After Present

I've just learned that there's a timescale other than "CE" (Common Era, aka "AD", Anno Domini/After [the] Death [of Christ]) and "BCE" (Before Common Era, aka "BC", Before Christ).

This new timescale is called "BP", or "Before Present".  Where "Present" is defined as January First, 1950, for reasons related to radiocarbon dating and atmospheric nuclear weapons testing, and thus also sometimes backronym'd to "Before Physics".

This makes sense to me – or more importantly (to me, personally), is pleasing to me, because I'm sick of having years reference Christ – because even if it's using the terminology of "Common Era", it's still referring to a timescale developed around ideas about Jesus.  Which pisses me off, as a staunch atheist and moderately anti-religious person.  (The latter because I see religion as harmful (see also: Salon, scholar, etc.).)

So, upon discovering "BP", I almost immediately had the thought that there should also be "AP", or "After Present", or "After Physics".  I think I prefer the latter term, and so I hereby declare that "After Physics"/"AP" should be "A Thing".  It's been talked about before, but I've not yet found anything "official"-ish that talks about using it as a thing.

I've also been deeply annoyed for a long time that BCE/CE don't recognize a year zero (0).  You can't put years directly on a number line.  This is mathematically stupid to me.

And so, therefore, I hereby declare (for the tiny amount of influence that me as an individual declaring this thing might do) "After Physics", aka "AP" to be a thing, and to be defined as, roughly, the number of years after the midnight that began the day also known as January 1st, 1950 CE.  (In UTC, presumably, though one also can presume that in most contexts, that level of detail won't matter.)  As such, the whole of the year known commonly as 1950 CE could also be referred to as the year 0 (zero) AP.  And thus the year I'm in as I write this, commonly known as 2017 CE, could also be referred to as the year 67 AP.  So here it is, August 10th, 67 AP.  And on that day, I've declare that this ought to be A Thing.  Of course, it won't be A Thing until a lot more people recognize it... but here's hoping that this blog post can start the process of propagating that meme.

I'd write up a wikipedia page for it, but I suppose that would constitute, at best, original research.

So, here's hoping other significant sources (scientific journals, major news outlets, what have you) start taking this up at some point, and it can eventually become "official".  In the mean time, feel free to link to this post as a way to provide an explanation for what is meant.  Or don't.  My hope is not for links to here so much as adoption of the term.  Hopefully wide adoption, eventually.


On personalized medication selection...

I attended a talk last night (Tuesday, June 2nd; 2015-06-02) on the future of medicine.  Doctors Hood and Srivastava gave an interesting presentation about such things as the history of gene sequencers (which Dr. Hood had much to do with), a model for thinking about medical care called "p4 medicine", wherein care and treatments are "Predictive, Preventive, Personalized and Participatory" (sorry, I'd add an Oxford comma, but I'm quoting that website directly), and a number of other technical and research advancements that are influencing what Dr. Srivastava described as a coming revolution in how medical care will be done.

And he (Srivastava) spent a bit of time talking about how this has been getting promised for some time now, but that he really felt that it was getting to an inflection point, where the difference between now and 20 years from now would be dramatically greater than the difference between 20 years ago and today.

I really hope he's right.  Because here's my take:

What we're doing today is primitive enough and problematic enough, in places (and great, in other places, don't get me wrong), that it will be looked back on at some point or other (I'll make no predictions of my own about time frame) as being utterly barbaric and cruel.

Example from my own life:

I had a horribly negative reaction to several different anti-depressant medications. In particular, Zoloft, Effexor, and Prozac.  They gave me akathisia.  They increased my suicidality (something I've ever struggled with) to the point (this being relatively rare in my life) of actually attempting something, at least once while on each of the above medications (so at least 3 attempts), and a couple more times (5 or 6 attempts, total) after this round of "therapies", which I still attribute in large part to the fact that I had been on them.  The effects of these medications (I believe) even had me bordering on homicidal, directed specifically towards my psychiatrist at the time, who, besides prescribing me not one but two other meds somewhat closely related to the first one I had the bad reaction to, with relatively little care taken to making sure I was well supported in avoiding or quickly stopping subsequent reactions, also would literally fall asleep during the course of our 15 minute sessions.  Regularly.  (And I heard from someone I met during a hospital stay around that time (October of 2000), who was also a patient of his, that he'd done the same to her.)  How can someone possibly be giving good care in such a manner?

Anyway, I could probably go on on the horrors of that time, and in particular my reactions to those specific medications.  The point, though, is that my reactions were horrible.  And yet, many people seem to report good results with them.  There was a big part of me that wanted SSRIs to be completely banned, on the premise that I wasn't the only one to be experiencing this (we may have lost comedian Phil Hartman to akathisia).

And while that (banning a med) hasn't happened with Prozac, Doctor Srivastava relayed (after me asking a question about this) the fact that a number of drugs have been completely pulled off the market, because of things like causing heart arrhythmias or liver failures or some such.  Which means that that people who were actually getting solid benefit from the drug (which is a little more questionable in Prozac's case than it seemed to be in some of the other drugs Srivastava was talking about) could no longer get it!  This has the potential, with some meds, to have just about as bad an effect from not having meds as those few who have a negative reaction to taking them (deadly disease, deadly med; which death will you get?).  But who can weigh the two?  Is it worth sparing a few folks from the negative experience, if that costs thousands or even millions of people the chance at a benefit?  What if (as I believe is the case with some medications) the negative experience is almost certain to be a fatal one, and yet, the beneficial experience is one that can save lives?  Would you kill one person to save five?  Not an easy question to find a satisfactory answer to.

But, there's a way to address it, I think, that is more prone to a satisfactory answer: Personalized prescriptions. In their talk, the speakers last night mentioned treatments that involved taking cells from someone's skin or blood, turning them into a stem cell line (because that's doable, these days), possibly modifying them along the way (for example, "teaching" T-cells how to detect a particular form of cancer cells, which they can then destroy with methods already available to them), then re-specializing the line again into the cells for a particular organ type, and re-inserting these new cells (or even whole organs made from them) back into the patient that the cell line originally came out of.  Pretty personalized!

And yet there's an even simpler version of this, that I've been thinking of (and deeply wanting) for a long time now, and which I asked about during the Q&A: It strikes me as obvious that, in gathering the kinds of data they're talking about gathering (whole gene sequences for an individual, as well as numerous other factors), and taking a systems approach to this (an idea that Dr. Hood in particular spoke to), we may at some point find (when correlating this data with other individualized data on patient responses) that there are markers that can help us tell in advance whether a particular drug is likely to cause a particular reaction, positive or negative, in a particular patient.  In his response to my question, Dr. Srivastava even took this idea a step further than I'd imagined, in mentioning that the embryonic stem cell lines that can now be cultured from skin or blood cells, could then be used to grow, say, heart cells, and, for the case of medications that create heart problems, you could actually test reaction of the individual patient's cells from the particular organ that matters, with the actual drug... all without actually putting the drug into the patient's body itself.  If a negative reaction happens, it happens to cells in a culture dish.  (Which hopefully most of us don't consider to be sentient life, and therefore have fewer qualms about damaging – though I must admit, especially once you start talking about growing whole organs in a lab, one starts to wonder where the line is drawn there... I want to mention that quandary, though, without going into it; that's a discussion for another day, I just don't want to pretend it's not one worth having – though I don't believe it was actually mentioned in the talk, sadly.)

Anyway, one way or another, it strikes me that we have the opportunity to know, with at least a high degree of confidence, whether a particular patient will have a positive, neutral, or negative experience with a particular medication.  And if we can know that – either as a stronger probability (changing "1 in 10 have a negative reaction" to "you have markers that indicate a 99.9932% probability of such-and-such reaction"), or as a relative certainty ("in a lab, your cells responded in such-and-such a manner", and note that the decision about which drugs to even test in this way could be shaped by the stronger probabilities, to start with) – then we can choose which patients to give Prozac to, which to give Wellbutrin to, which to give something else to, and who knows?  Maybe even which ones to send to a sleep study because they're likely to have sleep apnea, which, if properly treated, might rid them of the depression.  (More generally: we might have a better chance of treating or even curing underlying causative conditions, rather than merely treating symptoms.)

Which gets me, roughly, to the actual question that I asked.  While I don't remember my exact wording (perhaps a recording will be released at some point, and you can listen for yourself), the thrust of what I was attempting to get at was this:

It seems to me that culturally, current health care providers simply have no interest or willingness to even begin to try to do tests like this.  What roadblocks are there to gaining acceptance of personalized medicines amongst health providers, and what things can we do to help facilitate the cultural change that may be necessary to go along with all these technology changes, so that we can actually have the revolution in medicine that Dr. Srivastava was predicting for a mere 20 years hence?

There was discussion, too, about n=1 experiments.  Dr. Hood in particular mentioned how many dismiss these as not useful... And of course, as predictors of how an overall population will respond to something, indeed, they often are not!  (Though see link for some ways they might have broad applicability, even still.)  But in terms of predicting how that one individual might respond to something, it seems to me they're probably the very best way to go!  There could also even be considered to be n>1 experiments in the sense of having multiple cultures having the same experiment done to them, and in doing so, figure out some sort of general probability based on not just a single result, even if all the results are on cells from a single patient.  And that's to say nothing of the fact that many different experiments could also be done from a single culture line, thus giving a list of likely outcomes for a list of available treatments.

And I believe that's now set the stage for the thing that I'm really wanting to express:

What could be better, here, is if medical providers had the tools, time, and inclination to bring more science directly into their practice of medicine.  To put quantitative tools to work, whether that's a personal activity tracking device (and/or heart monitor, etc.; these got some discussion in the talk), or blood tests (which, who knows, may someday be done by personal tracking devices! There's certainly been attention on measuring blood glucose levels in such ways, though apparently that's not quite there yet), or DNA sequencing.  To start gathering that data, even if we don't yet know what to do with it, because we haven't yet figured out which markers correlate with, say, which responses to a medication.  But we'll never know, if we don't gather the data.  So, one thing I'd like there to be more of is data gathering around this stuff.

Now, it's worth mentioning that there are concerns around this.  Privacy concerns stand out to me in particular, especially if we're trying to gather large amounts of data, and then share it in ways to allow research to be possible on correlations (and, eventually, causation research) between various markers and various responses.  This is something that I hope will be given a lot of careful thought along the way for this.  And yet, I think that there are ways to handle such things that will at least be helpful, and... anyway, I hope it's not cheating too much to defer that discussion to another day, as well.  Because here's the thing:

With hard data, and analysis of such data, we can begin to make much better predictions about outcomes for various treatments.  We could prescribe Prozac to some depressed patients, CPAP to others, and a small specific dietary change (say, avoiding sucrose) to still others, and have them all respond better than they might to other interventions, because the intervention chosen was chosen based on data specifically about them.  We could know who not to give a particular medication for, say, diabetes, because we know that that particular person would have an adverse liver reaction (say).  And we could thus instead give them some different medication, which their liver would handle just fine.  Or a third medication, which their liver would also handle just fine, but would also be more efficacious for them in particular!  Or figure out what specific foods they need to eat more or less of, that would make them no longer need any other treatment at all!

Stuff like that.  So... let's get our data on, shall we?


On Suicide and Selfishness... (Is suicide selfish?)

I debated whether to place this here or on my personal blog.  It's an essay (in the sense of "trying"; see that heading at the link for more on what I mean), and I don't yet know what I'm going to say in the end that fits the "what could be better" theme.  (The post is also (about 5000 words, or 11 printed pages) long; this is intentional; you were warned.) But I think I'll have a few suggestions, by the end of this; I have a couple of rough ideas already... in fact, here's one such thought, right off the bat, based on the question I'm starting out with: Is suicide selfish?

Well, here's my first thought on what could be better:

The question of whether suicide is selfish or not deserves more serious discussion.

I came to the above conclusion after reading the first couple of hits, and starting to skim the third, for a google search on simply "suicide selfish".  The first two hits (for me) were rants against calling suicides (and/or suicidal people) selfish.  They were in ways nice to read, as I suppose I'm starting out leaning a bit towards "suicide is not (necessarily) selfish", and each of these was supporting that position.  But I'm not actually feeling any more ready to defend that position after reading these articles: I don't feel they really made the point well, and in particular, they didn't dig in to the question deeply enough.  And to my mind, it's still a question.  The third hit explored a variety of opinions, pro and con, but it still didn't really help me: I still don't know whether I myself would deem suicide to be a selfish act.  So, I want to explore that more.

Starting with the personal:

Why am I asking this question today?  Well, I confessed yesterday to a housemate of mine, who I've increasingly been considering a friend, that I'd had some suicidal thoughts.  Said housemate instructed me not to do that, and cited as a reason the assertion that "suicide is selfish".  I immediately, though silently, recoiled a bit.  I was saddened to hear this opinion.  Shamed a bit perhaps.  (Hmm, I'll probably need to dig in to shame in this essay at some point... I'll get back to that.  [See "Thoughts on Shame", below.])  Anyway, shame or no, it just didn't feel very good to hear these words.

an image of a wrist with "hospital" written across it, and "morgue" down the centerline.
When one cuts their wrist with suicidal intent
(as opposed to just making a suicidal gesture),
the "correct" way to cut is down, not across.
See, here's the thing.  I'd had a flash of suicidal thought, maybe 30 minutes before this conversation.  I'd been chopping vegetables in preparation for my making of the household's dinner [at this household, we share dinner most nights, with a rotation through the house of who makes it - or sometimes it's a bit of a group effort].  Having had a sharp (it was new) knife in my hands, and following an emotionally difficult train of thoughts (the details of which I don't even remember, but I think they had to do with rejections I've received in the past from people I'd dated, some of whom certain recent events have reminded me of), the thought occurred to me of slicing my wrists open ("down, not across"), and continuing to chop (the veggies for dinner) as I bled out.  I didn't do this, of course.  To have done it like that, I believe, would indeed have been a selfish act.  I'd have been bleeding all over the vegetables, for one thing, thus presumably making them unfit for consumption by the household.  And then obviously I'd be creating a big clean-up job for my housemates.  Not cool.  And those little points, of course, would presumably pale in comparison to the emotional pain that would be created by having housemates have to discover the corpse of their beloved (and I do believe that there's love for me here, probably from each of my housemates; it's also one meaning of my name) housemate, right there in front of them.  Or maybe they'd find me while I was still alive, and have to deal instead with figuring out how to get me medical help (as I'd presume they'd default to doing).  At any rate, I think it's quite safe to assume that it would have created a traumatic experience for whichever housemate(s) found me. And that, I would agree, is a selfish act.  In fact, it brings me to another point for what could be better:

People committing suicide would do well to consider the impacts of their suicide on others.

And granted, some do.  Some, though, do not, or do too little of it.  Or so I'm somehow imagining; I guess I don't really know how much people consider the impacts of their suicides on others.  What I do know is that it's certainly something I've spent a lot of time thinking about, and I think that's a good thing.

Still, while the above thought also brings up some other problems, which I'll get back to [under "Having a way out"], I first want to share a bit more of my personal context for this exploration.  So, I'd had this little bit of ideation, and let it pass, without action (unless you count taking a deep breath and re-composing myself to be "action").  This is something that happens to me almost every day, at least once.  Every. Fucking. Day.  Well, almost: yes, it is a bit of an exaggeration... but really, only a bit; in the last 35 years of my life (i.e. since I was about 5; I don't really remember whether this started before that, though it wouldn't surprise me), the maths say there've been 12,784 days.  I'd guess (and it is just a guess, but a fairly informed one) that I've had suicidal (and/or a young child's closest equivalent) thoughts on at least 10,000 of those days.  What's that thing about 10,000 hours?  Well, maybe it's bunk, and certainly there's more to what makes one an expert at something.  Just realize that I'm someone who may well have spent 10,000 days thinking, for at least some portion of the day, about suicide.  And some of those days it's been a major part of my day – whether having ideation over and over again throughout the day (and, on about 6 days out of my life, even making an attempt), or, like today, as I write this blog post, simply thinking about suicide in abstract terms (usually (though not too much today, it turns out) with little flashes of ideation along the way, while mostly thinking about it in level-headed ways – or at least relatively lucid ones).  I've read multiple books on suicide: from Methods and Consequences (which you might be able to find at public libraries; or just visit the author's website), to simply memoirs that include discussion of it, e.g. An Unquiet Mind (a bit easier to find at libraries than the former).  I've read blog posts.  I've thought about the surprisingly-frequent references in movies. I've talked with friends and lovers – sometimes helping them through their suicidal times, other times having them helping me, and still other times simply discussing the subject.  I wouldn't actually call myself an expert on suicide (I haven't studied it in more than a lay person's way)... but I certainly have a significant familiarity with the topic, including (importantly) familiarity with what it's like to be feeling suicidal – or, if "suicidal" isn't something one deems to be a "feeling", then having suicidal thoughts, and the concomitant feelings that so often accompany (and/or create) those thoughts.

And it feels pretty awful, let me just say. Because not only are you sitting there, thinking that your life is shitty enough that you might be willing to end it (a thing that biological imperatives tend to push you away from, it's worth noting; this is a pretty radical (with respect to genetic predispositions) thought), but you (or at least I) layer on top of that this whole stigma about the impacts of actually doing it: how your mother will be sad, your sister might feel ashamed to talk about her brother, your friends who loved you won't understand... and of course the people (whether friends or professionals) who find you, or have to handle your body (either trying to save your life, or dealing with the corpse)....  And really, that's just a few of the impacts that suicide can have.  There's the copycat problem, the costs (monetary and otherwise) of therapy for traumatized friends and family, the emotional cost of the various pains that drove them to need that therapy, et cetera, et cetera.

The impacts are very real.  So I get it why someone might think it's a selfish act.  It certainly is an act that can have a heavy impact on others.

But I'm going to go out on a limb here and guess that I'm not alone: People think about the impacts of the suicide they're pondering.  Or at least I certainly do.  I've spent many an hour pondering what the impact would be.  And frequently, that pondering is a part of what stays my hand.  The conscience that makes a coward of me is not so much fear of an afterlife (as a fairly strong naturalist, I'm fairly confident there'll be no afterlife that I will experience), but the fear of a different sort of afterlife: the life that continues on, after I'm dead – i.e. the impacts of my death upon the living who survive me.  Hamlet (or shall I say Shakespeare?) was right to point out that it takes a pretty big dread to stop a person with the methods at hand (which I don't usually have, but have had, at times), and who is suffering the whips and scorns of a long life of pains.  And for me, at least some of that dread is the dread of hurting those I love, who would survive me.

And so (unselfishly?), I bear those fardels another day.  (And another.  And another.  Times ten thousand.)

But is it really unselfish to live on?  Even as I live, I know the pain that I experience creates pain in others: whether it's those with whom I'm close enough to let them know I'm feeling suicidal, or even just to know (and some can simply see) that I'm in pain: These people worry about me (they tell me so).  They, then, experience a type of pain, because of me.  I've heard their stories, some of them.  I've seen their tears.  I've seen it written on their faces, tears or no.  And I've seen it written in their words to me.  Perhaps it is unselfish that I "grunt and sweat under a weary life"... but it's definitely not without impact on those around me.  So there's impact, either way.  Whether I commit suicide, or whether I live on, there's impact.  Can the impacts be weighed?  I don't know how to answer that.  I do know that there are times when I think the impact would be less if I were to go, than to stay.  Ten days ago, as it happens, I had a time when I was thinking some thoughts about suicide, and I had the thought, which I promptly wrote down in a note to myself (just because I thought it was interesting): "In the long run, I truly believe this will be better for everyone." Of course, I didn't actually attempt suicide at that point (I wasn't really even all that close to it).  I was just reflecting on it, and had that thought along the way.  Reflecting on it now, I'm not sure if I agree with the thought.  It was just something that I was considering as a possible note, for if and when I ever did commit suicide.  Something that, I think, would have some truth to it, even if I don't wholly accept it as true, so I imagined writing it down.

I've thought long and hard about suicide notes – whether to leave one, and what to say in one, if I did.  For someone like me, who truly does want to be unselfish about things, and is simply struggling to figure out how to do that, it's a hard question.  Whatever note one leaves, it'll probably never really capture the intricacies of things.  So maybe you don't even try.  Maybe you come up with something succinct like the above, and say nothing else.  Or, as a guy I knew in high school scrawled in the sand near the site of his self-hanging, a little quip from that same Hamlet speech I quoted above: "to sleep, per chance to dream".  Perhaps he had a dread of the afterlife.  Perhaps, given that he went through with his life, he hoped to see one.  I don't know.  And even though I didn't know him all that well, or consider him particularly much of a friend (certainly we hadn't stayed in touch, in the two years between high school graduation and his death), I still wonder what it was like for him.  And I know that, no matter what I do or don't say if and when I ever commit suicide, that people will have such wonderings (or, probably, very different wonderings; more on that in a moment) about what it was like for me, about why I did it, etc.

My wonderings, I think, are different from most, though.  I think (given what I've heard from people) that most folks wonder how someone with such promise (Stith was an olympic-hopeful) could ever come to such a place.  I wonder, instead, how others didn't see what I saw, when I got to know him a little bit through being in a drama class with him some 5 years earlier, and through a few minor interactions otherwise: someone who had a lot of pain, under the surface.  Maybe I'm wrong to think that; maybe I was projecting my own feelings onto him.  Or maybe, as someone who's lived a life filled with emotional pain, I'm more in tune to the hints of it, that we try to hide, and saw an inner experience that those who were closer to him failed to see.

And why do we hide the pain?  Oh, many reasons, I expect.  One of them being the stigma of it.  Which I think maybe brings me back to the shame thing:

Thoughts on Shame

In Dialectical Behavior Therapy (DBT), "shame is justified" when there is an actual risk that you might be ostracized from a social group that's important to you.  I think of that in terms of anything from a social group who you depend upon for your survival (in this day and age, perhaps coworkers, for your income), or simply who you feel a strong emotional connection to (one example for me is the local polyamory groups, in various cities I've lived in), or even just a single individual: a romantic partner, or close friend.  Whatever the "group", though, the interesting thing to me here is that it doesn't matter whether whatever you might do to create the shame situation is something that you feel is right or wrong; what matters is how the "group" will perceive and respond to it.  And right now, in our society, I think it's pretty safe to say that shame is justified for anyone seriously considering suicide: because people will distance themselves from you, if they hear that you're suicidal (I've certainly had that experience, anyway).  Or they'll effectively threaten a distancing, by telling you that you're being "selfish" – a general trait that's often going against the norms for a group, and thus (I believe) precisely the type of thing that the shame response has evolved to handle: preventing someone from doing things that would cause the group to cast one out.  And yet shame is exactly a trigger for suicidal thoughts and feelings, so to think it in the first place ultimately "justifies" having even more such thoughts.

But how fucked up is it that one who's thinking of checking out (an idea I'm using in the way described in Coercion and its Fallout [library]) – of life, and therefore of whichever group(s) might be relevant – might feel shamed back in to a group that might very well be a big part of causing (or at least extending) the pain that's creating the urge to check out?  I don't know, is it just me who sees a bitter irony there?  And with the impact of shame that can bring about further suicidal thinking?

Well, and allow me to talk now a little about a distinction that I make in different types of suicidal thinking: On the one hand, there's someone who's just gone through a particularly tough moment of their life, and is temporarily distraught about something or other, and through their distress, they aren't thinking so clearly, and they're hurting, so they think of suicide.  When these cases turn into actual suicide, to me, it's a tragedy.  I think most folks would agree with me, here.  The "permanent solution to a temporary problem" is sad to see happen, because, well, it was a temporary problem, and now that person won't live to see it resolved, when it pretty clearly could or would have been – or at least would have lost its gravity over time.

But there's another kind of suicidal person.  A person like myself, who, while surely experiencing temporary problems at various times, and having those problems lead to thoughts of suicide, also has a grander difficulty: Through whatever set of circumstances (be it genetic, or because of childhood abuse, or whatever), this person is someone who has a fairly chronic experience of intense emotional pain.  Yes, there are times when things aren't so painful.  There are times when such a person experiences joy.  Maybe those times are even frequent.  And it's easy, as an outsider, to look at such a person and see them as happy, and to think of whatever pain they may experience as a temporary problem.  But let me tell you, as someone who isn't feeling much pain in the moment I'm writing these words, that the pain is, none the less, a fairly ever-present thing.  A persistent thing.  And when it's bad, it's really bad.  And given the connections between psychological and physical pain, and in particular the similarity of brain response to each, I can tell you: chronic pain sucks – even when you're not actively feeling it, because even then, you're aware of it enough that you have to sort of plan for it.  You have to keep track of your spoons, as it were.  You have to actively work to avoid the situations that cause that all-too-painful sense of shame: that self-same emotion that both pushes you to want to check out, and pulls you towards sticking around; towards not being "selfish".  And even if you, like me, do a certain degree of embracing the pain, and finding the wonderful things (empathy, art, a desire to make the world better, ...) that can come from it... it's still bloody painful.

So, can there be another way?  I think maybe there can.  Let's start a new section.

Having a way out

There's a fascinating documentary by Terry Pratchett on "Choosing to Die".  Sadly, the two uploads of it that I'd known about online have been pulled on copyright grounds, but if you're sufficiently interested in this topic, I highly recommend digging deeper and finding a way to watch it.  (I found another instance of it on YouTube now.  Given the copyright issues (and my presumption that the copy I found, too, will get pulled at some point), I won't link to it; just go find it and watch it if you're so inclined.  Briefly, though, Pratchett has been diagnosed with Alzheimer's disease, and is struggling with the question of whether, when, and how to possibly make the choice for an assisted suicide.  This is a decision he is allowed to make, because he has a chronic physical illness.

Unfortunately (to my thinking, though I expect many will disagree), someone like me – who has been diagnosed with, among other things, chronic depression (I was first prescribed anti-depressants while still in high school, and given such a diagnosis long before that, I think) – is unable to get services from the "right to die" organization that Pratchett explored in his documentary. Dignitas says on its FAQ (I also confirmed it in an e-mail interaction, because other things they say seem like they might have allowed for it in some cases; not so much, it turns out) that those with "mental illness and/or psychological problems" cannot get the type of help that Pratchett was exploring getting.  And at some level, I can understand this... They're going for people making informed consent and a rational decision.  If decision-making and related abilities are impaired by things like depression (an interesting question, not (to my satisfaction, at least) fully answered), then clearly, there's good reason to be wary of considering a depressed person's decision to die to be an informed and rational one.  But can we go so far as to discount this ability entirely?  Even if their decision-making ability is impaired, do we not allow them the autonomy to make choices for themselves?  I would assert that in cases that are clearly acute (read: temporary), that removing autonomy is worth the cost, if it can get someone through the temporary problem and get them to a happier place, where they truly no longer wish to die.  When a condition is chronic, though, even when we consider that chronic is not synonymous with permanent, I would assert that some allowance for autonomy deserves to be given, and that a person deserves the dignity of being able to make decisions about their own life – up to and including a decision to end it.

A difficulty comes in, though, when trying to judge between the acute and the chronic.  Even a chronic disorder will have acute flare-ups.  And I think there's value to society in having an organization which might assist someone to carry out a suicide be careful about who and when they allow themselves to assist.  But are there benefits to assisting someone with a chronic mental-health condition?  I think there are:

It seems to me that if someone who (because of chronic depression, anxiety, traumatic stress, or the like (or all of the above)) would want to end their life was given a way to do so in a rational, considered, planned way, that this could create all sorts of opportunities to mediate the difficulties of the "selfishness" of this decision, among other problems. Having watched, through Pratchett's video, a person take their own life, by way of swallowing a lethal cocktail, I can say that to watch such an act is not without emotional impact (on the watcher).  But the impact is mediated, substantially I think, by a couple of factors: First, we know (we are shown in the documentary) that the decision is one that has been considered over time.  We know something about the inputs to the decision.  We can't, of course, know the exact details of the mental state of the person, but we can see evidence that they've considered things, that they understand that it will be difficult on those who love them, and that they've considered that impact, regret it, and even made the decision with input from said loved one(s).  And we know that a mental health professional has made an evaluation of whether this person is making this decision in a lucid way.  We also can see that the loved ones have had time to prepare themselves for this, to say goodbye... and even to hold their beloved's hand (or body) as they go.

Can we do that with a more customary suicide?  Generally not.  I actually have a close friend who has, in principle, agreed that she might go with me somewhere into the woods or something, to be there with me for my suicide, should I ever come to a considered decision to go that route.  This gives me great comfort, in ways: The idea that I might feel some love in the end, and feel close to someone, would be a great relief from the isolation I all-too-often feel in the world (especially when I'm feeling suicidal).  Isolation that increases when I'm told that my act would be a selfish one; for if it is a selfish act, then it's clearly one I must do on my own, if I'm to do it at all.  And maybe I won't do it... I haven't thus far, despite several attempts.  (Side note: Having learned helplessness around suicide itself is... a deeply depressing state of affairs; it is often some learned (through hard lessons) helplessness that's played a role in making me feel suicidal; to then feel helpless about even ending things, well... that's tough, when I'm at my worst.  But I digress.)

If I could have an option where I could make a careful decision to end my life, and have that decision be one that's expressed to friends, family, loved ones, and even acquaintances... To give those people a chance to make a plea for me to stay, and give their reasons; for me to carefully consider their pleas; for them to say goodbye, if I stuck to my decision; to request that I return some item that I've forgotten I had borrowed from them; or to return something to me, or give me a chance to change the loan into a gift; to ask me questions – whether it's some secret recipe of mine, or whether there was anything they could have done differently to change my decision: All (or at least many) of the things that the survivor of a traditional suicide might regret their inability to do, given the loss of the person with whom it would need to be done... To my mind, having such opportunities prior to the execution of a suicide would greatly lessen the "selfishness" of the act.  And so I deem that the world would be better if more people agreed with the following:

People should have a path to suicide that includes consultation with, and input from, those around them, and allows them to tie up loose ends before they go, and to have a "safe" and effective way of dying.

If we could settle our estates while living; say our goodbyes and give hugs; let people know that it wasn't their fault (or, perhaps sometimes, that it was, at least in part, but to say so to their face, and face their reaction)... If we could do these things, and have suicide not be a stigmatized action, but merely a thing that some people opted to do, and that those surrounding them could express their agreement or disagreement with, and perhaps try to influence the decision... This, then, would allow a different situation than what we have now:

Right now, if one decides to commit suicide, one is pretty much obligated (that one friend of mine is a rare one indeed – and far enough away, that it might prove impossible to go to her) to go it in complete isolation, without support, without love, and with the very real risk that if their attempt is discovered prior to completion, it will be interfered with, and great efforts will be made to keep the person alive, against their wishes.  (While some do make suicidal gestures hoping to be saved, that's not the situation I'm speaking of here; I'm speaking of a genuine and considered attempt to end one's life.)

And it's undoubtedly true that some who attempt suicide (even with full sincerity in their intent at the time) end up glad to have failed, I can also say with authority that some who survive are upset by that outcome:

Waking up after the unconsciousness of the crash from an overdose of Adderall, after having written 37 pages of (mostly chicken-scratch-looking) writing about why I had made my decision, and what it meant to me, and then recording a couple of hours of audio (after my body ceased to allow me to write) of me trying to dictate further thoughts, and then eventually of my troubled breathing, when I failed to be able to do even that... well, waking up was a proverbial slap to the face.  I really hadn't wanted to wake.  I'd had the hope, as I lost more and more control of my body, and felt unconsciousness approaching, that it really would end forever.  But then I woke up.  I relive this reawakening (on a smaller scale) on many days, when I wake up from regular sleep, wishing I could instead sleep that infinite sleep of death.  Dismayed to once again face the light of day, that others claim to take so much joy from.  Granted, some days I take joy in it, too, in ways... rarely if ever have I had the simple thought, though, that I'm glad to be alive.  When I do feel gladness, it invariably comes from something more specific going on.

Wrapping things up

I think I'm nearing the conclusion of this "attempt", this essay.  There's more I'd like to discuss – about failed attempts (at suicide), access to reliable methods, the problems I see with methods like what Dignitas uses, about the selfishness or not (that's a question I don't have a clear answer to, too) of saying that suicide is selfish, about over-population, and altruistic suicide, and... much much more.  And I still don't feel like I have a solid answer to the opening question.  But it's time to face the current day that I have in front of me, some 8 or so hours of writing (and related research, and editing) later than when I first woke up into it.

Thank you for reading.  I'll thank you even more if you consider my thoughts in a thoughtful manner, and, should you be so inspired, write down (or otherwise communicate) your own thoughts, and post them in response (either as a comment; or as a blog of your own, which you may link to or not, as you see fit; or as a personal message to me).  Ultimately, I think the key is for us all to talk about this more.  To have it out there, discussed, debated, considered... these would, I think, be things that would make the world a better place.  And I think they might help to prevent a lot of tragic suicides, actually... and enable some sensible ones.


  1. 2015-05-25: I'd opened more of those search results earlier, and had a few open that I hadn't read yet.  I just now read this one and think it's worth a read.  It brings me closer to an answer to the question... though still not quite there.  Either way, though, it has some useful thoughts.
  2. 2015-05-25: Also, I think it's worth noting that the original broadway cast recording of the Sondheim play Assassins has a track called November 22, 1963, which portrays an interaction between John Wilkes Booth and Lee Harvey Oswald, and addresses some, err, "interesting" thoughts on Suicide, let's just say.  I found a copy on youtube (check the link, maybe it'll still be there), or you could get the whole recording – lots of interesting stuff in there, beyond just that track, too... though that one is by far the most powerful, to me.
  3. 2015-05-30: Hmm, the fourth hit is pretty interesting!  I only wish they'd let me read both pages... oh, maybe I can.  Indeed, the first paragraph of the second page is profoundly interesting; partial excerpt, with emphasis added: "Friends and family ... often consider [suicide] to be deeply selfish. This is understandable because the bereaved are often convinced that the decedent did not consider the impact of his or her death on those left behind. However, those who die by suicide certainly do consider the impact of their deaths on others; but to them, death is a positive rather than a negative outcome. This is wrong, but nevertheless, it is the view of the person who attempts suicide."  I will also add that saying that seeing death as a positive outcome being "wrong" is a value judgement, that seems to be being made as though it were a factual claim.  It's probably factually wrong that the perception of the death by those around the deceased will be a positive one, but even that could be in error in some cases: For example, one of the differences in how I think about suicide (and how I thought about Stith's death, for example), is that I often view it with envy and respect.  So....... yeah.


DRY Legislation (Don't Repeat Yourself)

I don't know much about the United States Code, really. One thing I do know, or have at least heard, repeatedly, is that it's immense. Individual bills sometimes come in at thousands of pages, and go completely unread by a large percentage of the legislators who vote on them.

This is the story, anyway. I'm presuming it's accurate.

And it strikes me, in thinking about this, that probably a large percentage of all those words involve some sort of standard boilerplate-like language that shows up again and again - either across bills, or within a bill. Maybe that's not at all the case, I don't know. But knowing what I know about how I've seen things done elsewhere, I'm inclined to guess that it's likely. It's certainly a common thing in a lot of software I've seen (and some I've written), to express the same things over and over again.

And in software, it's often a horrible way to go about things. And I suspect the same to be true in the world of legislation.

It's understandable, mind you... One time you want to say "one time you want to say", and another time you want to say "another time you want to say". They're not identical statements. Yet there's a whole lot of repetition there.

There's been a movement in the software world to keep code "DRY"... An acronym for "Don't Repeat Yourself". In computer code, this is arguably a lot easier than in English. You have functions, and variables, and a readership who knows how to deal with these sorts of things. So you can do something like (in some arbitrary pseudo-code English):

1. Let "tywts" mean "time you want to say".
2. One tywts, "one tywts", another tywts, "another tywts".

There's arguably still repetition there, of course. And in a real code environment, there'd be ways to reduce it further. Still, if you decided you wanted to change things to be "one time you wished you had said", you only have to change it in one place (never mind that the acronym is now obsolete in its lettering; you could fix that, too, but you don't have to). This is one of the major wins with DRY code. And I suspect there are a lot of places in legislation where we could do something similar. After all, the readership of legislation is presumed to be sophisticated, too.

So make a library of specific definitions - within the body of law, overall, and within specific laws, as needed. An then express ideas in succinct, if slightly cryptic to the lay reader, ways. I think that might be better. At the very least, I think it's worth thinking about.

And maybe some day we'll set aside 5% of congress's time for a decade or three to "DRY off" the existing laws.


More atheists in Congress... (write your reps!)

Apparently, there are some 28 atheists in Congress, only one of which is open about their atheist views.

Personally, through a wide variety of inputs (perhaps I've written about these?  And/or perhaps I will (more) in the future), I've come to the conclusion that only an open atheist is really in the best of positions to be a legislator.

As such, I've just written to Jim McDermott, my representative in the House, the following message (which says a little more about why I hold this position):

Dear Congressperson McDermott, 
I've been voting for you for the last several years, and I've seen you speak a few times, and generally I must say: I like what you're doing. Which means I'm inclined to want to see you continue to represent me in congress. 
However, there's a point where I'd like to be more represented, where I'm less sure about how well you represent me: 
I'm a staunch believer in evidence and reason for deciding truth, and as such, my reason and the best evidence I've been able to find so far leads me to being a fairly strong believer in the absence of a personal god, or really pretty much any deity, though one does have to carefully define ones terms before one can reasonably have the conversation. 
At any rate, I've further come to the belief that I strongly want those who represent me in government to have a similar position, and take it openly.  For I feel there are basically two main possibilities for someone (and particular, someone in congress) who identifies as a religious believer (and specifically a believer in a personal god - which may or may not be you?  I'll get back to that): 
1. That this someone either has not looked at, or is ignoring (for whatever reason or reasons), the evidence for non-theistic explanations of the way the world works, and evidence against the existence of a personal god; or
2. Someone who has examined the evidence, and doesn't believe in a personal god, but for whatever reason or reasons (and there are some arguably good ones; cf. a talk on this topic by Daniel Dennett[1]), has chosen to lie about it. 
In the former case, I'd worry about this person's ability to use evidence and reason to make good decisions about how to interact with the world, especially when making policy decisions as my representative in congress. 
In the latter case, I'd worry about the mental hoops this person has to jump through in order to lie to me and others, and about what else they might be able and willing to lie about in the course of their service. 
In either case, I'd much prefer a representative who had examined the evidence, concluded that a personal god did not exist, and was then able and willing to openly admit to this. 
Now, according to wikipedia, you're a member of the Episcopal church.  According to the same page, you also led a recitation of the pledge of allegiance, rightly (in my opinion) omitting the added words "under God".  I've done a little bit of searching, and don't immediately find more information on your actual beliefs in this area... 
So I ask you: 
Are you, privately, an atheist? 
If so, I simply ask you to consider "coming out", and making your atheism public. 
If not, I ask you to consider the evidence (as presented, e.g., by Victor J. Stenger[2]) that exists against the hypothesis that a god exists, and if you find it convincing, to then consider my "if so" statement again. 
Either way, if you're willing to speak candidly (either in direct correspondence with me, or publicly) about your beliefs, or if you have in the past and can point me at some record of such, I would greatly appreciate hearing your views.  The one thing I will ask you NOT to do is to tell me that you're a believer if in fact, deep inside, you are not.  If you will keep your non-belief hidden, I can respect that (to some degree).  If you truly do believe, well, I'd again ask you to look more closely at the evidence, and/or I'd be happy to have a conversation with you about it, should you wish to do so.  If you disbelieve and explicitly say otherwise, though, then I have real trouble with that.  So I ask you not to do so. 
With respect and continued support, 
- David Lindes, a Seattle constituent.

[1] http://www.youtube.com/watch?v=BvJZQwy9dvE 
[2] http://en.wikipedia.org/wiki/God:_The_Failed_Hypothesis

Now, I ask you to do something similar.  Write it in your own words, to your own representatives (whether in the senate or the house, or ideally both; perhaps I'll follow up with Murray and Cantwell, as well).  If you'd like to link to this blog post, feel free, but mostly, just write, OK?

Thank you for reading.


Automatic tool tips need to die.

I just noticed a typo when re-reading my post (in preparation for sending it to a friend) about software pain, and went to go fix it.  And, in the spirit of that very essay, I'm now going to rant about the experience I had.

Because you see: the effort of doing the edit was impaired slightly by the fact that blogger decided it was time to tell me something about sharing on google+ or something.  I don't know, I didn't really read the thing, because I was trying to get something specific done.  Anyway, it was popping up a sort of "dialog box" kind of thing, over the editing field, being in my face about whatever new feature it was trying to tell me about.  And when I searched on the page for the typo, it seemed to go away for a moment (I guess when the page scrolled, and the CSS-positioning had to get adjusted by some javascript or something), but then it popped right back up.  Right over whatever text I was searching for, which... happened to exist in more places than one in the document (it wasn't a misspelled word, just the wrong word, so the string existed elsewhere legitimately).  So I couldn't tell if I was at the right place yet (let alone make the edit), because this window kept covering up exactly the thing on the screen that I was trying to look at.

I find this horribly non-user-friendly.

If you've got a new feature you want to make me aware of, send me an e-mail about it.  I might actually read it, at a time of my own choosing.

If it's something so dire that using the site can't be done without knowing about it, then don't let me even see the site.  Present me with a page and make me make a decision, or acknowledge that I've read something, or whatever it is you're trying to do.  This is annoying too, and is often over-used, but... still, it's better than the automatic pop-over thing, and if it's really both important and urgent, then it's the right answer.  If it's quadrant 1, don't let me do anything else until it's done.  But you're making something that, for me, is quadrant 4 into something that's quadrant 3, which gets in the way of me doing something I consider to be quadrant 2... and frankly, that pisses me off.

If you want to have tool tips for actual tools, where I actually have to hover my mouse over something to see it, that's totally fine with me.  (I'd like to have the option to turn them off, of course, but I find that in practice, I usually don't.)  And if you want to advertise some new feature or something, that you think I might really like to know about, then I'd even tolerate having a bit of screen real estate devoted to some sort of notice about that.  Make it dismissible, and I'll very likely take the time to read it and then dismiss it at some point when I have half a moment, so that I can get my screen real estate back.

But when you put something that for me is quadrant 4 directly in the way of me trying to get done my quadrant 2 work done, thus making it quadrant 3 (urgent, but not important), you're causing me some pain.  If you want to keep me as a customer[0], please stop doing that, lest I drop out.

Much as I dislike supporting Covey[1], I do like to try to stay in quadrant 2 of his urgency/importance matrix when I can.  Stop feeding me quadrant 3 stuff, please.

Oh yeah, and to the rest of the world: I ask you to stop putting up with annoyances like these.  if you'd like to understand why, please go read that article on software pain (linked up top).

[0] To some small degree, I specifically mean google and the blogger platform team.  Mostly, though, that was just the particular instance of a broader trend that I've noticed which caused me to write this post.

[1] For reasons I won't bother saying here, right now.


Zero configuration software (and much more)

Paul Graham once said:
If you think something's supposed to hurt, you're less likely to notice if you're doing it wrong.
Well, guess what: I'm strongly of the opinion that a whole lot of people are doing it wrong. Presumably because the following corollary (my own words, this time) also applies:
If you've been doing it wrong since you can remember doing it at all, you're probably inured to the pain.
And I, for one, am of the mind that allowing oneself to become inured to the pain is doing everyone (yourself, and everyone else, too) a disservice, and that standing up for pain-free things is a good thing.

Now, this could apply to all manner of things -- for example, in a great TED talk by Dan Ariely, some great observations are made (also viewable on YouTube) about pain treatment in medical settings.

Meanwhile, for this essay (in this sense of the word essay), I'm going to focus on something that I have more direct experience with:

Software, and especially the development thereof.  Note, though, that while I'm talking about the development of software, on the one hand, I'm also talking about its effect on end users, whether or not those end users are also developers.  So the software I'm talking about could be anything from a custom piece of software for some kiosk somewhere (or order-taking software at a restaurant, say – i.e. something that is used by people whose main business it is to do things completely other than dealing with software), all the way to programming languages (which of course have the primary audience of software developers – while also being written by them).


I am of the opinion that there's a whole lot of pain in the realm of software (the entire realm, as outlined above) that people just put up with, and that our world could be a whole lot better, if we (all software users, with a bit of special attention on developers, since they have a more direct ability to do something about changing the software itself) would just stop putting up with it.

That's Step 1: Stop putting up with software-induced pain. So then what? I'll get back to that.

But first: You know, actually, some of Ariely's observations might very well be useful in explaining why we do put up with it. (And I'm of the belief that knowing how and why something happens is one of the most powerful tools available for trying to prevent something from happening – or encouraging it to happen again, if that's what you're after.) For example, he says (emphasis mine -- though it mirrors some hand gestures in the video):
It turns out that because we don't encode duration in the way that we encode intensity, I would have had less pain if the duration had been longer but the intensity was lower.
I think that, for most of us, the intensity of pain of dealing with software annoyances is relatively low.  So, given the above findings from Ariely, we are able to tolerate it for hours and hours, days and days... months, even years – perhaps in some cases without ever even really noticing (at least in a conscious and remembered way) that it's painful.  Because the pain isn't that intense – it's not physical pain, after all, and hey, a lot of us are getting paid for experiencing it (because we're paid for jobs in which we basically have to deal with it), so it probably nets to being a positive experience for a lot of people – we're able to tolerate it pretty well, even if the duration gets to be quite extensive.

I think for me, though, the pain is more intense. I don't know why that's the case (and I don't think it matters, for the purposes of this essay), it just seems that I react differently to annoyances in software than other people around me. It seems to bother me more than a large percentage of the people I interact with.  I don't have any hard data to back that up, it's just an impression I get when I watch people interact with software, and sometimes even ask them about their interactions.  Things that drive me bonkers, they'll brush off, even when I ask them if it annoys them.  It does, they might even admit, but it's "just the way it is".  Ugh.  For me, such things are much harder to ignore.  It hurts when something is slow, or requires me to jump through a bunch of hoops to get it working the first time, or whatever.

I consider this to be a virtue of sorts: it becomes one of the things I can give back to the world: experiencing the pain so that I can try to help make the pain go away.  In this case, by drawing attention to it, with this blog post.  Consider this my little attempt at a bit of consciousness raising (and when you're done with this post, if you still want more consciousness raising, a bit more (in two parts) consciousness-raising, on some topics related to each other, but quite unrelated to this essay – what can I say, I have strange (?) tangents of thought, sometimes).  Anyway, my attempt at consciousness raising is done in the hope of encouraging others to join me in my efforts at finding and creating fixes and improvements – to software, software development paradigms, etc – that will benefit... well, ultimately, the hope is to benefit anyone that ever uses any software, anywhere, ever.  Grand plans.  Don't worry, we can start more locally than that.

Let's call it Step 2: Try to find ways to reduce the pain. While this does especially apply to software developers, I do not limit it to that audience.  Anyone reading this is almost certainly someone who uses software to some degree or other (unless someone printed out this page for you, and even then, you're an indirect user), and if we all work together at trying to find solutions, we'll do a lot better than than any of us can do on our own.  So I'm writing this for the non-developers, too – and, developers, please: do go and solicit (and/or welcome) their help.

Exploring further, I notice that Ariely also observes:
It turns out it would have been better to start with my face, which was much more painful, and move toward my legs, giving me a trend of improvement over time, that would have been also less painful.
He's talking about taking bandages off of burn wounds. Software is, of course, different.  But the principle, here, is this:

A decreasing level of pain is remembered as less painful than the same initial level of pain just stopping. I.e. the latter case has less "total pain" (the area under the curve of intensity over time), but a higher intensity of pain at end (because the pain suddenly stopped) of what we identify as the experience (which we presumably mark as a separation of experiences when the pain simply stops), and the greater "total" pain is remembered as "less painful".  Hmm, I think I'm not doing a great job of explaining it... Here: another TED talk, Daniel Kahneman on experience versus memory (also on YouTube), does a better job.

Anyway, it seems to me that this idea still applies in the world of software pain: If we can find some workaround (as we so often do) for our pain, the intensity of pain decreases, and so we remember it as having been less painful than it actually was at first.  Someone who faced exactly the same problem, but failed to find (or gave up on finding) a workaround, would remember it as much worse.  Even if you spend extra energy and experience extra pain in trying to find a workaround, you'll still remember that as less painful than the person who gives up!  (Moral to this story?  Don't give up, I guess.  But that's not step 3.  Not in that form, anyway.  We're not there yet.)

And let's dig a little deeper into the idea of a workaround (as described on wikipedia).  The description starts out simply enough:
A workaround is a bypass of a recognized problem in a system.
There's something in there, though: A recognized problem!  Guess what: If there's a "recognized" problem in something, that almost certainly means it's been "recognized" by more than one person – before it got to the point of having a workaround.  That means someone noticed it before, and didn't fix it.  Now, I'll grant that there are, at times, good reasons for not fixing a problem as soon as you notice it.  I do think, though, that taking that route creates part of the problem.  In fact, let's go ahead and define:

Step 3: Whenever possible, fix a problem as soon as you notice it.  The "whenever possible" part is an important piece, of course, and one might even weaken things to say "whenever practicable" or even "whenever practical", which leaves a great deal of leeway to say "it's not practical right now"... which I hope you'll rarely do – and when you do, it's because it's not practical for you to learn the things you need to learn in order to fix the problem, rather than that it's "not practical" to spend some time on doing the fix.  Well, and maybe this takes us straight to another step:

Step 4: When it's not possible to fix a problem as soon as you notice it, make some partial or unrelated fix, instead.  The idea here being to fix something (or make some progress toward a fix), because you noticed a problem.  While the motivation that the pain creates is still present.  Whether that's adding a message to the software about it having a problem, or adding something to a to-do list somewhere (though be careful with that one... it does need to be a TODO list that actually gets looked over and has things checked off of it for this to be enough), to just fixing something else that's been on the back of your mind but un-done, because you don't know how to fix this new thing, but are perfectly capable of fixing something else, and just haven't done it yet.  Better to fix something, even if it's unrelated, than to just continue living in the current state of pain that exists, when that's changeable.

And maybe you even come up with a workaround.  After all:
workarounds are frequently as creative as true solutions, involving outside the box thinking in their creation.
So I have nothing against finding whatever way you can to help reduce the pain.  A cast doesn't actually fix a broken leg, after all, though in that case it does help the healing process along, by protecting the healing process in some way.  If you can shield a developer from pressure by creating a workaround for software that you don't know how to fix, hey, that's useful.  Just remember:

Step 5: When you create a fix or workaround, be sure to share it.  It's not helpful to anyone else unless it's shared.  And maybe by sharing it, you'll give someone an idea about possibilities for how to fix it.  One great thing about open source (and especially these days with social networking and source code getting together on things like github) is that sharing is often possible.  Sharing is the way to help reduce pain for others.

Just remember, though, if you're doing workarounds, that:
A workaround is typically a temporary fix that implies that a genuine solution to the problem is needed.
 So, do try to do the "genuine solution" when you can – in fact, creating a workaround may be specifically be a bad idea, much of the time, because it goes directly in opposition to:

Step 6. Increase the pain.  No, I'm not after people being in more pain.  Quite the opposite.  BUT, I think increasing the pain temporarily can decrease the pain overall – because, after all, pain is a signal to us that something is wrong, and that we need to do something about it.  The stronger the pain, the quicker we'll respond – on the presumption that we've adapted the stronger pain response to things that tend to be more life-threatening.  Well, bad software (usually) isn't life threatening.  Not directly.  But, I do submit that it causes us harm – if only via the opportunity cost of every moment spent dealing with some ongoing problem, that could have (and might well have) been fixed, if it had only been more painful to start with.

So, if you're writing a C program, turn on the -Werror compiler flag -- make warnings be errors, so that you're *forced* to fix them, if you want to get a compiled program at all.  Stuff like that.  Make it hurt more, briefly, so that you'll be more likely to fix it.

Now, this may all seem like it's in direct conflict with Step 2.  Hrm.  It probably is, in a way.  I did mention this was an essay, right?  Well, let's see.  I guess that leads us to:

Step 7. Find cures, not band-aids.  Maybe not every single time, but do strive for this.

And now...

I want to get this essay out into the world.  I don't feel like it's "done" yet.  It's certainly not had all the editing that I could potentially put into it.  However: I started it several months ago, worked on it again maybe a month or two ago, and now I'm here again, facing lack of completion, and having lost a lot of the mental threads of where I was.  Maybe I could pick them back up.  Maybe I'll revisit it at some point, and do so, and make it better.  Applying band-aids to it, or... perhaps... I'll find cures! – ways to make it that much better of an essay.  For now, though, "done is good" (not the first place I saw that idea, but the first one I found that seems to explain it).  Done is good, so I'm putting this out there.  I can iterate if need-be.

I will, though, leave in a few only-very-slightly edited notes from my earlier draft, of things I wanted to include:

more from the Workaround page on wikipedia:
Typically they are considered brittle in that they will not respond well to further pressure from a system beyond the original design. In implementing a workaround it is important to flag the change so as to later implement a proper solution.

Placing pressure on a workaround may result in later system failures. For example, in computer programming workarounds are often used to address a problem or anti-pattern in a library, such as an incorrect return value. When the library is changed, the workaround may break the overall program functionality, effectively becoming an anti-pattern, since it may expect the older, wrong behaviour from the library.

Workarounds can also be a useful source of ideas for improvement of products or services.
Also worth looking at: Kluge and Convention over configuration.  I had a bunch I wanted to say about the latter... I guess in an edit or a follow-up post, maybe.

I also put aside another quote from Dan Ariely:
And it also turns out it would have been good to give me breaks in the middle to kind of recuperate from the pain, all of these would have been great things to do, and my nurses had no idea.
And wrote the following about it... which, I'm just going to leave here, no-longer edited (because Done Is Good, and I want this to be Done):

If we're dealing with pain day-in and day-out in our jobs, then of course we're taking breaks from it.  And surely that reduces our experience (or rather, memory) of the pain.

But here's the thing: There's still a whole lot of experience of pain!  And I, for one, believe that a great deal of that pain is totally unnecessary.  And that it's up to us to work on reducing it.  Because maybe a few of us have the problem of chronic pain (on YouTube).  Which, if you'll allow some stretching of the analogy, is something I think I've ended up suffering from, for one reason or another.

Anyway, taking a little break from relating the pain, I'd like to emphasize something else from Ariely's talk -- having to do with motivation.  Even if we take the stance that the pain I'm talking about is caused by people doing things wrong, we are of course under no obligation to consider that people are getting things wrong intentionally.  Leading in to the above quotes, Ariely says (emphasis mine):
Here were wonderful people, with good intentions, and plenty of experience, and never the less they were getting things wrong, predictably, all the time.
And while I'm sure that some of the pain comes from inexperienced people, or even experienced people that one might deem to fall short of the threshold of "wonderful" – and even, every once in a while, if there may in fact be some ill intentions – still, I suspect that most of the time, the intentions (at the very least) are good.  They're just "getting it wrong".  And so my hope with this essay is to impart some ideas on ways of doing things that just might help people (including, perhaps, yourself) to get things right.

The thing I most hope will be "gotten right" more often as a result of this essay is that more of you, more of the time, will fix problems as you find them, when the pain is fresh – thus (hopefully) preventing others from having to ever experience that pain at all.