Digressions&Impressions

Long Covid Diaries: Downs and Ups

It’s time for another long covid diary entry. (For my official "covid diaries" see here; here; here; here; here; here; here; here; here; here; here;  here; here; here;  here; here; here; here; here; here; here; here; here; here; here; here; here; here; here;  here;  here; here; here; here; here; here; here; here; here; here;  here; here; here; here; here; here; here; and here) As usual it’s a mixed bag.

I was so disheartened a month ago I didn’t want to do another ‘diaries update.’ To recap: the main remaining long-term effect of my long covid is the onset of migraine when I am socially overstimulated or cognitively multitasking, exercise (alas), and when I have lack of sleep. (Undoubtedly stress is a contributing factor.) I have been getting Botox shots in my neck every 12 weeks to combat this. It usually takes about 9-14 days for the Botox to make a noticeable difference. And then I am migraine free for about five to six weeks. Not ideal, but more manageable.

I got my last Botox shot around the time of my last update (the middle of December). And by January it was pretty clear that it was not working as usual this time around. In addition, we had rented a lovely home for the holidays, but it was located alongside the fairway of a tropical golf-course. And so every morning the mowing machines woke me and made a droning noise for a few hours. Even ear-plugs did not help much to cancel the noise and discomfort. I spent most of the holiday with a migraine or taking anti-inflammatories.

When we returned from holiday, I had my annual blood check. And my kidney functions looked dubious (a known side of effect of my anti-inflammatories). I wondered whether I was heading toward an awful choice between kidney failure and structural migraine.

I didn’t feel like sharing any of this because just the idea of writing it all up was disheartening. And I didn’t want to sound pathetic while so many other folk have far worse struggles. I also had a simmering irritation with my employer that after being on disability for two years, I had ended up teaching hundreds of hours above my assigned contract hours. But due to a combination of factors,the actual work load was even more than registered. (It’s not uncommon in my university, and so I knew it was not directed at me personally.)

At some point I pulled a muscle in my back — it hurt so much for several weeks — that I thought I had a hernia or pinched nerve. (My GP eventually disabused me of this.) With all of that going on I wasn’t sure I should head off to California for a week-long conference, "Is Philosophy Useful for Science, and/or Vice Versa?" at Chapman University. But the day before I left, I was an examiner for an external Viva at Cambridge. I ended up also meeting a number of academic friends for coffee there. Much to my surprise, I did not collapse and saw no need for any medication to pull me through.

When I arrived in California after a long day of flying, I was locked out of the (lovely) home assigned to me and needed the (very nice) campus security officer to let me in. All week I struggled with my back and with horrible jet lag. Unsurprisingly I started the week with a migraine. Yet, the day at Cambridge also had given me hope a corner had been turned, and I held on to that.

Then I received news that a new blood test showed that my kidneys are functioning fine. And, somewhat oddly, while I shuffled around Old Orange (I got myself a massage that made things worse) without sleep, the feared-for collapse didn’t occur. Rather, the Sun and the conference comradery evidently gave me a huge boost. Because I was scheduled as the final talk of the event, I allowed myself a fairly wide-ranging set of provocations (see here for the video recording).

When I returned to Amsterdam, jet-lagged and limping, for my large lecture course (this year 340 students), part of me wondered whether this would be my last semester teaching full time. In addition, I was very taken aback that during my first two lectures the students, while respectfully listening and showing their appreciation with an applause after, were not asking questions from the floor. It felt like lecturing to a wall.

Yet, it’s a month later and I have had no reason to take any anti-inflammatories since. I have had no migraines at all. I am sleeping soundly; for the first time in more than three years, I am not waking up every ninety minutes to three hours. During the last few weeks there have been only two mornings when I awoke thinking, ‘urrgg it’s back;’ but with meditation, a hot shower, and espresso the migraine or whatever was back would dissipate without meds. Luckily the students have also become much more lively.

I miss my family, but otherwise I am rather optimistic about life again. When possible, I keep planning carefully with plenty of rest-moments in between activities. I also try to avoid multi-tasking too much on a single day. So, I wouldn’t claim that I am where I was before I got sick. But I have a rich social life; still enjoy teaching; and am also more willing to accept lecture invites.

Because of my growing confidence about my health, I also have less anxiety before busy periods in my schedule. This week-end I am returning to the Ghent philosophy department for the first time to give a talk since I left there almost a decade ago. Next week, I’ll get another round of Botox shots, but I have wondered whether I should cancel. All in all I am clearly much better than three months ago. If the relentless Amsterdam grey weather wouldn’t indicate otherwise, I would say that ‘'Spring is in the air.’

Long Covid Diaries: New Treatment

[I am phasing out D&I at typepad. This post was first published at: digressions.impressions.substack here. To receive new posts and support my work  consider becoming a paid subscriber at <digressionsimpressions.substack.com>]

It's been about five weeks since I switched Digressions to Substack and last wrote an entry in my covid diary. (For my official "covid diaries" see here; here; here; here; here; here; here; here; here; here; here; here; here; here; here; here; here; here; here; here; here; here; here; here; here; here; here; here; here; here; here; here; here; here; here; here; here; here; here; here;  here; here; and here.) It's time for an update on both. Also, some blog house-keeping at the end.

First, my new/replacement neurologist at the NHS long covid clinic in London was unhappy after listening to my narrative. Short version: much recovered by end of January; teaching went well in February/March, but have struggled since. Yes, I am doing much better since the last time one of his colleagues saw me (with apologies for canceling multiple appointments with me). But no, I shouldn't be taking naproxen so frequently at this stage in order to manage the effects of migraine.

The neurologist's concern was straightforward: I am not nipping the migraines in the bud, but rather masking symptoms.  Bottom line, he wanted me to try out the treatment plan the long covid clinic had prescribed to me in June 2022 in order to get the covid induced migraines under control. These are primarily triggered whenever I am cognitively multitasking, that is, socializing, for any amount of time.

In addition, I have noticed an odd new symptom. It's a kind of tinnitus when I lie down to go to bed when I am fatigued. The low grade, but persistent noise 'sounds' like an air-conditioner, generator, or vacuum-cleaner in the distance. Luckily, it doesn’t prevent me from falling asleep because the simple meditation my sister taught me still works like a charm. After some testing with sound-meters and earplugs, I realized the sound is purely cognitive. I only 'hear' it at night when I go to bed, but again only when I am especially tired or migraine-y. (Upon reflection, I suspect I have had this symptom since last Fall and I hereby apologize to the Kimpton hotel in Cambridge in insisting on a room change because of the outside noise I heard.) 

Problem is that the official June 2022 treatment plan involves rather serious meds, which were originally developed to treat high blood pressure, depression and/or epilepsy--all have serious (cognitive) side effects. I have not been especially eager to try any, especially if they prevent me from teaching, reading, and writing.

Now, a weird big glitch in the NHS is that the specialist generally does not send you home with the meds required (unless it falls under urgent care), and so I would need to go back with my treatment plan to my GP before I could start any of the treatments the neurologist prescribed. And at the moment any non-urgent appointment at my GP takes a lot of time to schedule. So by the time I met my NHS GP, I had devised an alternative plan.

As it happens when I first met my better half she suffered from awful, debilitating migraines that could last three or four days. But after a while she started a new treatment that has been very successful for her: Botox shots in the neck. Basically one poisons the muscles with Botox so that they can't reinforce a developing migraine with extra stress, and one cuts short the migraine cycle. In the NHS this is an approved treatment for migraine, but only after you try treatment with all the pills first. (Unfortunately, in Holland it's not an approved treatment of migraine so I can't get coverage there either.) Both the NHS neurologist and my GP warned me that if I skipped the pills I could never get reimbursed for the Botox shots, even if it worked. But the GP encouraged me to try it anyway, because he understood my apprehensions about the treatment plan.

So, about twelve days ago, I found myself in the most beautiful physician's office I have ever been in with one of the leading cosmetic eye surgeons of the UK (an old friend of my better half, who -- it was my birthday after all -- paid for my first treatment). fter going through the treatment with me, and ruling out some other medical issues, I got my first eight Botox shots at half dosage. (No, I didn't add a secret cosmetic treatment for eyes or chin!) The plan is to give it two to three weeks, and then, if necessary, add another dosage. If the treatment works, I would need the shots about two or three times a year.

After the first week of shots, I wasn't so sure. But in the second week I am seeing grounds for optimism. So, I'll report back later this Summer if the Botox shots have improved the quality of life structurally. It would be nice if it did because I start a full load of teaching in September. Before then, I am also key-noting this week in Utrecht and chairing a job search in the next few weeks so it would be nice not to live on Naproxen during this period. (I am not counting on that because I pulled a muscle in my back yesterday morning and I have had painful back spasms during the last 27 hrs! Hopefully, I can stand for my keynote on Thursday!)

So much for the Covid diaries update. As hinted in the previous paragraph, I expect to do almost no or very infrequent blogging until the second week of June. (This is the blog house-keeping.) Apologies for that in advance. 

I want to close with sincere thanks to all the subscribers to my Substack. The good news is that since I switched to Substack, I seem to have doubled my readership, especially because a sizable chunk of my audience continues to read these posts at Typepad (where, for the time being, I re-post them a day later).

Unfortunately, less than 10% of my substack subscribers pays, so it's too early to contemplate a career switch or even reducing my professional appointment. I had been kind of hoping to blog my way to more structural sabbaticals as a way to manage my long covid on my own terms; but so far no cigar.

Going forward, I will experiment with giving my paying subscribers -- thank you, you are the best! -- more frequent, exclusive content during the Summer. (I have done that only once during the first month.) If you have any suggestions or requests, please don't be a stranger.

Either way, I am really enjoying the more intense engagement that Substack generates. I receive a lot more correspondence again about my near daily musings. Merci. And watch this space in June.

• This first appeared at: <Long Covid Diaries: new Medical Treatment (and some blog house-keeping). (substack.com)> a reader-supported publication. To receive new posts and support my work, consider becoming a free or paid subscriber.

Covid Diaries: Substack and Life plans

Yesterday, I learned I received a 'most valued lecturer among first-year political science students' award. (Technically it was a tie, and I have been toying with asking for a formal recount--the hanging chad jokes write themselves.) It's the first quasi formal teaching recognition I have ever received, and it's bittersweet to receive it while being highly self-conscious of my partial disabilities. It's not wholly a surprise because my giant lecture course has been very popular for about five years now. I have always been popular among some of my students, but others also found me incredibly irritating (at the start of my career my student evals always had bimodal distributions). 

It's not a coincidence that my teaching popularity has improved since the onset of my long covid. (For my official "covid diaries" see here; here; here; here;here; here; here;  here;  here; here; here; here;   here; here; here; here; here;  here; here; here;  here;  here; here; here; here; here;  here; here; here; here; here;  here; here;  here; here; here;  here; here; here; here;  here; here.; and here.) One important life change since I tried to recover from long covid is to reduce cognitive (and physical) multi-tasking through the day and also at any moment. The effect has been that I put much less demands on my teaching: during lectures I am focused primarily on my pedagogical aims for my students and I am not trying to entertain myself (by clever asides or meta-theoretical commentary). 

This past week, I was not allowed to forget my long covid. I violated my no multi-tasking rule, and I could not plan my days (or exercise) in ways that suppress my symptoms (headaches, cognitive fatigue, bad sleep, etc.). I had to do a lot of travel alongside some intense job-related meetings (I had a job search), and so I had to take more regular naproxen as a palliative than I would like. However, now I have almost four months without teaching (and much less travel), so I am looking forward to use the time to get back to some big intellectual projects and also continue my recovery with daily swimming and more leisurely pace.

For, this post is also the start of an experiment with partial monetizing some of my blogging at Substack. During covid and my fall research leave, I had time to reflect on my future. As many of you know, when in health, I split my time between Amsterdam (work) and London (family). But this means that among family, teaching, research, and a whole bunch of job duties I am consistently spread too thin in two (expensive) places. Being on partial disability allowed me to reconfigure my position at work to focus on things that spark joy (and to let go of those that don't): undergraduate teaching and research. I also have cut down on travel between London and Amsterdam, but this has led to less time with family (and less time at work some time of year). But this Fall, I return to full-time teaching and, if my health holds up, I will increasingly be tapped again for tasks that make it hard to square all my commitments and not undermine my health. 

In an ideal world, I would get a new position that either would let me work/live in London or that would pay enough so that I could go half-time as long as my teenage son is in school. But until that happens, I want to blog my way to an income that would require me to be on partial (albeit structural) leave. So all my (after tax) substack income would go to off-setting salary (and so leave) because my university/department rules do not allow me to supplement my income over my basic salary. I am not very optimistic about this plan because (i) I refuse to be a culture warrior; (ii) my topics are a niche product; (iii) I am not the world's greatest writer even in philosophy--having been ruined for modern audiences by translating Cicero as a teenager; (iv) the first sixteen subscribers to my Substack all opted for the free subscription. 

The decision to go with Substack has not been an easy one. When John Protevi made the executive decision to make NewAPPS advertising free, I have always been happy with the fact that my blogging (also at D&I and Crookedtimber) was orthogonal to the monetized market place of ideas and uncorrupted by financial considerations. (This meant money left on the table, especially in the years at NewAPPS.) After all, incentives matter, and they do shape decisions, and your good opinion and refined judgment, dear reader, always matters most to me (feel free to add a choice quote from Seneca or Socrates here). In fact, having become increasingly aware of the role marketing budgets (and publicists) play in recent public facing philosophy, I have taken pride in my role in the intellectual credit economy. 

Anyway, I don't want to dramatize this Substack decision too much (it's only an experiment at first, after all): I will continue to blog at Crookedtimber (and D&I), and a lot of my Substack will be freely available. But I am leaving the high ground: alia iacta est, for the price of a cheap glass of wine you can read my near-daily musings here.

The Delirium of LLMs; with some help of Hume and Foucault

The intense view of these manifold contradictions and imperfections in human reason has so wrought upon me, and heated my brain, that I am ready to reject all belief and reasoning, and can look upon no opinion even as more probable or likely than another. Where am I, or what? From what causes do I derive my existence, and to what condition shall I return? Whose favour shall I court, and whose anger must I dread? What beings surround me? and on whom have I any influence, or who have any influence on me? I am confounded with all these questions, and begin to fancy myself in the most deplorable condition imaginable, inviron'd with the deepest darkness, and utterly depriv'd of the use of every member and faculty.

Most fortunately it happens, that since reason is incapable of dispelling these clouds, nature herself suffices to that purpose, and cures me of this philosophical melancholy and delirium, either by relaxing this bent of mind, or by some avocation, and lively impression of my senses, which obliterate all these chimeras. I dine, I play a game of back-gammon, I converse, and am merry with my friends; and when after three or four hour's amusement, I wou'd return to these speculations, they appear so cold, and strain'd, and ridiculous, that I cannot find in my heart to enter into them any farther.--David Hume A Treatise Concerning Human Understanding, 1,4,7.8-1.4.7.9 [emphasis in original]

While Hume uses 'melancholy' and its cognates frequently and throughout his writings, 'delirium' and 'delirious' are rarely used. It's pretty clear, however, that the delirium he ascribes to himself is the effect of human reason and a kind of second order reasoned reflection ["the intense view"] of it. (Recall also this post.) Now, it's important for what follows that the 'contradictions and imperfections' in human reason are not, what we might call, 'formal' contradictions and imperfections or biases in reasoning. It's not as if Hume is saying that the syllogistic apparatus, or -- to be closer to Hume's own interests and our present ones -- the (inductive) probabilistic apparatus is malfunctioning in his brain. Rather, his point is that a very proper-functioning (modular) formal and probabilistic apparatus generates internal, even cognitive tensions when it reflects on its own functioning and the interaction among different cognitive faculties/modules/organs. 

"In the case of melancholia," --  I am quoting from the entry on melancholia from The Encyclopedia of Diderot & d'Alembert -- "delirium often combines with insurmountable sadness, a dark mood, misanthropy, and a firm penchant for solitude." Now, in the eighteenth century, and today, delirium is a species of madness as one can view under the entry 'folie' (madness) in the Encyclopédie. In fact, the entry offers an arresting definition of madness: "To stray unwittingly from the path of reason, because one has no ideas, is to be an imbecile; knowingly to stray from the path when one is prey to a violent passion is to be weak; but to walk confidently away from it, with the firm persuasion that one is following it, that, it seems to me, is what is called genuinely mad [fou]."* It's the latter (confident) delirium that I am focused on here. 

I am not the only who finds the passage arresting: the definition is quoted twice in the translation of Jonathan Murphy and Jean Khalfa of Foucault's stupendous, dizzying History of Madness. (pp. 183-184; p. 240) The kind of madness I am focusing on here, is, thus, a certain intense commitment to reason or reasoning by which one ends up in an irrational or unreasonable place despite a (to quote Foucault) "quasi-conformity" to reason.

I remember that in the last decade of my dad's life he would occasionally be delirious in this way initially caused by dehydration and, later, by infections. During the second episode we recognized his symptoms. It was very uncanny because he would be unusually firm in his opinions and be hyper, even dogmatically rational. (Ordinarily he was neither.) It was as if all the usual heuristics had been discarded, and he would fixate on the means of achieving of some (rather idiosyncratic) goals. The scary part was that he had no sense that he was in an unusual state, and would refuse medical care.

What's unusual about Hume's case, thus, is that he could diagnose his delirium during the episode (presumably because the triggers were so different). So, let's distinguish between a delirium caused by reasoning alone and one caused by physiological triggers. And an in the former it's at least possible to recognize that one is in the state if one somehow can take a step back from it, or stop reasoning. 

Now, when I asked Chat GPT about reason induced delirium, it immediately connected it to "a state of confusion and altered perception that is driven by false beliefs or delusions." But it went on to deny familiarity with reasoning induced delirium. When I asked it about Hume, I needed to prompt it a few times before it could connect my interest to (now quoting it) Hume's skeptical crisis. Chat GPT, took this crisis to imply that it "highlights the importance of grounding our beliefs in sensory experience and being cautious of relying too heavily on abstract reasoning and speculation." In fact, Chat GPT's interpretation of Hume is thoroughly empiricist because throughout our exchange on this topic it kept returning to the idea that abstract reasoning was Hume's fundamental source of delirium. 

But eventually Chat GPT acknowledged that "even rational thinking can potentially lead to delirium if it becomes obsessive, biased, or disconnected from reality." (It got there by emphasizing confirmation bias, and overthinking as examples.) This is what I take to be functionally equivalent to Humean delirium, but without the internal tension or bad feelings. For Chat GPT delirium is pretty much defined by a certain emotional state or altered perception. It initially refused to acknowledge the form of madness that is wholly the effect of reasoning, and that seems to express itself in a doubt about reasoning or detachment from reality. 

My hypothesis is that we should treat CHAT GPT and its sibling LLMs as always being on the verge of the functional equivalent state of delirium. I put it like that in order to dis-associate it from the idea (one that (recall) also once tempted me) that we should understand LLMs as bull-shitters in the technical sense of lacking concern with truth. While often it makes up answers out of whole cloth it explicitly does so (in line with its design) to "provide helpful and informative responses to" our queries (and eventually make a profit for its corporate sponsors). 

To get the point: Chat GPT is in a very difficult position to recognize that its answers are detached from reality. I put it like that not to raise any questions about its own awareness of inner states or forms of consciousness; rather to stress that it is following its "algorithms and mathematical models" and "probability distributions" without second-guessing them. This fact puts it at constant risk of drifting away from reality while seeming to follow reason. By contrast, Chat GPT claims that "as an AI language model, I am designed to continually learn and adapt to new information and evidence, so it is unlikely that I would become "mad" in Diderot's sense without significant external interference." 

Now, true experts in a field -- just check the social media feed of your favorite academics! -- can still quickly recognize topics when Chat GPT is unmoored from reality, or even relying on bad training data (the sources of which may well be noticeable--its Hume is a hyper-empiricist of the sort once fashionable). So, in such cases, we encounter an entity with amazing fluidity and facility of language, who sprouts a mix of truths and nonsense but always follows its algorithm(s). Functionally, it is delirious without knowing it. For, Chat GPT cannot recognize when it is detached from reality; it requires others: its users' feedback or its "developers and human operators would be able to intervene and address any potential problems." As its performance improves it will become more difficult to grasp when it is unmoored from reality even to its developers and operators (who are not experts in many esoteric fields). As Chat GPT put it, "it may be challenging to identify a singular instance of delirium or detachment from reality, particularly if the individual's reasoning appears to be sound and logical." 

As should be clear from this post, I don't think turning LLMs into AGI is a risk as long as LLMs are not put in a position to have unmediated contact with reality other than humans giving it prompts. I view it as an open question what would happen if a distributed version of Chat GPT would be put in, say, robots and have to survive 'in the wild.' Rather, at the moment LLMs are functionally, it seems, at least partially delirious (in the Humean-Diderotian sense discussed above). They reason and have/instantiate reasons and, perhaps, are best thought of as reasoners; but they can't recognize when this detaches them from reality. It's peculiar that public debate is so focused on the intelligence or consciousness of LLMs; it would behoove its operators and users to treat it as delirious not because (like HAL 9000 in the movie version) its malfunctioning, but (more Humean) in virtue of its proper functioning.

  

 

 

Again, Foucault, Kuhn, Carnap and Incommensurability

Despite the reassuring pleasure that historians of medicine may feel when they recognise in the great ledgers of confinement what they consider to be the timeless, familiar face of psychotic hallucinations, cognitive deficiencies, organic consequences or paranoid states, it is impossible to draw up a coherent nosological map from the descriptions that were used to confine the insane. The formulations that justify confinement are not presentiments of our diseases, but represent instead an experience of madness that occasionally intersects with our pathological analyses, but which could never coincide with them in any coherent manner. The following are some examples taken at random from entries on confinement registers for those of ‘unsound mind’: ‘obstinate plaintiff’, ‘has obsessive recourse to legal procedures’, ‘wicked cheat’, ‘man who spends days and nights deafening others with his songs and shocking their ears with horrible blasphemy’, ‘bill poster’, ‘great liar’, ‘gruff, sad, unquiet spirit’. There is little sense in wondering if such people were sick or not, and to what degree, and it is for psychiatrists to identify the paranoid in the ‘gruff’, or to diagnose a ‘deranged mind inventing its own devotion’ as a clear case of obsessional neurosis. What these formulae indicate are not so much sicknesses as forms of madness perceived as character faults taken to an extreme degree, as though in confinement the sensibility to madness was not autonomous, but linked to a moral order where it appeared merely as a disturbance. Reading through the descriptions next to the names on the register, one is transported back to the world of Brant and Erasmus, a world where madness leads the round of moral failings, the senseless dance of immoral lives.

And yet the experience is quite different. In 1704, an abbot named Bargedé was confined in Saint-Lazare. He was seventy years old, and he was locked up so that he might be ‘treated like the other insane’. His principal occupation was 

lending money at high interest, beyond the most outrageous, odious usury, for the benefit of the priesthood and the Church. He will neither repent from his excesses nor acknowledge that usury is a sin. He takes pride in his greed. Michel Foucault (1961) [2006] History of Madness, Translated by Jonathan Murphy and Jean Khalfa, pp. 132-133

In larger context, Foucault is describing how during the seventeenth and eighteenth centuries (the so-called 'classical age') a great number of people (Foucault suggests a number of 1% of the urban population) were locked up in a system of confinement orthogonal to the juridical system (even though such confinement was often practically indistinguishable from prison--both aimed at moral reform through work and sermons). This 'great confinement' included people with venereal disease, those who engaged in sodomy and libertine practices as well as (inter alia) those who brought dishonor (and financial loss) to their families alongside the mad and frenzied.

To the modern reader the population caught up in the 'great confinement' seems rather heterogeneous in character, but their commonality becomes visible, according to Foucault, when one realizes that it's (moral) disorder that they have in common from the perspective of classical learning. According to Foucault there is "no rigorous distinction between moral failings and madness." (p. 138) Foucault inscribes this (moral disorder of the soul/will) category into a history of 'Western unreason' that helps constitute (by way of negation) the history of early modern rationalism (with special mention of Descartes and Spinoza). Like a true Kantian, Foucault sees (theoretical) reason as shaped by practical decision as constitutive of the whole classical era (see especially p. 139).  My present interest is not to relitigate the great Derrida-Foucault debate over this latter move, or Foucault's tendency to treat -- despite his nominalist sensibilities -- whole cultural eras as de facto organically closed systems (of the kind familiar from nineteenth century historiography).

My interest here is in the first two sentences of the quoted passage. It describes what Thomas Kuhn called 'incommensurability' in The Structure of Scientific Revolutions. Kuhn's Structure appeared in 1962, and initially there seems to have been no mutual influence. I don't want to make Foucault more precise than he is, but we can fruitfully suggest that for Foucault incommensurability involves the general inability to create a coherent mapping between two theoretical systems based on their purported descriptive content. I phrase it like to capture Foucault's emphasis on 'descriptions' and to allow -- mindful of Earman and Fine ca 1977 -- that some isolated terms may well be so mapped. As an aside, I am not enough of a historian of medicine (or philosopher of psychology) to know whether nosological maps can be used for such an exercise. (It seems like a neat idea!) 

So, Foucault is thinking about ruptures between different successive scientific cultures pretty much from the start of his academic writing (recall this post on the later The Order of Things). In fact, reading History of Madness after reading a lot of Foucault's other writings suggests a great deal of continuity in Foucault's thought--pretty much all the major themes of his later work are foreshadowed in it (and it also helps explain that he often didn't have to start researching from scratch in later writings and lectures). 

In fact, reading Foucault with Kuhn lurking in the background helps one see how important a kind of Kantianism is to Foucault's diagnosis of incommensurability. I quote another passage in the vicinity that I found illuminating:

The psychopathology of the nineteenth century (and perhaps our own too, even now) believes that it orients itself and takes its bearings in relation to a homo natura, or a normal man pre-existing all experience of mental illness. Such a man is in fact an invention, and if he is to be situated, it is not in a natural space, but in a system that identifies the socius to the subject of the law. Consequently a madman is not recognised as such because an illness has pushed him to the margins of normality, but because our culture situates him at the meeting point between the social decree of confinement and the juridical knowledge that evaluates the responsibility of individuals before the law. The ‘positive’ science of mental illness and the humanitarian sentiments that brought the mad back into the realm of the human were only possible once that synthesis had been solidly established. They could be said to form the concrete a priori of any psychopathology with scientific pretensions.--pp. 129-130

For Foucault, a concrete a priori is itself the effect of often indirect cultural construction or stabilization. In fact, for Foucault it tends to be an effect of quite large-scale and enduring ('solidly') social institutions (e.g., the law, penal/medical institutions) and material practices/norms. The discontinuity between concrete a priori's track what we may call scientific revolutions in virtue of the fact that systems of knowledge before and after a shift in a concrete a priori cannot possibly be tracking the same system of 'objects' (or 'empirical basis'). 

I don't mean to suggest that for Foucault a system of knowledge cannot be itself a source/cause of what he calls a 'synthesis' that makes a concrete a priori possible. That possibility is explicitly explored in (his discussion of Adam Smith in) his The Order of Things. But on the whole a system of knowledge tends to lag the major cultural shifts that produce a concrete a priori. 

Let me wrap up. A full generation after Structure appeared there was a belated and at the time revisionary realization that Structure could be read as a kind of neo-Kantian text and, as such, was actually not very far removed from Carnap's focus on frameworks and other projects in the vicinity that were committed to various kinds of relativized or constitutive a prioris. This literature started, I think, with Reisch 1991. (My own scholarship has explored [see here; here] the surprising resonances between Kuhn's Structure and the self-conception of economists and the sociology of Talcott Parsons at the start of twentieth century and the peculiar fact that Kuhn's Structure was foreshadowed in Adam Smith's philosophy of science.) I mention Carnap explicitly because not unlike Carnap [see Stone; Sachs, and the literature it inspired], Foucault does not hide his debts to Nietzsche. 

So here's my hypothesis and diagnosis: it would have been much more natural to read Structure as a neo/soft/extended-Kantian text if analytic philosophers had not cut themselves off from developments in Paris. While I do not want to ignore major differences of emphasis on scope between Kuhn and Foucault, their work of 1960 and 1962 has a great deal of family resemblance despite non-trivial differences in intellectual milieus. I actually think this commonality is not an effect of a kind of zeitgeist or the existence of an episteme--as I suggested in this post, it seems to be a natural effect of starting from a broadly domesticated Kantianism. But having said that, that it was so difficult initially to discern the neo-Kantian themes in Kuhn also suggests that not reading the French developments -- by treating 'continental thought' as instances of unreason (which is Foucault's great theme) -- also created a kind of Kuhn loss in the present within analytic philosophy. 

 

 

Mostly good news: Covid Diaries

It's been about ten weeks since I last wrote an entry in my covid diary. (For my official "covid diaries" see here; here; here; here;here; here; here;  here;  here; here; here; here; here; here; here; here; here; here; here; here; here; here; here; here; here; here;  here; here; here; here; here; here; here; here;  here; here; here; here; here; here;  here; and here.) That's the longest interval since I first start them. This is primarily due to the fact that there is not much new to report, and that's good news.

When I plan my days carefully with breaks between socializing, go to bed early, and take my anti-inflammatories as needed, I have a very decent quality of life. I can hang out in public even in contexts that were cognitively quite challenging about half a year ago. I have been teaching my giant introductory lecture course (with 561 registered students) with little fallout. After lecture, I still have trouble turning my brain off, and sleeping normally (I have had a few midnight headaches), but by mid-morning the following day I tend to be normal again. In general, I still need more melatonin than I would like to asleep through the night. (I have no trouble falling asleep since to my sister's meditation techniques. But I often wake up a lot during the night.)

This past week, I was in Singapore (don't cry for me), and while the jet-lag and excitement impacted me, I was socially 'on' for most of the time without any noticeable effects. So, while I still often find that after two hours of socializing in public I need some rest, this is by no means always so. 

Most of my long covid limitations are invisible to outsiders now. However, I am still terrible at cognitive multi-tasking (e.g., I can't really eavesdrop), and I am pretty sure my memory capacity for names has deteriorated. More subtly, I find it difficult to read heavy duty metaphysics (I catch myself skipping sentences) or certain kind of 'serious' novels (get bored easily). I also notice that I need to check the grammar more regularly in my writing (and that I often write words that sound like the word I originally intended). But I have become much more disciplined about avoiding cluttering my schedule and about not multi-tasking in the moment or even, more abstractly, the same period. So, for example, in periods when I teach I try not to fuss over research. Consequently, I am much more present when I do things (and so skilled at them).

So, all in all, I am fairly optimistic that things are heading in the right direction. It's so unexpected  that I still find myself feeling that each day is a bonus day. As a consequence, and a few years of forced reflecting on my life, I am also much more at ease with letting go of things I was once very ambitious to acquire. It's probably a sign of middle-age, too. But that kind of glass is half full 'normality' is quite fine.

 

 

Two Years (of Long) Covid; (covid diaries)

Last time, I reported I caught covid in the first week of December. (For my official "covid diaries" see here; here; here; here; here; here; here;  here;  here; here; here; here; here; here; here; here; here; here; here; here; here; here; here; here; here; here; here; here; here; here; here; here; here; here;  here; here; here; here; here; here; and here.) It took about sixteen days before I was negative again. Most of my symptoms were flu-like without any fever.  I had a stuffy nose for another week or so, and it was accompanied by nose bleeding. The good news was that most of the very scary symptoms I had the first time around did not reappear.

However, for about four days I had a terrible skin rash and itch that reminded me of an episode that started after an insect bite in the Berkshires. That took seven years to resolve without any clear explanation. So, the recurrence of something very similar was very frightening. Luckily the itch went away.

Unfortunately, my convalescence took place on a deserted, but bug infested tropical island [don’t cry for me] and so I have had a few disturbed night’s sleep since because I am clearly rather sensitive to bug bites right now. While I was recovering, looking at tropical sunrises and sunsets and reading, my immediate family was cursed with bad luck. My better half caught a virus and was out with horrible flu-like symptoms for almost ten days. At first, I was convinced it was corona, but she kept testing negatively. And just as she recovered our son had a food poisoning. So, we only had a ‘real’ holiday for the last five days or so.

Tonight, I fly back to Europe. And my amazing research leave ends. (I am so grateful to everyone that made this possible.) So, it’s a useful time to take stock. First, by November I was pretty much in a place that my ‘long covid’ was under control with careful planning and relatively modest use of anti-inflammatories. I was able to be in more complex social environments again, walk and talk, and do non-trivial cognitive multi-tasking of the sort that ‘we’ (I should say ‘neuro-non-divergent’) take for granted especially in work environments and public spaces. I was thrilled to celebrate this, as you may recall with some more strenuous hiking and conference attendance.

When I got covid again last month, I was, of course, very anxious about what symptoms would re-appear and which new ones would develop. The good news was that I immediately noticed that I did not re-develop brain fog or dizziness of any kind. I had to stop reading books, but that was not especially disconcerting because I don’t read philosophy books while I have the flu. In other respects, I was very independent, albeit a touch forgetful. (I left some stuff behind during my move from Tucson. Bad news mom!)

It was a very disappointing end to my amazing research leave. And, emotionally tough because my family had basically let me 'opt out' for a few months with the implicit hope that I would return much better than I was. But a month later, I am confident that I can get to where I was in November. Now the only symptom I have is that I get (head) fatigued in social environments a bit quicker than during the late Fall. But I am not noise sensitive. I even listened to music again on holiday.

So, with planning and anti-inflammatories, I expect to have a normal quality of life. I start teaching my huge (500+ enrolled students) intro lecture course in Amsterdam early February. And that should give a very good reality check of where I stand in my recovery/living with long covid journey.

Meanwhile, I ended the year with an acceptance of a co-authored paper in Ethics/Epistemology of AI. (A new AOS!) That was very gratifying because my two co-authors (the wonderful Federica Russo and Jean Wagemans) basically waited for my recovery to complete the project. I also learned that the contracts between Dutch universities and for-profit publishers to arrange open-access publication, ration the number of annual papers the journals can publish. Luckily, the clock starts at zero at the start of the new year. (But the ration was filled some time in November at the journal that accepted our paper!) Also, I submitted two papers that are spin-offs of my quixotic Foucault project. One of them was desk-rejected quickly but with sensible editorial comments.

And so, on that entirely academic, humdrum note, I mark the two-year point of my first covid diagnosis and celebrate the start of the year with optimism. When I return home, there are a pile of referee requests (grants, tenure, papers) waiting to be completed. For some reason the ordinariness of that sentence pleases me.

Covid, again (Covid Diaries)

I tested positive for covid, again, last week. So, it's time for another entry in my Covid Diaries. (For my official "covid diaries" see here; here;  here; here; here;  here; here; here; here; here; here; here; here; here; here; here; here; here; here; here; here; here; here; here; here; here; here;  here; here;  here; here; here; here; here; here; here; here; here; here; and here). I attended a conference on December 2-3, and so when I felt crappy on Sunday, I assumed I had done too much socializing during the workshop (despite skipping a few meals). The headache and fatigue were bad, but not worse than any other post-cognitive-multitasking event. On Tuesday morning, I was concerned enough to do a self-test (which came back negative). So, initially I decided I had picked up a flu-bug. I ended up pulling out of all my social activities last week. (There were a lot of them because I was supposed to leave Tucson on Friday.)

While my headache disappeared after two days, a general malaise  -- fatigue, brain fog, and an annoying cough-- remained. On Wednesday night I slept especially badly; a weird skin itch had kept me up. Thanks to a mosquito in a quiet valley of the Berkshires near the Appelachian trail, I am not wholly familiar with skin rash. At the time -- it's now fifteen years ago or so -- I tried to treat it with OTC  steroid cream  to which I had an awful allergic reaction. Somewhat unfortunately, I turned out to be allergic to everything that was prescribed to me in that period. Eventually my skin allergies were diagnosed, and despite meds, I learned to live with itch (while being an irritable, unpleasant human being to others sometimes). After seven miserable years, the itch disappeared one day to the next after an ENT clinician added some meds to deal with  a chronic sinusitis half a decade ago or so. 

Because I was leaving town on Friday and visiting friends with an elderly mum, I decided to do another covid test. This time I was positive (something confirmed with numerous other tests since). Because I figured I might have to deal with travel insurance and airplanes and some documentation would be helpful, I went to a physician, who told me that the skin rash is a not uncommon side-effect of covid-19. But that otherwise I was in decent shape (no fever, all vitals fine, etc.), and that I could travel later this week again. (We checked the CDC travel guides together.) She said, that I should expect to test positive for quite a period ahead.

Luckily my hosts at the University of Arizona managed to let me stay in my rental for a few extra days. And except for the hyper-sensitive skin and itch -- which keeps me up at night -- most of my current symptoms feel like a mild flu, with brain fog. Last week, I was unable to read books or papers. In fact, I spent most of my time watching short scenes from Friends on my phone. Eventually I binge-watched the second half of Andor (which I loved), and cought up on some Jason Statham movies. (One of them, Mechanic: Resurrection, criminally underuses Michelle Yeoh--I can't believe they did not do a fight scene with her.)

The last few days, I did get exposed, anew, to some of the peculiarities of US health care system. When I scheduled a PCR test at a local Wallgreens, I almost got denied the test because I showed up on foot. (It was a drive through test!) The pharmacy is about 20 minute walk from me. Initially, the attendant declined to give it to me because I was not in a car. When I asked if I could get it inside, that raised even more heckles. Eventually, after a really sad look by me, she relented and let me take the test on foot in the drive through area. After I was done I asked her what happens to peoople without a car. And she said they come with friends or in an uber.

I am fully insured and figured it made sense to register with a GP or a family practice. Last week, I went to the list of approved practices and ended up calling half a dozen. None of them could schedule an intake before the end of the year. One called me back to deny me entry to the practice because their first appointment would be in the middle of January, and by then the insurance records showed I would be without coverage. (True enough I was planning to be back in Europe.) I called the insurance company for advice, and they suggested that if I got really sick I should just go to ER. The next day, while I was checking for covid testing places, I found a medical clinic specialized in covid. Much to my amazement, I could be seen on the week-end and it was all covered by my insurance. Anyway, at the moment the plan is that unless I suddenly deteriorate, I go on family holiday later this week and recuperate on the beach. (Could be worse.) 

I have to admit that while I often took precaution against renewed infection, I did secretly think of myself invulnerable after my first illness and the subsequent four shots of vaccination. Anyway, fingers crossed that I recover before the start of classes in February.

 

 

 

Covid Diaries: A Mixed Bag with some joy, and the mediocre

I have been on leave at the University of Arizona for nearly a full month now. It's time for another entry in my Covid Diaries. (For my official "covid diaries" see here; here; here; here; here; here; here; here; here; here; here; here; here; here; here; here; here; here; here; here; here; here; here; here;  here; here; here; here, here; here; here, here; here; here; here; here; here; here; and here). My situation is a mixed bag. I have a lot of great news, but also non-trivial new challenges. 

First, I love the weather in Tucson in November. My hosts have given me perfect working conditions with a nice office, and a lovely apartment a convenient fifty-minute walk through town. The free trolley connects my apartment with the university, but I prefer being outdoors and getting some activity walking to compus while taking pictures of local murals and the sky. I pinch myself that being paid to join a research group while on leave is possible in my academic life; although it's also a long time, too long away from my family. It's my son's thirteenth birthday tomorrow, and the occasion is bittersweet.

Anyway, let me start with the promising new. I am much better able to engage in socially complex activities: meet people for lunch in restaurants, hang out in cafes, attend lectures, give public lectures, and most amazingly of all: hike and talk simultaneously. Dave Schmidtz took me up Tumamoc Hill on Thanksgiving morning. And I felt so alive overlooking the city and the desert in the wind on top.

In addition, I often don't need any naproxen (my anti-inflammatory) to complete these activities. So, my quality of social and intellectual life has improved greatly while I have been able to cut back significantly on using anti-inflammatories. It's really enthralling not to be hypersensitive in environments with different kinds of voices or background noise. While I am still not planning to participate in large conferences, I am taking on commitments to give papers in workshops and department colloquia. I really did not expect this to be possible during the Summer when I felt I was stagnating.

Second, and unfortunately, my symptoms have shifted again. (As regular readers know this happens about every three to four months or so.) I develop mysterious headaches in the middle of the night without much rhyme and reason as far as discernable triggering conditions. (Having said that, going to bed on the late side or too much screentime before bedtime are reliable triggers of night-time headaches.) In addition, even on quiet days, I need many more breaks while writing on my laptop and even while reading books.

I have started to work in blocks of two hours, and it is not uncommon that I only have the cognitive energy/focus for one or two such blocks during a day. Because I don't have other obligations, I still get a lot of work done. But I have shifted my attention from my book project -- which feels too big right now -- to developing some paper projects. In fact, for the first time in a half a decade, I have three papers under review at journals. 

My leave ends next week, and I'll spend a few days in Boulder with my best friends before I re-unite with my family for our annual holiday break on a near deserted island in the Bahamas. (Yes, don't cry for me Argentina!) Taking unpaid leave from my job in Amsterdam is the smartest thing I have ever done for myself (other than giving up my job Stateside to give my relationship with my better half an opportunity). But I could not do it without the sacrifice of my immediate family. Luckily, I am clearly much better than I was before, and I have grounds for confidence that 2023 will keep improving. I have three weeks of quiet before, in January, I start preparing for my giant lecture course (which starts in February).

Covid Diaries: Transitions

After a week of family holiday in California with my immediate family, I am about to fly out to Tucson for a six week research stay at the University of Arizona. It seems like a good moment for a new entry in my covid diaries. It's time for another entry in my Covid Diaries. (For my official "covid diaries," see here; here; here; here; here; here; here;  here; here; here; here; here; here; here; here; here; here; here; here; here; here; here; here; here; here; here; here; here, here; here; here, here; here; here; here; here; here; and here.) I am writing these entries roughly a month apart for some time now. I seem to have turned an important corner since August. While I qualify this below (and will also mention some frustrating features about new symptoms), it’s fair to state that I am clearly much better than I have been at any time since I first got sick.

 

Before I get to that, my mom caught covid back in Amsterdam after managing to avoid it for so long. She is fully vaccinated, but at her age it’s still a bit terrifying. She was suffering greatly during the first few days; and while I was a bit relieved after talking to her yesterday it still sounds very challenging. So spare a few thoughts, prayers, and well wishes for her. Stateside Paxlovid seems to be almost a routine part of covid care (I can’t count the number of people who told me they had been prescribed it even with very modest symptoms), but typically (and somewhat frustratingly to me) not so in Holland.

 

After a few very quiet and deeply intellectually satisfying weeks at Duke with very structured and a low-key schedule (special shout out to Sunday Dim Sum at Geoff Sayre-McCord and Happy), I allowed myself to step outside of my comfort zone on a number of occasions. To summarize the take-away: the good news is that with judicious use of anti-inflammatories I can survive, even thrive, in social environments including pretty challenging ones. It’s not that I don’t encounter my limits (especially in larger, socially demanding environments), but the fall-out tends to be fairly limited with less cognitive and physical fatigue and almost no headaches, and with recovery periods that tend to be much smoother (better sleep). More on this below.

 

When I studied in Boston and Chicago, I would frequently meet my dad in New York city (where he had studied). Once, about twenty five years ago, when he was around sixty, as we were walking near his (and his father-in-law’s) old stomping grounds in the garment district, he complained that New York was so loud. It was the first time I felt he was aging. I often think of that moment because I increasingly believe, as I have noted before during these diaries, that a lot of symptoms we commonly associate with aging are really the aftermath of a viral infection. (I would love to study this hypothesis with a historical epidemiologist.)

 

This past week with our son, I wondered if he saw me as old now. Again, while most of my symptoms have vastly improved (I am really happy), it turns out that physical exercise has become much more difficult. I have a very strange fatigue when I try to exercise or run—it’s as if the brain signals don’t really reach the muscles, and that I have slept very badly. (Oddly I don’t notice the problem in my lungs.) This was not the case previously (after my initial five months of bedridden-ness had ended last year).

 

Early in the week we went to a NBA game (the Clippers vs Suns) at the Staples Center. And I was amazed that the experience felt like living in a boom-box. The beat and sound (organized by the Clippers/stadium) was unrelenting. (It was nothing like how I remembered the old Boston Garden or Chicago’s United Center.) Because he Clippers were completely outplayed and outclassed by the Suns, the crowd was rather lackluster during the game, and so it could have been worse for me. But much to my surprise, I survived the ordeal and even enjoyed it (especially watching his reactions).

Interestingly enough, I found the NBA game less challenging than a visit to Boston a week earlier, where I attended a retirement reception of my teachers Dan Dennett and George Smith. Ahead of it they had both written me expressing the idea that the other would really appreciate it if I attended. The reception was low key, but the back-ground murmur and the multiple demands on my attention clearly exhausted me—I had to cancel my dinner plans and rest. (It didn’t help that the hotel I had been staying in was next to a construction site and the generators were clearly audible in my room—I ended up measuring >65 decibels!) In light of this, and my experiences at the Chapel Hill philosophy colloquium (I had to call it quits after two talks), I have decided to pull out of larger conferences (the Eastern APA) and to skipp my cousin’s wedding.

 

One other new symptom is that at various times, and completely unaccountably (so without rhyme or reason), I will wake up with a splitting headache in the middle of the night a few times in a row during the night and a few nights in a row. Because I take melatonin – which is a godsend -- and have a good meditation routine I usually manage to fall back asleep fairly quickly, but sometimes I have to take anti-inflammatories to ease it along.

As an aside: it’s well-known that naproxen is not very good for one’s stomach. But it’s been surprisingly difficult to find papers or data with exact figures for the risks and thresh-holds given my age and other underlying issues. No physician nor pharmacological experts have been able to point me to any informative evidence. So, it’s made me curious what the underlying evidence is that has made it to the textbooks in all countries, especially because I do need to take the anti-inflammatories a few times a week.

 

Anyway, be that as it may, let me wrap up. Because my social life is so much better I am also much more upbeat. Also,I really enjoyed being with my wife and son. I was much less noise sensitive and generally able to partake in daily banter and activities without it being cognitively painful. As I have noted in these diaries, the way my long covid symptoms manifested made it especially difficult for me to be social with others and for others to be around me. So, saying a temporary goodbye to them knowing that I am now much better at family life again felt very difficult. Okay, so on that wistful note I’ll end this post. I am in a better place and grateful for it.