blood type, wrong site surgery, wrong patient surgery, surgical materials left in the patient, wrong blood type transfusion, anesthesia (too much, too little, or complications resulting from the failure to check the patient’s history), and manufacturing errors.  Birth injuries are often caused by oxygen deprivation and mechanical trauma.  At home, patients can fail to take their medications, and/or can implement their treatment regime improperly. (5) (Patient Safety: Health Literacy – Wikipedia, Medical Error: Examples of Errors – Wikipedia, Preventable Medical Error - Wikipedia, Types of Medical Mistakes – Wrong Diagnosis.com)   

There are a number of precautions a patient can take to reduce the risk of being the victim of a medical mistake: The most important consideration is that you should be an active member of your health care team.  To find a good doctor try asking the head ER or ICU nurse at a large local - ideally teaching - hospital for a recommendation.   Find out who other doctors recommend.  Your pharmacist is also an excellent source of free advice, since he/she has a from-the-trenches view of how patients respond to different medications.  Schedule appointments as far ahead as possible.  Make a prioritized list of all the issues you want to discuss with him/her.  Get copies of all medical records, current medications, and test and procedure results.  Bring them with you when you see any doctor, give all of them copies, and keep a copy with you.  Be honest with your doctor(s) and tell them about any of your unhealthy habits.  Bring your spouse with you when you describe your history and/or problems.  Two memories are better, and you won’t be as inclined to bend the truth.  (That is, unless you are hiding something from your spouse.)   Make sure your doctor(s) know every medicine, herb, and supplement you’re taking.  Let them know about any allergies or adverse reactions to medicines you have had.  If your allergies are severe get a Med Alert bracelet.  Also, be sure allergy information is on your chart, and your pharmacy’s computer.  Ask questions:  Learn everything you can about your condition.  What advocacy organizations can your doctor recommend?  What is your prognosis?  How accurate is the test you are about to do?  How long will it take you to recover?  Have your doctor explain your treatment options, his/her whole treatment plan, his/her reasoning, and then get a second opinion.  More treatment isn’t always better, so you need to justify everything you do.  What would happen if you had no treatment?  How soon do you need to make a decision?  Is there a research trial out there that would be right for me?  Will my health insurance cover this?  And just to be morose, in case things don’t go well you will want to have a living will on file.  (20 Tips to Prevent Medical Errors: Patient Fact Sheet – U.S. Department of Health and Human Services, 8 Crucial Tips for Keeping the Elderly Safe from Medical Errors – Aging Parents Authority, How to Avoid Medical Mistakes with Doctors and Hospitals - eHow, How to Avoid Medical Mistakes – eHow, Medical Errors: Tips to Prevent Them – FamilyDoctor.org., 20 Tips to Help Prevent Medical Errors: Patient Fact Sheet - AHRQ, 6 Secrets of Getting Better Doctor Care by Michael F. Roizen and Mehmet C. Oz – Shine)

Understand your medications: Get in writing the name and purpose of any new medication you are prescribed.  (For that matter always get everything in writing.)  Make sure you can read and understand your doctor’s prescription.  Whenever you are prescribed a new drug, if you have an allergy remind your doctor.  Know what each of your medications are for.  Does this medicine replace anything else you are taking?  How do you take them?  When do you take them?  For how long?  What are their side effects?  How do you handle them?  Do any of your drugs interact with each other or anything else?  Are there any foods or drinks you should avoid while taking them?  If you have trouble swallowing a medication ask if it comes in a liquid, and if you do have a liquid medicine make sure you know what to measure it in, and how to do so.  For example, teaspoons often don’t hold a unit teaspoon.  Don’t crush, chew, break, or mix your medicine in a liquid unless you are told this is OK.  Take medications with water unless directed otherwise.  Know what to do if you miss a dose.  How should you store your medicines?  What are their expiration dates?

When you pick up your medicine, check to make sure it’s what you expected, the instructions are clear, and the dose is right.  If you take a large number of medications, put them all in a bag and schedule a brown bag appointment with your doctor and/or pharmacy, and go over all of them.  Know both the brand and generic names of all your medications so you don’t accidentally take duplicate ones.  If you use only one pharmacy the pharmacist will be more likely they will catch interactions, if you don’t then bring a complete list of what you take to all of them.  Have your doctor’s name and number, and provide them to the pharmacist so they/you can call if there are any questions. (How to Prevent Medication Errors – ISMP)

Don’t save medications.  Don’t share medications.  Don’t throw your medications in the garbage since children can get into them, and also the drugs can get into the soil.  Don’t flush them down the toilet because they can get into the water supply.  See if your pharmacy has a drug recycling program.  If not, perhaps your hazardous waste facility will take them.  Lastly, there are organizations that donate expired medicines, those which are still good, to third world countries.  (How do I Dispose of Expired Medicine? – WiseGeek)

In the hospital:  If possible chose a hospital that handles many cases of your type.  Find out how a hospital compares to others in general.  (How Safe is Your Hospital? by Kathy Mitchell – The Austin Bulldog,)  While in the hospital verify everything that is to be done for any procedure.  For surgery you should put your initials on the site to be cut.  One of the most important things you can do to prevent an infection is when you deal with caregivers ask them if they have washed their hands.  Don’t let anyone give you medication without checking your patient identification bracelet first.  Ask your nurse to keep your medications in their original package, and open them at your bedside right before giving them to you.  If a medication doesn’t look like what you have been taking ask why.  When you leave the hospital go over all your medications, and when you get home update your current medication list.  If you aren’t able to be your own advocate have a family member or friend present doing all the above and double checking everything.  When they can afford it some people even go so far as to hire their own private nurse who stays with them in the hospital and double checks all of their treatments. (When Hospital Staff isn’t Enough by Abigail Trafford - Kaiser Papers) Be sure to specify those who will need to have access to your medical records.  Here is one service I ran across which is an electronic personal health record system that provides online access to your records anytime you are involved in a medical emergency or disaster.  (MyCrisisRecords.com)

Looking at medial errors from the provider’s point of view:

There are parallels between the aviation and medical industries that suggest some common approaches to safety might be productive. (Patient Safety: Safety Programs in Industry – Wikipedia) Some methods that have been adapted from aviation include: mandatory and non-punitive reporting of mistakes, systematic data collection and analysis, teamwork training and feedback, and near miss reporting.  What all of these measures have in common is that they involve a systems improvement approach, which aims to identify and eliminate the underlying system defects that lead to mistakes rather than focus on finding fault regarding a particular caregiver.  One example which many people will be familiar with is the Deming Model of Total Quality Management.  Anesthesia happens to be the area of medicine which has most thoroughly implemented the systems improvement philosophy.  Some of the safety measures that have been adopted here include the standardization of IV medications to 1 ml doses, uniform color coding standards, uniform equipment controls, and back up safety mechanisms for ventilators.  Several other such system safety practices more broadly adopted throughout the health care industry include: centralized sterile admixture services, the use of pharmacy computers to screen patient’s medications for interactions (5), requiring a patient’s informed consent, recommended second opinions and reviews of treatment regimens by specialists, unit dose packaging, and the Formulary System (which specifies the safest and most effective drugs for medical practice).  (Risk Factors and Prevention of Medication Errors in Critical Care - Medical News Today) The limitation of a systems approach is that there are tradeoffs for the changes involved in increasing system safety.  For example, there is an increase in workload when you add additional checks, and you get increased numbers of false warnings.  Both of these problems might themselves cause additional errors.  Another example of such a tradeoff would be the blood shortages that were created when the medical establishment limited blood donations to only very low risk donors to protect the nation’s blood supply.

Similar to the systems approach is the evidence-based medicine one.  (Patient Safety: Evidence-based Medicine – Wikipedia)  The aim here is to combine a doctor’s judgment regarding a particular case with the best evidence from medical research.  In theory the advantages of this approach are that it should reduce problems arising from the use of outmoded medical practices, provide a common framework for communication, help consumers make better choices, and keep providers up to date with the newest practices.  Problems with evidence based medicine might include providers using it to cut costs by unnecessarily limiting services, costing time and resources through implementing guidelines, disrupting the traditional relationship between providers and patients, increasing the risk of liability for those who fail to follow the guidelines in exceptional cases where they don’t apply, and limiting treatment options in harmful ways to the current consensus within the medical community. (7)

Several approaches to improving medical safety are based on changing the incentives facing caregivers.  The problem with this approach is that the  healthcare providers are also often the victims of the medical mistakes they make.  Such mistakes can have a large emotional impact on them, so they are already highly motivated to avoid them.  We seem to have reached the point of diminishing returns regarding using incentives to change outcomes, and programs based on changing incentives don’t seem to have been very successful.  Pay-for-performance has been tried, but some studies have shown it has only slight incremental value.  (Patient Safety: Pay-for-Performance – Wikipedia)  There is also some evidence of unintended consequences, since it creates incentives for care givers to avoid high risk patients, one category of which is the poor and uneducated.  It also can create incentives to meet the demands of an overly simplistic performance measure, with patient care adversely affected.   Another incentive based approach is to reduce payments for medical errors.  One program reduced payments for eight categories of error: blood transfusion reactions, air embolisms, falls, objects left in a patient during surgery, urinary tract infections from catheters, mediastinitis, sepsis from catheters, and pressure ulcers.   A problem here is that in such a system there is a risk of creating a culture of silence and driving reporting underground.  On the other hand, if reports are made confidentialto alleviate this particular problem then consumer groups complain that this denies the public the information it needs to make informed choices.  Another problem with reducing payments is that patients often deal with many care providers, and assigning responsibility for mistakes is often difficult.  Finally, still another incentive based reform which has been implemented has been the laws protecting whistle-blowers.  

An assessment of the current situation by the Agency for Healthcare Research and Quality (AHRQ) concluded that:  In spite of the fact that most of the measures of healthcare quality were improving, some were still deteriorating.  The rate of change is modest.  Improvement varies by phase of care and setting, and, overall, variation in care is high.  

For further reading here are a few books I found on-line that looked interesting: Medication Errors by Michael Richard Cohen, The Consumer’s Guide to Medical Mistakes by Robert A. Peraino, Never Go to the Hospital Alone by Steve Harden; all found at Medical Mistakes – Google Books.

(1) One tradeoff regarding the risk of mistakes is that for at least some physicians this is likely to be part of what makes being a doctor rewarding.  So without the risk the psychological rewards of medical practice would be reduced for many doctors. 

(2) Some causes of poor communication are: the use of a foreign language, poor handwriting, improper documentation, a high patient to nurse ratio, patient dishonesty, numerous hand-offs of patients, unclear lines of authority, incorrectly thinking that someone else is addressing the problem, and similarly named medications.

(3) Her site lists the following alternative models: Benefactor Model: A New Model of Charitable Care: The Robin Hood Practice; Ideal Micropractice: Going Solo: Making the Leap, Going Solo: One Doc, One Room, One Year Later, What’s a Micropractice?; Cash Model: Cash and Carry Healthcare; Community-Designed Practice: The Community-Focused Family Medicine Clinic; House Call Model:
House Calls Bring Relief to Physicians, Patients; Free Clinic: Common Ground Health Clinic   Video, USCD Student-Run Free Clinic     Audio; Retainer Model: Dr. Knope’s Concierge Medicine Blog   Video)

(4) Misdiagnosis errors often occur because a particular disease isn’t considered, incorrect information is supplied to the doctor, too much weight is given to one factor, or the symptoms of the condition aren’t sufficiently salient.  Also, misdiagnosis is especially likely to occur with several types of mental illness: dissociative identity disorder, bipolar disorder, and schizophrenia.  (Medical Diagnosis: Errors in Diagnosis – Wikipedia)

(5) A study of 2,600 patients found that between 26-60% of patients could not understand medication directions, informed consent, or basic health care information. M. V. Williams, et al. (1995). “Inadequate functional health literacy among patients at two public hospitals” ”low health literacy levels negatively affects healthcare outcomes.  In particular, these patients have a higher risk of hospitalization and longer hospital stays, are less likely to comply with treatment, are more likely to make errors with medication, and are more ill when they seek medical care.” (See also: SES Status, Health, and the IQ Connection - Lost Wanderer)

(6) A RAND study estimated that the U.S. healthcareindustry could reduce mistakes if health information technology were widely adopted.  This includes such things as electronic patient records, electronic medication ordering (including a standardized bar code system), automated drug-drug/drug-food interaction checks, allergy checks, patient education, tracking referrals and test results.  Potential problems with such reforms include: default selections can potentially override non-standard medication regimens, computer system backup might lead to a false sense of security, irrelevant or frequent warnings could interrupt work flow, and mistakes due to staff inexperience with this sort of new system. (Patient Safety: Technology in Healthcare – Wikipedia)  

(7) I have a very strongly held disagreement with the U.S. healthcare industry’s attitude towards risk.  For a critical view of the U.S. healthcare industry’s attitude towards risk and medical practice I recommend the book, “Risk Watch: The Odds of Life“ by John Urquhart and Klaus Heilmann.  The authors argue that the news creates a false understanding of the dangers in life, they discusses the risks involved in medical treatment and daily life, and argue that life is safer today than in the past.  It seems to me that the health care industry is so obsessed with not making mistakes (partially for fear of liability) that overall by omission of treatment it causes many more injuries and deaths than would otherwise be the case.  In other words, if you give a person a drug and it injuries them you are potentially liable.  But if you don’t give ten thousand people a drug that would have saved them, because it hasn’t yet been approved, no liability applies, and this isn’t counted as a mistake.  For what is overwhelmingly likely to eventually prove to be an example of this, see: Hookworms are our Little Friends – Lost Wanderer.  In my opinion this asymmetry needs to be corrected by reforming liability law.  Part of that reform would involve the idea that reasonable risks (and the tragedies these will inevitably create) need to be allowed and accepted to reap the huge benefits that are currently being forfeited.  In many circumstances patients should have the right to take personal responsibility, and assume the risks of unproven treatments. 

(Oops, Wrong Patient: Journal Takes on Medical Mistakes by Denise Grady – New York Times, Root Cause Analysis – Wikipedia, Medical Errors and Patient Safety – U.S. Department of Health and Human ServicesMedical Errors by Rebecca Frey - Encyclopedia of Surgery, Dead by Mistake by Cathleen F. Crowley and Eric Nalder – Hearst Newspapers, An Epidemic of Medical Errors: The Scope of the Problem – Bear Market News)

Blog Break

January 22nd, 2010 by lost_wanderer

I have started sorting through and organizing all my old files from the past 3 years.  This could take as long as 1 to 2 months, so I won’t be blogging for a while.

Fire Safety & Burn Prevention

January 8th, 2010 by lost_wanderer

Here is a summary list of the things to do (and not do) if you want to go all out in avoiding getting injured or killed by a fire:  Don’t drink, smoke, or use candles.  Have smoke alarms, fire extinguishers, and a sprinkler system in your home.  You should have ground fault circuit interrupters, arc fault circuit interrupters, a home gas detector, and a fire escape plan.  You should have good house wiring, and your house should be wired such that you don’t feel the need to use extension cords.  Excess electrical cords should be tied up.   It’s best never to use any sort of space heater at all, but if you do then be very careful with them.  Your appliances should be in good repair, serviced properly and not abused.  Also, all appliances should be unplugged when they aren’t being used.  Have anti-scald devices, and set your water heater’s temperature down.  Wear fire resistant sleepwear, and don’t wear loose clothes when around fire.  Children simply have to be restricted around burn and fire hazards.  Don’t use fireworks, don’t have a natural Christmas tree, and don’t use candles in jack-o-lanterns.  Build a fire-proof house with fire-safe landscaping around it.  If you are staying in a motel be prepared for the possibility of a fire.  For the details read below:

Every year about 4,000 people in the United States die in fires.  Approximately 3,500 (80%) of these deaths are from residential fires.  The other 500 deaths are from motor vehicle crashes, aircraft crashes, electricity, chemicals, hot liquids, hot substances, and other sources of burn injury.  (Burn Incidence and Treatment in the US: 2007 Fact Sheet - American Burn Association)  Burns are one of the most expensive catastrophic injuries to treat.  A burn involving 30% of your total body area can cost as much as $200,000 in initial costs and fees. (BURN INJURY FACTS - Burnfree)

Certain groups are at higher risk from fire-related injuries and deaths.  These include males, children under 5, adults 60 and over, African Americans, American Indians, people who live in small rural communities, the poor, those living in substandard housing or manufactured homes, and people in the Southeast.  Risk factors for fires also include it being wintertime, and alcohol use (40% of deaths). 

In home fires most people die from smoke inhalation while they are asleep, and not from burns.  About 2/3 of these deaths occurred in homes without a working smoke alarm, and installing one reduces you chance of dying from a home fire by about half. (1)  The safest type of alarm has a combination of ionization and photoelectric sensors, which gives you better protection against both fast flaming and slow smoldering fires.  You should have one on every level of your home, inside bedrooms, and outside sleeping areas.  Alarms should be placed either in the center of the ceiling, or, if installed on a wall, between 6 and 12 inches below the ceiling.  You should test the batteries regularly, or get the kind of alarm with sealed lithium batteries designed to last 10 years.  Don’t locate them too close to a fireplace, heating appliance, or stove since this might cause false alarms.  Don’t locate them near bathrooms, windows, or ceiling fans.  Keep them free of dust, and replace them every 10 years. (Smoke Detector Guidelines – Township of Edison New Jersey)

A sprinkler system is one of the best protections against fire, and will typically lower insurance rates by 5% to 15%.  For a new home the cost of a sprinkler system is about $1.00 to $1.50 per square foot, and retrofitting a home with a sprinkler system can be done using minimal extra piping.  (Fire sprinkler system – Wikipedia, Residential Sprinkler Systems – USFA, Fire Protection Systems: Industrial & Commercial – Koetter)  If you want to protect your electronics and books, etc. from water damage you can get a Sapphire system that uses 3M’s Novec 1230 fluid.  It looks like water, but doesn’t get things wet and damage things.  (Sapphire: A Liquid That Won’t Get Things Wet) (Ansul SAPPHIRE™ Fire Suppression Systems & Ansul Products both by Tyco Fire and Security) (Vanguard Sapphire Systems) Commercial properties sometimes use foam/water sprinkler systems.  (FOAM/WATER SPRINKLER SYSTEMS, ANSUL® R-102 kitchen fire suppression system)

You should have and practice a fire escape plan.  Draw up a floor diagram, so everyone can see the whole plan.  Every room should ideally have two escape routes.  Keep an emergency ladder on upper floors of your home, and, of course, make sure all your windows will open and you can crawl out through them. (Portable Fire Escape Ladders – firesecapesystems.com)  If an alarm sounds don’t try to save property, but get out. (2) Sleep with the bedroom doors closed, since this will give you more time by keeping smoke out of your rooms.  Everyone should know to roll out of bed, stay low, and crawl to get out of a fire.  Staying low makes it easier to breathe and see, since smoke rises.  Practice alerting other household members.  Have a designated meeting location, with one person assigned to go to a neighbor’s home to call the fire department.  Teach your children how to call 911.

You should buy sleepwear that’s labeled flame-resistant. (How to Pick Flame-Resistant Sleepwear – eHow)  Make sure everyone knows to stop, drop and roll if their clothing catches fire.  Cover your face and hands to prevent fire from getting to your eyes, nose, and mouth.  If you get burned remove all clothing and jewelry from the area of the burn, and immediately place the wound in cool water for 10 minutes.  Cover the area with a clean dry cloth.  Do not use butter on a burn, since this could further damage the skin.  If a burn blisters or chars, or is bigger than your fist, see a doctor immediately.

Once you have escaped from a fire get medical attention even if you think you are fine.  You might have been exposed to smoke, will suffer its effects later, and not realize it immediately. This site (After a Fire – FireSafety.gov) provides advice on how to recover after a fire.  It has suggestions on what to do in the first 24 hours, insurance issues, how to value your property, valuable documents, salvage tips, fire department operations, etc.

Heating and cooling equipment are very common sources of home fires.  These include your furnace, space heaters, fireplaces and chimneys, water heaters, and heat transfer systems.  All of these should be inspected annually.  

Space heaters are especially dangerous, since two thirds of home heating fires in the U.S. in 1998 were caused by space heating equipment.  All types of them are involved in fires: electric heaters, kerosene heaters, wood stoves, fireplaces, and room gas heaters.  Never leave any space heater unattended.  Electric space heaters must have the Underwriter’s Laboratory (UL) label.  Check to be sure it shuts off if tipped over.  Don’t use one to dry clothes.  Don’t store things on top of it.  Keep all combustibles at least three feet away from a space heater.  Unplug it when it’s not in use.  Turn off space heaters (or unplug them) whenever you leave the room.  Kerosene heaters must be UL approved.  Never fill one with anything but clear K-1 kerosene, and never overfill it.  To prevent carbon monoxide poisoning use one only in a well ventilated area.  (Carbon Monoxide – Lost Wanderer)  These are dangerous devices that have been banned in New York City.

Electrical fires are commonly caused by faulty wiring and lighting, and they are the third leading cause of home fires.  Problems can come from frayed wires, faulty electrical outlets, extension and appliance cords, plugs, overloading circuits, and old wiring.  Wiring should be replaced when it becomes stiff or cracked through wear, flexing, or age.  Unless you are trained don’t “fix it” yourself, but have an electrician do it. 

Extension cords shouldn’t be used as a long term solution for too few wall outlets; one reason is that they can become damaged when they are run under rugs or furniture.  Don’t run them over nails, in high traffic areas, or against walls where heat can build up.  You shouldn’t use an extension cord with a space heater, microwave, any other cooking appliance, and any appliance that draws much current.  Don’t run multiple high amperage devices off of one outlet by using a power strip.  Instead you should have an electrician install more outlets.  Check if any electrical outlets, switches, or cords are overloaded by feeling if they are unusually hot to the touch.  Are any of your electrical outlet cover plates discolored?  This could also be a sign of overheated wires.  You should tie any excess electrical cord with twist ties to reduce the likelihood a child or pet will chew on them.  You can also buy a holder designed to hide extra cord.  (Organize and Protect all Your Cables and Cords - Cablecordorganizer

Only use the proper sized fuses in your fuse box.  Unplug all the bathroom appliances when you’re not using them. (3)  You should install ground fault circuit interrupters in the bathrooms and kitchen, (How does a GFCI outlet work? – HowStuffWorks) and install arc fault circuit interrupters throughout your house. (Preventing Home Fires: Arc Fault Circuit Interrupters (AFCIs) - Consumer Product Safety Commission)  When buying a house have the electrical wiring fully inspected. (Fire Safety Tips)

The appliances that cause most electrical fires are electric stoves and ovens, central heating units, televisions, dryers, radios, and record players.  Keep electrical appliances away from water, and be especially careful about this in the kitchen and bathroom for fear of electrocution.  Don’t allow children to play with or around appliances such as irons, hair dryers, or space heaters.  Look for the Underwriter’s Laboratory (UL) mark on the appliances you buy.  Keep combustible items, such as curtains or clothes, three feet or more away from all heaters.  Only use three-prong plugs in three-slot outlets, otherwise you have defeated the ground on the appliance.  Shut off and replace light switches that are hot to the touch, or if the lights flicker.  Use electrical outlet covers to child-proof them. (Children and Electrical Outlets – State Farm Insurance, Electrical Safety – KidSafe Home Safety ProductsSliding Safety Plate for 3-Pronged Outlets – Safebeginnings.com

Position your television and stereo equipment against the wall, so children can’t get to the back surfaces and cords.  But also be sure these appliances have adequate ventilation, so they don’t overheat.  If you use an electric blanket be sure to follow all the safety precautions provided.  Only buy new electric blankets, and replace any that is over 10 years old.  (Older blankets cause 99% of electric blanket fires.)  Clean the clothes dryer vent of lint after each use.  Regularly inspect your electrical tools for signs of wear.  Replace any chords that are frayed or cracked, and replace any toy, tool, or appliance if it causes small electrical shocks, overheats, shorts out, smokes, emits an unusual smell, or sparks.  When kids get older make sure they’re careful when using irons or curling irons, since they can be very hot for some time after they are used.

Be sure to use the correct wattage bulbs for a fixture.  Keep combustibles away from light bulbs, especially halogen ones.  Don’t place clothing or cloth on top of a lampshade to dry items, and always use a lampshade.  Nightlights should never be in contact with fabric.

Mattresses (4), bedding, and upholstered furniture are where many fires start.  They are often ignited by open flames from such things as cigarettes, cigars, cigarette lighters, matches, and candles.

Smoke outside if you can, and consider using fire-safe cigarettes.  (But many smokers say they “taste like crap.”) (Smokers burned up over ‘fire-safe cigarettes’)  Set your lighter on low flame.  Close your matchbook before striking.  Use deep stable ashtrays placed on sturdy and hard to ignite furniture.  Extinguish all smoking materials before you leave.  Dowse butts and ashes in sand or water.  When smokers visit your home ask them to smoke outside.  If they smoke inside you will need to check in and under furniture afterwards for left butts.  Try not to smoke if you have been drinking, are taking medicine, drugs, or are sleepy.  Of course, never smoke in bed, or even when lying down anywhere.  Don’t smoke in a house where oxygen is used. 

Keep matches and lighters away from young children by storing them in a locked cabinet or drawer, and teach them they aren’t toys.  About 7% of structure fire deaths in the United States are caused by a child setting a fire, and children playing with fire cause more than one-third of preschool child deaths by fire. (BURN INJURY FACTS – Burnfree)  Don’t leave a child alone in the bathroom, kitchen, or a room with a lit candle, lit fireplace, hot appliance, stove, or portable heater.

If you use candles put them in stable holders positioned where they can’t be easily knocked down, and don’t put them near fabric.  If an area has a draft, something like a drape could be blown into a candle.  Never leave lit candles unattended.  You can also get flame-protective shades or globes for candles.  Never spray an aerosol can near a lit candle or any other open flame.  If the power goes out use a flashlight instead of a candle. 

Cooking accounts for most home fires, and unattended cooking causes most of these fires.  You actually shouldn’t leave the kitchen if the stove is on, but if you must you should set a timer to remind you.  Never leave the house when the stove is on.  In general, don’t wear loose clothing when cooking anything anywhere.  Try to avoid clothes with sleeves, but if your shirt or blouse does have sleeves at least roll them up.  If possible avoid reaching over the stove, and, to reduce the risk of this, don’t store things over or behind the stovetop.  Since children often don’t appreciate the danger, there should be a three foot zone marked out around the stove (or anything else that is hot, such as a fireplace or a portable heater) where children aren’t allowed.  Don’t allow a child use a walker in the kitchen.  Turn the handles inward so your pots and pans won’t be knocked or pulled (by a curious child onto themselves) off the stove.  Install a stove shield, and cook on the rear burners of your stove.  (Stove Top Shield – Security World)  Install stove and knob locks.  Keep cooking surfaces clean.  Keep curtains, pot holders, towels, flammable cleaners, and solvents away from kitchen heat sources.  Don’t get in the habit of leaving anything make of fabric, such as pot holders, on the stovetop when the burners are off.  Don’t hold a baby while cooking.  Don’t drink hot beverages or soup when a child is sitting on your lap.  Don’t carry hot dishes or liquids around kids.  Kitchen appliances should be unplugged and their chords hidden when not in use. 

Close the oven door and turn off the heat to smother a broiler or oven fire.  To put out a pan fire slide a lid over the flames to smother an oil or grease fire, and then turn off the heat and let the pan sit and cool.  Keep a lid handy in case you need it.  Use baking soda to put out other food fires. Don’t use flour or water on cooking fires.  Have the right type of fire extinguishers throughout your home, especially in your kitchen, and know how to use them.  (Fire Extinguisher Reviews and Buying Guide – GALT) (5) 

Don’t heat baby bottles in a microwave.  The milk or formula might heat unevenly and scald your baby’s mouth.  Allow food cooked in a microwave to cool for a few minutes, and open microwave food containers carefully.  Be careful with hot foods and drinks around children.  Don’t use tablecloths or large placemats with children because they could pull a hot drink or food onto themselves.  Keep hot things away from table edges.  Test a food’s temperature before giving it to a child. 

For barbecuing, before lighting up, check the fuel line and connection between the propane tank and grill.  Make sure the tubes where the air and gas mix are not blocked.  Check your grill thoroughly for leaks or cracks before using it.  You do this by smell and the soapy bubble test.  Don’t overfill the propane tank, and never start a propane grill with the lid closed.  Never grill or barbecue in enclosed areas since the carbon monoxide could poison you.  (Carbon Monoxide – Lost Wanderer)  Keep the grill at least 10 feet away from your house, garage, and trees.  Don’t use grills on top of anything that can catch on fire. 

As always when dealing with fire, don’t wear loose clothing while barbecuing.  Use long handled barbecue tools and flame resistant mitts.  Only use barbecue starter fluid on a barbecue fire, and when using it don’t squirt fuel into a fire.  The flame can run up the stream to the container causing it to explode.  Of course, keep matches and lighters away from children.  Don’t let kids play around a grill or fire pit.  Mark out with a chalk line a no child area three feet around the grill.  Keep all alcoholic beverages away from the grill since they are flammable.  Don’t leave the grill unattended.  Have a fire extinguisher and water nearby so you can douse the fire if necessary.  When you are done, douse hot coals with lots of water and stir them thoroughly.  Clean and store the grill properly.  Never store flammable liquids or pressurized fuels in the house, in the garage, or near any source of flame or heat. Never keep gasoline in the house.

If a fire starts, turn off the burners on a propane grill, close the grill lid on a charcoal grill, and disconnect the power on an electric grill.  On a propane grill if you can reach the safety valve shut it off, but if the fire involves the tank leave the area and call the fire department.   

Beware of turkey fryers, since they have burnt a number of homes down. (Turkey Fryer Safety – Scottsdaleaz.gov, Turkey fryer – Wikipedia, Turkey Fryer Safety Tips)

Fireplaces need to be cleaned frequently since they build up creosote in their chimneys.  They should also be regularly inspected for cracks and obstructions that can lead to fires.  Make sure the damper is open when starting a fire.  Flammable liquids should never be used to start a wood fire.  Don’t burn trash, paper, or green wood in your fireplace, since they cause more creosote buildup than wood, and also can lead to large uncontrolled fires.  Use a heavy and large screen to catch flying sparks and rolling logs.  It should cover the entire opening.  As always, don’t wear loose-fitting clothes near open flames.  Teach children to never put anything into the fireplace, especially when it is lit.  Also teach them that the glass doors to the fireplace can be very hot.  Make sure the fire is totally out before going to bed or leaving the home.  You should store the cooled ashes in a sealed metal container outside. 

Build campfires away from dry grass and leaves where they won’t spread.  Have water and a shovel on hand to douse the fire when you’re done.  Douse it, stir it, and douse it again.  Don’t leave it unattended.

Wood stoves cause about 4,000 home fires each year.   You should follow the installation and maintenance instructions.  Buy one that is solidly constructed with plate steel or cast iron.  Make sure that there aren’t any cracks, and that the joints and seams are smooth.  You should screen it as you would a fire place.  Never burn treated lumber (Lead Poisoning – Lost Wanderer), plywood, green wood, artificial logs, or trash in one, but only seasoned wood.  Check and clean the chimneys and pipes every year.  Check monthly for obstructions or damage.  Keep all combustibles three feet or more from it.  It’s okay to leave a wood burning stove operating unattended on the condition that it’s in good working order.  If they are hot to the touch radiators and electric baseboard heaters need to be screened the same as a fire place. 

Always test the bath water with your elbow (and possibly a meat thermometer) before putting your child in.  Bath water should be warm (100 F), but not hot.  Set the thermostat on your water heater to 120° F (49° C), or the “low-medium setting.  Also install anti-scald devices. (Anti-Scald Shower Valves – HomeTips)  You should turn the cold water on first, and then turn it off last, when running water in the bathtub or sink.  Turn kids away from the fixtures in the tub, so they’re less likely to play with them.  Use a cool-mist type of humidifier or vaporizer rather than a hot-steam one.

The safest choice is not to use fireworks, but, if you do, always have a bucket of water and fire extinguisher handy.  Never ignite them indoors or near dry grass.  Of course, (for the last time) when using fireworks don’t wear loose clothing.  Stand back from lit fireworks.  If a device doesn’t perform don’t pick it up or stand over it.  Pour water on it, pick it up with tongs, and throw it out.  (You should also wear hearing protection when setting them off.  (Tinnitus and Permanent Hearing Loss – Lost Wanderer))

When you select a Christmas tree the needles should be green and pliable.  If you shake a branch, and a lot of needles fall off, the tree is too dry.  The trunk should also be sticky.  Don’t put it up too early, and don’t keep it up longer than two weeks.  If the tree has been stored for more than three days without water cut one inch off the bottom of the trunk, and then place the tree in a stand that holds at least a half-gallon of water.  Keep the tree stand full of water.  Don’t place the tree close to a heat source, such as a fireplace or heating vent.  Don’t flick or drop smoking ash on it.  Never put lit candles on a tree, and don’t go near it with any open flame.  You might try using the product No-Burn 1019 Christmas Tree Fire Gard.  Don’t put the tree where it cuts off an exit. 

Make sure your light strands are in good condition and fused properly.  Check for frayed wires, cracks in the insulation, broken or cracked sockets, or excessive kinking.  Unless the directions say otherwise, don’t link more than three strands together.  The wires shouldn’t be warm to the touch.  Test them before you put them on the tree and don’t leave them on unattended.  Use only nonflammable decorations.  If you use an artificial tree be sure it is flame resistant. (How to Prevent a Christmas Tree Fire – eHow, Holiday Fire Safety – USFA)  Don’t use electric cords on a metal tree.  Don’t burn the tree in your fireplace or stove, but dispose of the tree by taking it to a recycling center, or through a community pick-up.   

During Halloween it is best to not use candles in jack-o-lanterns, but instead use battery powered lights.  Only use flame retardant costumes.  (Halloween safety tips – New York City Fire Department

To protect your property from an advancing fire keep your lawns trimmed and leaves raked.  Thin the trees and brush within 30 feet around your house.  You should plant fire resistant plants.  Your roof and rain-gutters should be kept free from debris.  Try to wash your roof on a regular basis.  Keep flammable materials, such as stacked firewood, at least 30 feet from your house, other wooden structures, and fences.  You can install protective roofing, stone, brick, and metal to protect your home.  Exterior vents, attics, and eaves can be covered with fine metal mesh screens.  Multipane windows, tempered safety glass, and fireproof shutters will protect large windows from radiant heat.  Fire resistant draperies offer added protection.  The Castle Defense company sells foam and gel systems for spraying down your home and property that create a defensive fire barrier.  (Castle Defense)  During winter clear snow away from fire hydrants in front of your home or building.

If you are building a new home you have many more options for building in fire resistance.  To fire harden one particular home the architect used ICF foam building blocks manufactured by Arxx, a steel interior frame, insulated shutters, no ventilation, and defensible space landscaping.   (Fireproofing a Dream Home – Napa Valley, CA)  (See also: How to Build a Fireproof Home By Amy R. Hughes and Mark Powers – This Old House, How to Build a Fireproof Home – eHow)  I was once told by a workman that galvanized steel tubing conduit (aka Galvanized rigid conduit (GRC)) is the ultimate gold standard for wiring conduit, but it’s difficult to work with, so it tends to be used only in industrial applications.  (Electrical conduit – Wikipedia)  I’ve written before about one man who built The Ultimate Secure Home.  (Secure Homes and Survival Shelters – Lost Wanderer)  The house is an underground Formworks steel reinforced concrete home, which should stand up to any forest fire. (6)

If you live in the country you should post house address signs that are clearly visible from the road.  Emergency vehicles must have access to the property, with roadways and driveways at least 12 feet wide with adequate space to turn around.   Hydrants and ponds must be accessible to the fire equipment.  Be careful if you burn waste, and be sure to check the local laws before you do so.   

Arson occurs about 18,000 times a year and accounts for around 320 deaths a year.  To reduce your risk from arson keep trash from accumulating on your property, don’t have abandoned vehicles on it, remove dead branches, and install outdoor lighting to deter intruders.  If a child exhibits fire-starting behavior seek professional help, and don’t hesitate to report a neighbor’s child who starts fires to her parents or the authorities.  

There are a number of good general rules for dealing with high-rise, motel, and hotel fires, but you should remember that every fire is different, and sometimes you will have to make very hard decisions without knowing all the facts. 

In a high-rise never lock or block the fire exits, doorways, halls, and stairways.  Make sure that your apartment door is a tight-fitting self-closing type of door.  Keep rubbish out of the hallway.  Don’t prop a fire door open.  The exit stair doors should ideally be self-closing, snap shut, and unlock from both sides.  Have the building manager post the evacuation plan in high traffic areas, and have everyone learn it.  Practice your escape plan together.  Post emergency numbers near all telephones.  Fire hazards include such as things as blocked exits, piled-up trash, missing exit lights and open fire doors. Report them to your superintendent.  If the fire starts in your room get out quickly, close the door (but don’t lock it), sound the alarm, and let the front desk know.

If the alarm sounds feel the door with the back of your hand to see if it’s warm.  If it is warm don’t open it, but instead stuff the door’s cracks, the ventilators, and any other sources of smoke with wet cloth or tape to keep the smoke out.  Fill the bathtub with water, and use it to douse and cool the door or any other hot surface.  Create a mask of wet towels.  If you have a phone, call the fire department and tell them which room you are in.  In general turn off all fans and air conditioners, but remember the bathroom vent might be useful for clearing smoke.   Signal at a window with a flashlight or by waving a sheet.  Do not break the window because smoke might come in and you will need to re-close it, but see if you can open it to get fresh air.  If fire is outside your windows then close them, tear down the drapes, and move combustibles away from them.       

If the door is cool and you decide to open it, get low to the floor, brace your body against it, and slowly open it a small bit.  If the hall and stairs is clear of smoke then evacuate the building, but take your room key with you.  Close the door behind you to keep smoke out of it in case you have to return to it.  Stay low and crawl.  A few feet above the floor might make the difference between toxic gasses and heat versus breathable air.  If you run into smoke or flames on your way out you might have to return to your apartment.  Never use an elevator to escape since it might stop, instead use the stairs.

When staying in a hotel or motel ask if they have smoke alarms and fire sprinklers.  When you get to your destination read the evacuation plan, locate the two exits from your room, the fire alarms on you floor, and count the number of doors from your room to the exits as you walk the escape route.  If the exit doors are connected to an alarm obviously don’t test them.  Check if the stairwell doors will lock behind you.  If they do, and if a fire occurs, be careful about committing to that route of escape.  Check and see if you can open your room’s windows, and if not, plan what you would use to break them.  Locate the fire alarms and extinguishers, and review how to use them.  Try to get a room on a lower floor.  Ask for a map of the building.  You should take a flashlight and a battery powered smoke detector along when you travel.  Place the detector on the inside top of the door of your room, but not near any vents.  Put your flashlight and room keys in your shoes when you go to bed.  If a fire starts leave everything else behind.  Use the wall as a guide as you crawl.  If your escape is blocked then either return to your room, or hope the building has a rooftop exit.  If you end up on the roof, close the door behind you, stay on the windward side, and signal the firefighters below.  If you are traveling in another country remember that many of the industry’s standard safety features might not apply. (How to Survive a Hotel Fire - wikiHow)

(1) Post 1989 homes commonly are built with a hard wired interconnected smoke alarm system.

(2) You might consider using a safe deposit box, or having a fire safe box (or even a room) in your house, for your important items and papers, so you won’t be tempted to save them.

(3) Actually experts recommend that all appliances be unplugged any time they’re not being used, including computers, TV’s, and stereos.

(4) You might consider replacing any mattress made before 2007, because after that date they have had to meet the Federal Flammability Standard.

(5)  To avoid a kitchen explosion and fire from a natural gas leak or propane leak you might consider buying a home gas detector.  For example First Alert makes the GCO1CN, which is a combination gas and carbon monoxide detector.  (See also: MANUFACTURER LIST: GAS DETECTORS: RESIDENTIAL AND RECREATIONAL VEHICLES: LISTED BY UNDERWRITERS LABORTORIES

(6) For more general information on robust construction methods, see:  Hurricane construction guideHurricane construction, house building methods in high wind prone areas.)

(firesafety.gov, How to Prevent Burns – eHow, Preventing Burns, Shocks, and Fires – Household Safety, Child safety: How to prevent burns - Mayo Clinic, Fire Safety – Safetyresource.org, Fire safety – New York City Fire Department, Home Fire Prevention – U.S. Fire Administration)

Update on Not Using Soap or Shampoo

December 31st, 2009 by lost_wanderer

Following up on an earlier post, (You Don’t Need to Shampoo Your Hair (Or use Soap) – Lost Wanderer) Boing Boing has just blogged (Body washing with water alone) about a report by Free the Animal (Paleo I Don’t Care: I Like No Soap; No Shampoo) in which he talks about his very good experience with going soap and shampoo free for the last six months.  Both the Boing Boing and Free the Animal posts are followed up with numerous comments by readers.

Food Poisoning

December 22nd, 2009 by lost_wanderer

Each year food poisoning causes about 76 million Americans to get sick, over 300,000 to be hospitalized, and 5,000 people to die.  It’s estimated that only five pathogens account for more than 90 percent of food-related deaths: Salmonella (31%), Listeria (28%), Toxoplasma (21%), Norwalk-like viruses (7%), Campylobacter (5%) and E. coli O157:H7 (3%).  (Food Poisoning Information Center)  The typical fatality involves a child, an elderly person, a chronically ill person, or a person with an impaired immune system.

One problem people have is determining whether they have food poisoning or if they have the flue.  Food poisoning tends to start and end much more quickly than the flu, and usually lasts from 12 to 24 hours.  Flu symptoms generally develop slowly over a day or so and a person typically develops a headache, fever, weakness, and a sore throat.  In addition to the speed of onset the three main clues suggesting you don’t have the flu and do have food poisoning are frequent vomiting, repeated diarrhea, and (sometimes) if others who ate the same food are sick in the same way.  

If someone is poisoned the advice varies depending on how severe it is and how vulnerable the patient is.  If the victim is a member of an especially vulnerable population, such as an infant, you should go to a doctor.  If you are a healthy adult, and any of the following symptoms occur, the advice also is to get to a doctor:

See medical attention if you have a fever over 101 F, you have been vomiting for more than 12 hours, you haven’t been able to keep fluids down for at least 12 hours, you have serious muscle cramping, you have bloody diarrhea, or suspect you have botulism. 

The big concern with food poisoning, except if you have botulism, is dehydration.  Dehydration is indicated by any of the following symptoms: having a dry mouth or sticky saliva, have little urine or dark urine, being dizzy, lightheaded, confused, having an increased heart rate, having problems with breathing, having a fast rate of breathing, having no tears, or having sunken eyes. 

In very serious cases of food poisoning medications may be prescribed to stop the cramping and vomiting, and a doctor might also prescribe antibiotics.  However, you should never stop diarrhea because its purpose is to clear the toxins from the body.  

Botulism is a much more serious matter, and you should get to a hospital if you think you have it.  Its symptoms include a headache, double vision, dizziness, weakness, droopy eyelids, constipation, dry mouth, paralysis, or the loss of reflex to light.  The antitoxin for it must be given in the first 72 hours after symptoms first appear, and cannot be used on infants.

If you choose not to go to a doctor you should rest in bed, avoid activity (especially after eating), take plenty of fluids (ideally containing electrolytes - but not lots of sugars), and have someone monitor you.  You can get electrolyte drinks sold in drugstores.  Unless the condition is extreme (and if it is you should be in the hospital) you shouldn’t take medicines to prevent the vomiting and diarrhea because, as mentioned above, these are the mechanisms by which your body gets rid of food toxins.  If you can, temporarily discontinue all oral medications.  Avoid dairy products (because of temporary lactose intolerance), and caffeinated drinks.  Don’t eat solid foods until you stop vomiting, when you began to do this limit them, and only eat light, soft, bland foods (such as saltine crackers or plain bread).  One option is to try the BRAT diet, which gets its name from the four foods it includes: banana, rice, applesauce, and toast.  Eat and drink slowly, and don’t mix hot and cold foods.  Avoid brushing your teeth after eating since this can make you nauseous.

Alternative medicine sites sometimes recommend taking charcoal tablets that soak up toxins.  Others recommend treatments with two bacteria found in milk products, Lactobacillus acidophilus, Lactobacillus bulgaricus, along with citrus seed extract.  A fluid to replace water and electrolytes can be made by adding one teaspoon of salt and four teaspoons of sugar to one quart of water. Two herbs that are sometimes recommended for treating forms of food poisoning other than botulism are Arsenicum album and Nux vomica. You might consider calling your doctor and asking about any other foods or liquids, and off the shelf medicines, you should take. 

From my prior posts regarding symbiotes (We Need Our Symbiotes – Lost Wanderer , We Need Our Symbiotes II – Lost Wanderer, and Umami Hypothesis – Lost Wanderer) readers will know that I have mixed feelings about going all out to avoid germs, (For a lighthearted spoof of this issue see: Germs – Weird Al Yankovic) but with that in mind here’s the advice I’ve been able to find on-line regarding trying to prevent food poisoning:  

Prevention:

Foods from animal sources (FFAS) include such things as meat, milk, poultry, seafood (such as fish and shellfish), and eggs.  Check the expiration dates on FFAS before buying or preparing them.  Keep FFAS cold, and do not allow them to sit at room temperature.  Cover and refrigerate these foods within a few hours.  Be careful to keep juices from animal sources from contaminating other foods, such as by dripping down in the refrigerator.  Don’t thaw FFAS at room temperature.  Thaw meat in the refrigerator allowing 1 day for every 5lbs.  Alternatively immerse FFAS in a cold water bath and change the water every 30 minutes (a 20 lb turkey will take 12 hours to thaw in cold water.)  Don’t refreeze foods that have been thawed (especially poultry), and don’t partially cook a FFAS one day and then finish cooking it the next.  FFAS should be cooked thoroughly to the appropriate internal temperature for the type of meat it is, (See the chart at: Safe Food Handling – USDA) and you should be sure of the temperature by using a good instant-read, digital, probe meat thermometer that is sensitive at the tip.  (Of course, some FFAS are safe because they have been pasteurized.)  Don’t cook stuffing inside the turkey, and remove it from the turkey before refrigerating leftover meat.  Gravy and broth should be stored separately, too.  The general rule is keep hot foods hot and cold foods cold.

Don’t drink unpasteurized milk (or foods made from it), juice, or cider.  (Commercial juices sold at room temperature are safe because they have been pasteurized.)  (Buying food that has been sterilized by using gamma radiation is another option. (Food irradiation – Wikipedia))  Breast-feeding is safest for infants and might prevent many food borne illnesses as well as other health problems. Don’t eat shellfish that has been exposed to red tides or are from contaminated waters.  Don’t give honey to children under 1 year of age. Don’t store food in containers that previously held poisons or are made of metals.  Don’t eat wild mushrooms unless you are certain they are safe.

Wash your hands, cutting boards, work surfaces, and utensils with soap and hot water both before and after handling raw FFAS.  Wash raw fruits and vegetables thoroughly before eating them, out of concern for E.coli, Salmonella, and pesticides.  (Some people recommend avoiding alfalfa, bean, clover, or radish sprouts altogether since they are difficult to clean.)  Wash your hands with soap after handling reptiles, birds, or feces.  If you are ill (especially with diarrhea or vomiting) do not prepare food for others.  Cover any sore on your hands before preparing food

If you do home-caning, of course, use the proper procedures, while remembering that undercooking is the main problem in home canning.  Rotate dry and canned food products.  Put a “Use by” date on your canned products, and if a store bought product does not have a “Use by” date take a black ink marker and write the purchase date somewhere on the label.  High-acid canned food such as grapefruit, tomatoes, and pineapple can be stored for 12 to 18 months.  Low-acid canned foods such as poultry, fish, meat, and most vegetables will keep from two to five years if stored in a cool dry place.  Avoid containers that are swollen with bulging lids, are rusted or leaking, are dented, have an unusual odor, or have an odd color.  The rule is when in doubt, throw it out.  (See: Safe Home Canning of Fruits, Vegetables and Meats - University of Minnesota Extension and USDA Complete Guide to Home Canning, 2009 revision

Those at high risk, such as people with weakened immune systems, infants, the elderly, and pregnant women should avoid soft cheeses (such as feta, Brie, Camerbert, blue, Mexican style) and foods from deli counters.  (Hard cheeses, processed cheeses, cottage cheese, cream cheese, and yogurt are considered safe.)

If you need to move anything from its original package to a new container, take a marking pen and write on the new container in large letters the common name of the product.  This is especially important for products that are not easily identifiable, because while what it is might be obvious to you it might not be obvious to someone else.  To help prevent cross contamination have separate color-coded plastic cutting boards or cutting plastic surfaces for different foods.  An example would be red for red meats, yellow for poultry, tan for seafoods, green for fruits and vegetables, blue for ready-to-eat foods, and white for dairy.  Store baking utensils together and keep them separate from cooking utensils.  The same goes for the pots and pans and so forth. 

Things you should have in your kitchen include:

You should have a liquid soap in a dispenser for hand-washing at your kitchen sink.  (Antibacterial soaps aren’t an improvement, but what is important is to thoroughly scrub under running water for at least 20 seconds.) 

You should also have an easily readable thermometer for your refrigerator placed in front for easy reading. (This is also the warmest part of the refrigerator.)  Keep your refrigerator set so it reads 40° F, and your freezer at or below 0 F. 

You should have a paper towel dispenser instead of using kitchen sponges or cloth towels, since they are excellent breeding grounds for bacteria. 

You need shallow pans or containers to store foods in the refrigerator.  Shallow pans allow more surface area for more rapid cooling.

Restaurant Eating:

You should order foods or dishes that are mostly made-to-order.  This means most of the cooking of the main part of the dish (the meat, chicken or seafood part) is done after it is ordered.  If this is not clear from the menu then ask.  Temperature abuses are more likely to occur with foods that the cook is keeping warm with a steam table or a warmer rather than keeping cold in a refrigerator.

Stick with ordering foods that you are familiar with, either because you have had it before or you know how it’s prepared.  You will be more likely to notice if something is wrong.

Know the minimum cooking temperatures of the meat and seafood products you order and make a request that the food be cooked to this temperature. For example, when ordering a hamburger, ask for it to be cooked to an internal temperature of at least 160 F.

If you are served an undercooked meat or egg product in a restaurant, send it back for further cooking.  You should also ask for a new plate.  If the problem is more than it simply being undercooked, but the sight, smell, or taste suggests some other concern don’t eat it and don’t re-order the same food again.  The server might possibly re-serve you what you just returned, or perhaps all the servings of that food might be unsafe.  This is especially likely to be the case if it came from a batch processed food.  Avoid raw or rarely cooked meats, eggs, and seafoods; this includes such dishes as sushi, sashimi, raw oysters, rare hamburgers, or raw egg sauces (such as hollandaise, béarnaise, etc.). 

If you are going all out you should regularly review a restaurant’s inspection and violation history.  This is part of the public record.  Familiarize yourself with the structure of the food inspection report used by your local program.  Look at previous inspections for temperature violations and food-borne illness investigations.  Investigate the training that your restaurant chef received by looking for food safety certificates, degrees, etc.  Many local public health programs now publicize the inspection results on the Internet as well as require food facilities to post inspection grades, and will make them available for review by the public upon request. (For more information regarding preventing restaurant food poisoning see: Food Poisoning Information Center)

(Food Poisoning – Medline Plus, What medicine is there to treat food poisoning? – Go ask Alice!, Food Poisoning – Treatment, Food poisoning prevention – University of Iowa, Food Safety – Prevention – NOAH, Food Poisoning, Food Poisoning Prevention, Food poisoning prevention – MedlinePlus)

Radon Gas

December 16th, 2009 by lost_wanderer

Radon is an invisible, odorless, radioactive gas that is created when naturally occurring uranium in rock and soil decays.  People breathe this gas in and while it is in a person’s lungs it decays into radioactive particles, which are trapped there while they, in turn, undergo further decay.  It accounts for about 56% of all the radiation the typical person receives in a year, and can eventually lead to lung cancer. (1) (Your radiation exposure - Radiological Protection Institute of Ireland)

Even though radon has always been with us, until homes and buildings became well insulated it didn’t present much of a problem since the average concentration of radon in outside air is a low 0.4 picocuries per liter (pCi/L). (2)  The real concern is that radon can accumulate to much higher concentrations in indoor air because over the years construction standards have improved resulting in better sealed homes.   In such situations radon can seep into buildings through cracks in their foundations, through well water, or come in around water or sewer pipes, and increase in concentration. (3)   The result is that the EPA estimates that the average indoor level of radon is 1.3 pCi/L and at this level over a lifespan it will cause between 3 and 13 lung cancer deaths per 1,000 people.  (The Health Risk of Radon Gas – VSI Environmental)  A level of 1 pCi/L is the risk equivalent of 20 chest x-rays per year, and a level of 4pCi/L is the risk equivalent of 200 chest x-rays per year.  (Radon Myths and Facts – Radon Doctor)  It’s estimated that radon causes about 21,000 additional lung-cancer deaths every year in the United States.  By comparison drunk driving kills about 17,400 people a year, falls in the home 6,000 a year, and home fires about 2,800 a year. 

Given this situation standards were necessary, and the EPA eventually determined that a reasonable action level was 4 pCi/L.  Even at this moderate concentration it’s estimated that one in fifteen homes are above it, and over a lifespan there will be between an additional 13 and 50 people in 1,000 who will die from lung cancer.  For those who smoke the issue is even more pressing since it is known that smoking synergistically interacts with radon, multiplying the risk of lung cancer for any given level of exposure.  Because of these facts the U.S. Congress has set a goal that indoor radon levels should eventually be reduced to the same as outdoor levels, but the problem is that this can’t be done with the current technology and available resources.  For now people can generally afford to reduce radon to around 2 pCi/L. 

Radon levels do vary greatly within buildings, with the highest concentrations in the lowest areas, and above the first floor the problem largely disappears in many homes.  To determine the level of radon in a building there are do-it-yourself kits as well as professional testing.  The kits are of two types, short term (less than 90 days) and long term (greater than 90 days).  The advantage of the short term kits is that they provide a quick understanding of the situation, while the long term ones give a better understanding of the average indoor radon level throughout the year.  This is important since the concentration of indoor radon can vary greatly depending on such factors as how often windows are left open.  Frequently both methods are used since they are both fairly inexpensive.  However when selling a home these methods often aren’t sufficient and professional testing is necessary since independent documentation is frequently required. 

If the levels are above 4pCi/L, there are several common methods available to address the problem.  The simplest approach is to seal the cracks in the building’s foundations.  Then the next step is a vent pipe system, which involves using a pipe and fan to suck radon from beneath the building’s foundation and vent it to the outside air.  These methods aren’t excessively costly, and typically run about $1,200 for repairing a home if a contractor is used.     

(1) Although the literature is generally of the opinion that lung cancer is the only health risk from radon, some people speculate that radon might also be a risk factor for Alzheimer’s. (Alzheimer’s – Lost Wanderer

(2) It should be noted that, since the risk from radon is continuous, no level is safe.  Even at the 0.4  level over a lifetime such exposure will lead to about 1-3 people in 1,000 to die from lung cancer.

(3) Radon levels in homes can get very high.  In 1984 Stanley Watras was a construction engineer working on the Limerick Nuclear Power Generating Station in Pottstown, Pa.  Before the plant had gone into operation he found himself setting off the radiation alarms when he was entering the plant.  The problem was eventually traced to high levels of radon in his home, which had 4,400 pCi/L in the cellar, 3,200 pCi/L in the living room, and about 1,800 pCi/L in the bedrooms.  (Radon – A Short History)  This level presented an equivalent risk  to him of smoking 135 packs of cigarettes a day, or 49,275 packs a year. (Stanley Watras – Wikipedia)

(A Citizen’s Guide to Radon: The Guide to Protecting Yourself and Your Family From Radon – EPA, Radon – EPA)

We Need Our Symbiotes II

December 15th, 2009 by lost_wanderer

For a short follow-up to my prior blog post, (We Need Our Symbiotes – Lost Wanderer) Gut Buddies reports the following:

  • The Bifidobaterium lactis strain may be partly responsible for breast-fed infant’s enhanced immune systems.
  • Bifidobacterium infantis may reduce symptoms associated with inflammatory bowel disease and irritable bowel syndrome (bloating, cramps, gas, diarrhea).
  • Lactobacillus bulgaricus and Streptococcus thermophilus are used in yogurt and help decrease lactose intolerance and may prevent diarrhea. Be sure the label on the yogurt says it contains live and active cultures.
  • Lactobacillus rhamnosus GG (LGG) and Saccharomyces boulardii may help treat diarrhea associated with antibiotic treatment. Antibiotics sometimes destroy healthy bacteria while trying to kill unhealthy bacteria and sometimes diarrhea will result.
  • Lactobacillus acidophilus may help decrease yeast infections.
  • Lactobacillus casei may help reduce the incidence of cancer, specifically bladder cancer.