Your Inner Voice, Musk's Satellite Monopoly, Strange Medical Superstitions, and Painful Words - Dinner Table Digest № 59
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I’ve been doing a lot of interesting reading over the last while, so these Digests have been coming fast and furious lately. The first piece, about the running inner voice inside our heads, was first read in the middle of the night while I was trying to stop the running voice inside my head. Also included is a New York Times report about the consequences of Elon Musk’s monopoly on Starlink, the satellite internet system that is powering Ukraine’s defense of their territory against the Russian genocidal invasion. This is followed by a reflection on the superstitions found in operating rooms across the western world. The digest concludes with a piece on how the words we use to describe and manage pain affect how we experience the pain itself.
Sections: The Conversation in Your Head / Elon Musk Owns the Stars / Surgical Superstitions / Painful Words
The Running Conversation in Your Head - Julie Beck - Pocket App
I've been interested in the concept of the ‘inner voice’ for some time. Usually late at night, when my own inner voice is going faster than a thoroughbred racehorse running the Kentucky Derby, I often wonder what it would be like if I could just get my thoughts-in-inner-voice-form down on paper, recorded as it is, without any edits. I'm pretty sure that would be a fascinating document, one that would reveal both my greatest character flaws and my greatest character strengths. Or it would be meaningless philosophical mumbo jumbo that makes little sense. Either way, I'm sure I'm not the only one who would be interested in obtaining a transcript of their inner voice…
Beck: People are not very good generally at reporting the specifics of what’s going on in their minds, right?
Fernyhough: When we use descriptive experience sampling [DES, in which people are asked to report on their own inner speech] , we assume that a lot of what people say when they are asked about their experience is kind of generalizations about what they think is in their own minds rather than what is actually in their own minds. And that's why people can be surprised by DES. People can think their thoughts are a bit negative but they turn out to be quite joyful, or vice versa. And that is a really fascinating philosophical question, because it suggests we can be mistaken about our own experience. And if we can be wrong about what goes on in our heads, then that's pretty wild.
Beck: So people might have fundamental assumptions about their personality or their thought patterns and then find out they're not true?
Fernyhough: Yeah, exactly, and it even could apply to certain aspects of mental health. Russ Hurlburt, [who created DES], has an example of somebody with OCD in one of his papers, where he talks about this character who complained of having constant intrusive obsessive thoughts, but when he did DES, he found there wasn't nearly so much of that.
Beck: He was just noticing those ones more perhaps?
Fernyhough: Yes. So I think what is happening is we make a lot of self-generalizations about our experience, we have a kind of self-theoretical approach to our experience that doesn't always match up with what's actually there when you try and capture it moment by moment.
Elon Musk’s Unmatched Power in the Stars - Malika Khurana - New York Times
There are few men more powerful in our world today than Elon Musk. The increasingly unstable tech mogul recently bought Twitter (sorry, I mean X 🙄) only for his leadership to cause the company to lose half of its value, over $20 billion, in a matter of months. Since he took over the communications platform, he has repeatedly loosened restrictions on hateful speech, allowing banned racist, sexist, homophobic, and transphobic harassers back onto the site. But Musk doesn't only own the internet on land, he also owns the internet in the skies.
Since 2019, Mr. Musk has sent SpaceX rockets into space nearly every week that deliver dozens of sofa-size satellites into orbit. The satellites communicate with terminals on Earth, so they can beam high-speed internet to nearly every corner of the planet. Today, more than 4,500 Starlink satellites are in the skies, accounting for more than 50 percent of all active satellites. They have already started changing the complexion of the night sky, even before accounting for Mr. Musk’s plans to have as many as 42,000 satellites in orbit in the coming years.
An animation showing circles that represent Starlink satellites orbiting Earth as it rotates. Most of the satellites are spaced out and move in a gridlike formation between Earth’s poles, while a few are closely clustered and move together in lines.
The power of the technology, which has helped push the value of closely held SpaceX to nearly $140 billion, is just beginning to be felt.
Starlink is often the only way to get internet access in war zones, remote areas and places hit by natural disasters. It is used in Ukraine for coordinating drone strikes and intelligence gathering. Activists in Iran and Turkey have sought to use the service as a hedge against government controls. The U.S. Defense Department is a big Starlink customer, while other militaries, such as in Japan, are testing the technology.
But Mr. Musk’s near total control of satellite internet has raised alarms.
Alarmingly, Musk has apparently been interfering in Ukrainian battlefield decisions, vetoing the use of Starlink for operations he seems unpalatable:
"Mr. Musk has restricted Starlink access multiple times during the war, people familiar with the situation said. At one point, he denied the Ukrainian military’s request to turn on Starlink near Crimea, the Russian-controlled territory, affecting battlefield strategy. Last year, he publicly floated a “peace plan” for the war that seemed aligned with Russian interests."
With so many satellites required to make the system work - continuous internet is maintained by passing the connection from one satellite to another - it's unlikely that there will ever be an effective competitor to Musk's Starlink project, even if designed by state actors. This has the effect of giving one billionaire veto power over high level military decisions taken by sovereign states, an obvious threat to democracy. This is only exacerbated by the way that Musk has placated authoritarian regimes with respect to Starlink:
Other governments are wary. Taiwan, which has an internet infrastructure that could be vulnerable in the event of a Chinese invasion, is reluctant to use the service partly because of Mr. Musk’s business links to China, Taiwanese and American officials said.
China has its own concerns. Mr. Musk said last year that Beijing sought assurances that he would not turn Starlink on inside the country, where the internet is controlled and censored by the state. In 2020, China registered with an international body to launch 13,000 internet satellites of its own.
Whatever the genius of Elon Musk - which I think is more legend than fact - the wisdom of letting an unstable billionaire hold the keys to global internet access over the heads of both authoritarian and democratic governments is, well, questionable at best.
Omens - Alessandra Colaianni — VQR
Dr. Colaianni talks through the superstitions that even the most scientifically minded of medical specialists, surgeons, hold:
In medical school I thought of surgery as a refreshingly concrete enterprise. Surgery was pure cause and effect. You have a lump in your neck that you can feel; I remove that lump and now it’s in my hand, now it’s out of your body and you can’t feel the lump anymore. Medicine and its endless subspecialties held all sorts of uncertainty that my brain refused to parse; surgery was (forgive me) cut and dry. Objective. Scientific. Serious. No room for superstition.
Except when there is.
I have witnessed experienced surgeons who are decades into legendary careers—surgeons I would trust to operate on my loved ones—get surprised during supposedly routine cases, and make mistakes, and be illogically anxious about their work, and insist on doing things a certain way with no scientific basis for it. I’ve sheepishly excused my own anecdotal evidence, brushing away imagined judgments with phrases like “Well, this is voodoo, but…” or “I just do this to ward off evil spirits.” Once, I heard one of my mentors say, “Now we close the wound and pray.” Some surgeons claim they aren’t superstitious at all, that everything they do has a concrete reason. Some are embarrassed by the idea that superstition could still be a part of surgery. Some note that they have habits or rituals, but deny that they are superstition, just part of being prepared. Others embrace it.
“I stopped taking pictures of my free flaps,” one head and neck surgeon I know told me, describing a particularly finicky type of reconstructive surgery, which involves sewing arteries together with suture thinner than a human hair. She explained: “I’m convinced if I revel in how nice it looks, the flap will surely die later.” “Pride goeth before a fall,” a thyroid surgeon in Atlanta wrote to me, “so I practice humility before the Gods of Surgery, the Gods of Airway, and the Gods of Bleeding. They hate arrogance in the OR and will punish you.” A breast oncologic surgeon agreed: “The gods of surgery are vengeful and the day you don’t prep and drape the arm for an ax dissection is the day that touchprep comes back positive. The day you don’t prep and drape both sides of the neck for a port is the day you need to go to plan B.” “No high-fives till the drapes are down and the pulses have been checked,” wrote a vascular trauma surgeon, wary of undoing a successful outcome by celebrating too soon.
Practicing surgeons were quick to own up to lucky totems: Wonder Woman scrub caps, lucky necklaces or earrings, auspicious colors, particular types of music. Some refuse to wear red during Labor & Delivery days, or orange anytime, or listen to Pearl Jam (“it kills free flaps”). One sent a picture of her delicate forearm tattoo depicting a manicured hand crossing its fingers, describing it as an “anti-jinx,” later hedging—“Really just for fun and to celebrate the uncertainty of surgery. Not ’cause I think it works.”
Superstition is built into medicine’s foundations: Though there are twenty-six operating rooms in the main hospital where I work, there is no OR 13.
Words can hurt me: how language makes things worse - Manuela Callari - Oncology Republic (from 2021)
This piece takes seriously the words that we use to describe our medical issues, focusing particularly on descriptions of pain. While I have developed some go-to ways of describing my chronic pain, it is often difficult for people to understand the kind of pain that I experience. It takes a bit of mental work for people to realize that the words we have traditionally used to describe our experiences with pain are actually fairly limiting, and only describe certain kinds of pain. And yet, the words we use to describe pain have impacts on how we perceive and understand pain, as well as how we show empathy to others who are in pain.
Chronic pain is notoriously tricky to diagnose and treat. Clinicians often use numerical scales to assess the intensity of pain, i.e. how severe it is on a scale from 1 to 10. Linguistic descriptors are included in some diagnostic tools, such as the LANSS Pain Scale that aims to capture the pain’s quality or what it feels like (e.g. hot versus cold). The commonly used McGill Pain Questionnaire exploits 20 groups of linguistic descriptors to capture both the quality and intensity of pain experiences (e.g. hot, burning, scalding, searing, in assumed order of increasing intensity).
But several studies have highlighted how such scales and questionnaires are belittling and fail to reflect the complexity of chronic pain.
Metaphorical language can be a handy diagnostic tool as it can help communicate effectively the multidimensional nature of pain. Listening carefully to how a patient describes their pain might help recognise if they have neuropathic pain or nociceptive pain, for example. But many metaphors routinely used in the clinical setting are not only ineffective, but can also be damaging.
This is the most common way that I describe my pain to others:
Imagine you are surrounded from the neck to your knees with a metal tube that wraps you up like a cocoon. Now imagine that someone comes along with a mallet and a hammer, and, alternating between them, repeatedly bangs hard on the tube. After a while, they stop, but you don’t know when they will stop. You also don’t know when they will restart their banging, but you know that they will be back. You also know that this metal tube and the person banging is permanent, that you’re stuck with this situation for the rest of your natural life.
I am here trying to draw attention to the fact that not all pain can be described in terms of sharpness or stabbing. If you’re in a metal tube you’re more likely to feel extreme physical and mental discomfort and an unrelenting need to escape the trapped space, which vibrates endlessly with each strike of the mallet. Yet many of us don't have a vocabulary for pain that is not rooted in some kind of war-like or violent language. Callari explains:
Patients have to rely primarily on language to communicate their pain experience. These are the circumstances in which both patients and doctors might have more challenges in communicating, and in which patients tend to feel misunderstood and misbelieved.
When we are in pain, we tend to describe the variety of sensations we feel with metaphoric expressions that refer to bodily damage. These metaphors – stabbing pain, shooting pain – evoke weaponry and war, suggesting that pain is the enemy to fight. This is “a common and powerful metaphor we want to challenge,” says Professor Moseley.
Current pain science indicates just the contrary: pain is allied. Over the past 30 years, pain scientists have dismantled the notion that pain is a direct response to damage, i.e. the more severe an injury, the greater the pain. Instead, they have discovered that pain is a much more complex protection mechanism the brain uses to change our behaviour and avoid injuries.
While the author is concerned primarily with the effects of words on how pain is experienced, finishing the piece by arguing that negative descriptions of pain only add to the negative experiences of pain, I mostly wanted to draw attention to the fact that some kinds of pain are much harder to describe than others. It's simply inappropriate for those who don't know or can't experience the odd and different ways that pain is felt in the body to minimize or otherwise delegitimize the challenges faced by those who live with daily chronic pain.
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