Breast cancer: some psychological questions

I hope for this series to be helpful to others.   Some of the stuff I am encountering, though, has got to be less than common.  

I mentioned last time that there is far more in the way of options than you are likely to hear about from your surgeon(s). And while you might well think a female breast surgeon is the best choice, there is at least one possible downside. You may have very different values. I have, for example, come to think that the cosmetic aspects of her breasts are an extremely big deal to my surgeon.  I value non-intrusive surgery much more than she does (duh!).

So one problematic situation I am in is that I have two really world class surgeons – one the breast surgeon (BS) and the other the plastic surgeon (PS) who think I’m making a huge cosmetic mistake in insisting on a lumpectomy over a mastectomy (plus reconstruction), AND for them, a huge cosmetic mistake is a huge mistake.  Everyone is clear that the medical benefits are too close to choose between them. 

I’ve spoken to another doctor, totally separate from this, and he’s said there’s all this stress on cosmetics because they just haven’t had the time to explain why it is really medically important. But they’ve had plenty of time to tell me and I am pretty sure that with the whole crew cosmetics is a very big deal.  They record the amount of time we discuss things as I think we’re at about 3 hours now.

It may be that they would benefit in some way I can’t see yet, but it may also be the culture.  According to Wiki, for comparable cancers, the percentage of mastectomies over lumpectomies is 76% in Eastern Europe, 54% in the US, 42-44% in No. and So. Europe and 36% in New Zealand and Australia.  (I’m relying on memory so I might be a point or two off.)

Further, to say that I have had to go to some effort to get the surgery I want is an understatement, if one counts enduring highly stressful situations as work.  When I had my consultations with the PS, he simply went beserk.  It really was awful.  My spouse compared him to a famously nasty academic.  I’ve seen people turned red and say angry things when I’ve said “I understand that that is your position, but I disagree for the following reasons.”  But this quickly became uncivil, and I couldn’t even finish a sentence before he rushed in to say it was a stupid question or to jeer at me.  

So I am putting in a lot of effort to do avoid a highly invasive surgery, and I may well fail.  The surgeon needs to get “clean margins,” which is a cm at least of tissue without any malignancy; if she can’t, it is bad news for the breast.   But I think putting in the huge effort will make me feel better if I do fail.  And I’m wondering about whether this sense is fairly idiosyncratic or whether it might even be a general human psychological characteristic.  That is, other things being equal, would putting in a lot of effort even though you eventually fail make the failure easier to endure?

Suppose there’s a job possibility or a grant available and you put in a great deal of effort to get it.  Will the effort  make you feel better about not getting the job or not getting the grant?  Or perhaps the actual effort has secondary effects that make it worth it?  Or is it that some of us don’t want to be the sort of people who approach important things carelessly?  And why?

The second question is about the stigma of not being a good patient.  Are there things, such as people’s efforts to help you, that really you cannot complain about without a big social cost?  I was brought up short by someone’s saying to me last night, “Remember these people are all trying to help you.” 

At the risk of showing myself to be very ungrateful, I will mention the the physician’s assistant, who stood between me and the BS. She is a very sweet and nice young woman who obviously takes it as her mission to explain why the BS is right. She’s also the first line of defense, so she’s supposed to answer one’s questions. One day I said that I wanted to find out the grade of my cancer.   Grade is important in finding out how aggressive it is.  She looked at the chart, saw it wasn’t there and appears to have inferred that the pathology people couldn’t determine it.  So she explained to me that they couldn’t grade the cancer since there weren’t enought cells to test.

Even I could see that couldn’t be right.  And in fact the initial grading showed up in the system a few days later.

And then there was the psych consult, which I should have refused. Having happily, but with faulty statistics, explained which behavior of mine caused the cancer, the social worker decided to show me how to change my behavior. We started with a big circle to cover all aknowledge. I knew this was not going to go well, but to my credit, I think, I remained very polite though it all.  The kind of cancer I have is very rare and no one knows what causes it, btw.

My hair guy would disagree that they are all trying to help me.  He thinks they are part of a conspiracy to make money.  He holds that cancer is a fungus and is best treated with baking soda.  And there are people on cancer discussion boards who say they believe this theory.  And that’s how they will act.  This is American, after all, when people apparently learn so little in school that they actually believe a lot of stuff that seems really clearly  loony.

August 26: Women’s Equality Day

What is Women’s Equality Day?

At the behest of Rep. Bella Abzug (D-NY), in 1971 the U.S. Congress designated August 26 as “Women’s Equality Day.”

The date was selected to commemorate the 1920 passage of the 19th Amendment to the Constitution, granting women the right to vote. This was the culmination of a massive, peaceful civil rights movement by women that had its formal beginnings in 1848 at the world’s first women’s rights convention, in Seneca Falls, New York.

The observance of Women’s Equality Day not only commemorates the passage of the 19th Amendment, but also calls attention to women’s continuing efforts toward full equality. Workplaces, libraries, organizations, and public facilities now participate with Women’s Equality Day programs, displays, video showings, or other activities.

And, as we have noted before, it is also Dogs’ Day!


Racism in US Academia?

Grant applications at NIH and NSF are peer-reviewed; there is a serious worry, substantiated by research recently reported in Science,  that the peer-reviewing at NIH either is racially tainted or reflects a disadvantageous racism in African-American scientists’ careers:

It takes no more than a visit to a few labs or a glance at the crowd at a scientific meeting to know that African-American scientists are rare in biomedical research. But an in-depth analysis of grant data from the U.S. National Institutes of Health (NIH) on page 1015 in this issue of Science finds that the problem goes much deeper than impressions. Black Ph.D. scientists—and not other minorities—were far less likely to receive NIH funding for a research idea than a white scientist from a similar institution with the same research record. The gap was large: A black scientist’s chance of winning NIH funding was 10 percentage points lower than that of a white scientist.

The NIH-commissioned analysis, which lifts the lid on confidential grant data, may reflect a series of slight advantages white scientists accumulate over the course of a career, the authors suggest. But the gap could also result from “insidious” bias favoring whites in a peer-review system that supposedly ranks applications only on scientific merit, NIH officials say.
As far as I know, there isn’t any comparable data for NSF.
Do note that the concern that the grant applications from African Americans were less good is recognized, but no one doing the study thinks they have good grounds for saying that.  Nonetheless, the “series of slight advantages” covers factors that could well affect the quality of grant applications, such as strong mentoring.  Further research is being divised to isolate some of the causes of the award gap.
The original article, linked to in the post, has a lot of information and some useful references.

APA Rockefeller Prize for best paper by Philosophy PhD

Many of us received emails announcing this prize for “non-academics,” but NOTE:  “to qualify, one may in fact be teaching at a university in a part-time or a full-time temporary position as long as one also meets …requirements” including not having a permanent full-time position in a philosophy department.  So this is an award for authors without academic affiliations and/or without a permanent academic affiliation in philosophy.  I’ve met readers of this blog with part-time positions in Women/Gender Studies.  You may qualify!  So may sessional/contingent employees of philosophy departments! (Thanks to Jean for emphasizing this.)

The winner’s work will be published in The Journal of Value Inquiry, by mutual agreement of the author and the editors of the journal.

Award Amount: $1,000

Submissions procedures

The APA invites members who have no permanent academic affiliation to participate in this competition for the best unpublished paper-length work in philosophy. To qualify, one may in fact be teaching at a university in a part-time or a full-time temporary position as long as one also meets the following requirements: Authors must not hold a full-time position at an institution of higher education in philosophy that continues beyond the end of the current academic year, nor may they have held such a position within the last three years. The author must hold a Ph.D. in philosophy or its equivalent at the time of submission, and must be a current member of the APA in good standing. Professors emeriti are not eligible. Previous winners of this prize are not eligible.

Submissions must be unpublished at the time of submission* and must be prepared neatly and legibly, and with all references which would identify the author removed. Submissions must be no more than 40 double-spaced pages in length. Please submit (electronically) the work to be considered, together with your current CV to: Linda Nuoffer ( The deadline for the 2012 award is November 1, 2011.

Reviewing will be [doubly anonymous]. The prize amount is $1,000. Co-authors of a winning submission, or authors of winning submissions judged to be equal in merit, will share equally in the prize. The prize will be announced in the Proceedings and Addresses, and it is expected (but not required) the winning submission will be published in The Journal of Value Inquiry.

See here for more information.

H-Disability Discussion Network

H-Disability is a scholarly discussion group that explores the multitude of historical issues surrounding the experience and phenomenon of ‘disability.’ H-Disability was established in response to the growing academic interest and expanding scholarly literature on issues of disability throughout the world.

Go here.

Men Write About Wittgenstein

Mind Someone has put together a collection of the “Top Wittgenstein Articles” (from a variety of journals). They are currently available for free access here.

They are all by men.

(Thanks, N!)

Update: Mind‘s Editor in Chief, Prof. Tom Baldwin has helpfully joined in the discussion (see his comment below). Apparently, though it was linked from the Mind website, this list comes as a surprise to the editors of Mind and isn’t something they had anything to do with! Prof. Baldwin has asked OUP to remove the link to the list from Mind‘s website.

Margaret Whitford – obituary

The Guardian has published the following obituary, written by her friend and fellow academic Anne Seller:

My friend Margaret Whitford, who has died aged 64, lived the life of the mind to its fullest extent. She grew up in Cornwall and described her childhood as claustrophobic and isolated, saying that it was no surprise to later find herself living alone in a room full of books in a teeming metropolis.

Margaret was professor of French at Queen Mary, University of London; a founder member of the UK Society for Women in Philosophy; an author and translator; and a practising psychotherapist. Her vision and energy were pivotal in developing the new field of feminist philosophy. The radical nature of her life’s work was devoted to the development of ideas that would express and illuminate the experience of being a woman in a male-dominated world. Typically this included encouraging and respecting other women’s contributions.

After moving to London in 1977, Margaret lived in a council flat in Wapping. In 1987 she moved to a house in Stratford, east London, of Dickensian dinginess and dilapidation. When she finally admitted a TV licence officer indoors to prove there was no set, his report suggested she was telling the truth because the house “was too full of books”. But she was fully engaged with the world.

In the 1990s, Margaret moved to a light, airy flat, published prolifically, and developed a passion for contemporary art. In 2000, at a stage when most academics would be happy to recycle familiar ideas, she began training as a psychoanalytical psychotherapist, qualifying in 2005 when the effects of her ovarian cancer were particularly severe. Finding the right moment to move her clients on became a preoccupation as her cancer advanced.

One of the last memories I have of Margaret is her indicating a book on Pakistan, saying that she wanted to read it before she died. She did, and had a lively argument about it with an attending doctor. My final memory is of sitting with her waiting for the call to go into the hospice. She passed the time with a vigorous critique of the film Of Men and Gods. She never stopped thinking and never stopped caring. Her friends were like her family, and we will miss her laughter, generosity and conversation with its never-ending gift of fresh insights.

Her brother, Chris, survives her.

Feminist philosophers right again…

Okay, that’s possibly overstating it slightly.  But we posted in July about the worrying decision of the UK’s Equality and Human Rights Commission to intervene in four cases being taken to the European Court of Human Rights. These cases involved

  1. Being forbidden to wear a cross at work (Eweida, Chaplin);
  2. Being required to perform a public service without discriminating against gay people (McFarlane, Ladele).

In all four cases, UK courts had found that there was no discrimination on grounds of religion, and the EHRC’s press release suggested it was equally critical of the UK courts’ positions in all four cases. But now – vindication! – it has apparently changed its position.  The full consultation document is on the EHRC website, and says,

We propose to intervene in:

  • Eweida and Chaplin on the basis that the Courts may not have given sufficient weight to Article 9(2) of the Convention.
  • Ladele and Mcfarlane on the basis that the domestic courts came to the correct conclusions.

If you feel strongly about this, do respond to the consultation *by 5 September* to support the EHRC’s new position. I shall certainly be doing so.