Diagnosis, prognosis, and trusting G-d

Neuro "psychic" evaluations

https://ishayirashashem.substack.com/p/diagnostico-pronostico-y-confianza

Part 1: Introduction

My parents were worried because I started to talk comparatively late, and they consulted a doctor because of it.

-Albert Einstein, 1954

Ancient astrologers were trusted for centuries. Professional care has changed since ancient times, but the desire to control the future is as strong as ever.

While people did not expect astrologers to cure illnesses, they might use urine, blood, and star interpretations from the person’s date of birth to treat diseases and to make predictions. This was ineffective, but they were considered effective at the time.

Just like parents today, ancient parents wanted to optimize their children's futures. Today's experts ask for birthdays, but no one seems interested in the constellations at the time of birth.¹

A doctor may speak authoritatively about how much time a person has until they die,² or whether they will be able to have children. This is based on published statistics. A psychologist likewise uses standardized methodologies to assess a child's intelligence and future potential.³ These predictions are often wrong for individuals.⁴ Why?

( Text of image: top left: a pile of books labeled moon, astrology, and the zodiac signs. Bottom left: a modern day expert using statistical proofs to foretell the future. The examples given are: he has 4 months to live, she will never become pregnant, and your child cannot learn to read.)

Perhaps this is because there is a spiritual dimension. Since there appear to be physical rules, scientists have come to believe there are physical rules “all the way down”, with apologies to Stephen Hawking.⁵ Like astrologers, our experts today sincerely believe in their current powers.

There is a bit of truth in every lie. Humans do have special powers, but not from science. Humans are indeed unique - in being able to overcome - their own nature.⁶ Descendants of Adam and Eve can choose to trust in G-d rather than ask the dead about the future. In fact, there is a rule that whoever goes beyond nature in their own behavior, G-d will overcome nature for them.⁷

Rebbetzin Devorah Fastag, my mentor, told me about a couple who didn't have children for five and a half years.⁸ They went for medical help, and were told that it is physically impossible for them to have children.

The husband learned that doing something against one's nature will cause G-d to change nature for them. What could they do against their natural desires? What about getting rid of something highly rewarding, like social media or internet access? He told this to his wife, and they decided to throw out their smart phones and stop using the internet. Nine months later they had a baby.⁹

The expert was working with incomplete information. Therefore, one should accept professional predictions, but with feelings of hope and faith. We know they can be wrong.

Deuteronomy, chapter 18¹⁰ says:

Be wholehearted with the Lord, your G-d.

This is the commandment to wholeheartedly trust only in G-d, and not seek out the future from other sources. Therefore, all types of fortune telling, magic, divination, and sorcery are forbidden. For example:¹¹

There shall not be found among you anyone who passes his son or daughter through fire,¹²

a soothsayer,

a diviner of auspicious times,

one who interprets omens,

or a sorcerer,

or a charmer (one who collects snakes, scorpions, or other creatures into one place),

a pithom sorcerer (The sorcerer raises the spirit of the dead, and it speaks from the sorcerer’s armpit),

a yido'a sorcerer (who inserts a bone of the animal called yido’a into his mouth, and the bone speaks by means of sorcery),

or a necromancer;

or one who consults a skull.

For whoever does any one of these things is an abomination to the Lord,

and because of these abominations, the Lord, your G-d is driving them out from before you.

Be wholehearted with the Lord, your G-d.

I wonder if this prohibition may apply not only to the occult, but also to more scientific ways of predicting the future, such as neuropsychological evaluations.¹³ The parable of John Doe illustrates this nicely.

Part 2: Neuro “Psychic” Evaluations

Let's talk about Jack and Jane Doe.¹⁴ Jack and Jane didn't know about being whole-hearted with G-d. And so, when their 10 year old son, John, was referred by his teacher for neuropsychological testing, Jane called all ten places¹⁵ on the list provided by the school. None of them could help John get an ADHD diagnosis in a timely manner.¹⁶

The school said that John would be expelled. He was failing academically, his belongings were disorganized and messy, and he teased his classmates. John had only one friend, and he only talked about sports and computer games.

Jane and Jack knew something had to change. They couldn't afford to wait two years for a neuropsychological evaluation for their only son, who was suffering. They also couldn't afford the fees.

Jack had an idea. The school had, after all, essentially requested that they hire someone to tell John’s future and advise them. Jane's best friend, Vashti, charged only $40 an hour, and she had a reputation for accurate predictions. Vashti worked at the Local Psychic as a Pediatric Fortune Teller. She specialized in college admissions.

Jack and Jane were educated, and they thought that Vashti was probably a fraud. However, many people were happy with her work, and she had a good reputation. The school wanted an expert to weigh in. Vashti was an expert.

So Jane called her friend Vashti, the fortune teller, for help.

🔮

Jane: You already know, of course, that our John is struggling, and he needs a neuropsychological evaluation for a diagnosis and recommendations for the future. Could you predict this for us?

Vashti The Fortune Teller: Of course! As your best friend, I am happy to help, especially since there is no real way to tell his future anyway.¹⁷ Please sign this legal document, approved by my in house counsel.

Jane: I didn't know you have in house counsel.

Vashti: Predicting the future is big business! I'm also a superforecaster on Metaculus, under the name Sargon Ashurwitz.¹⁸ I won $2000 last month making accurate predictions using my crystal ball. I'm actually Chaldean,¹⁹ but on Metaculus, everyone thinks I'm a programmer of Jewish descent.

Jane: I don't know what Metaculus is, but I trust you anyway, because we are best friends. What do I need to sign?

Vashti: Firstly, you acknowledge, in writing, that I am a fortune teller and not a professional psychologist or a prophetess or a doctor. You affirm that you will never sue me for any reason, even if it has nothing to do with this evaluation.

Jane: Of course not.

Vashti: You'd be surprised how often fortune tellers are sued when things dont work out. Our malpractice insurance costs more than an obstetrician.

Jane: Are you as expensive?

Vashti: No, because most health insurance doesn't cover psychics. You are liable to pay only $40 an hour for my services out of pocket. You might get 20% reimbursed if you can justify it as a psychiatric expense.

Jane: That's amazing. Health insurance really covers everything these days.

Vashti: Finally, you will send me a copy of the neuropsychological report, when you receive it, in around two years from now, and permit me to use it in future advertising. Details will be changed for anonymity, of course.

Jane, eagerly signing on the dotted line: Your process makes so much more sense than any of the places I called. Can you see John this week? Or is there a waiting list?

Fortune Teller: Please return with these forms about his development and his general behavior, completed as truthfully as possible, without incriminating anyone in any criminal matters. Also, please have these same forms filled out by a teacher from his school, so I can verify your responses. And bring all his academic records.

Jane: This is way more logical than waiting for a neuropsychological evaluation! What do people do if none of their friends are fortune tellers?

Vashti the Fortune Teller, sadly: Tragically, their children often suffer significant harm while they wait for their assessments.

(A few days later)

Jane: Here are his report cards, a copy of his behavior reports for the past 3 years, and his standardized test results.

Vashti: Great work. Please bring John to see me in person.

Jane: I'll have him here by 12:30 P.M.

(John and Jane return at 12:29 P.M.)

Vashti: Welcome, John! I'm Vashti the Fortune Teller, and I've heard a lot about you. Now, I will connect with my Inner Eye and gift you with insights about John. These are based on accredited fortune telling procedures and scientifically valid astrology. Please have him sit here next to me, as neuro ‘psychic’ evaluations work better with close proximity.

(John takes a seat next to the Fortune Teller.)

Vashti: John, my Inner Eye is showing me a path filled with creativity and success. You have a unique talent in problem-solving.

John: Yesterday I figured out how to build a model of my bedroom in Minecraft.

Vashti: You will successfully explore many biomes, in Minecraft and elsewhere. However, I also sense some challenges ahead.

Jane, worried: Please tell us more about those challenges.

Vashti: John might face moments of self-doubt. It's important for him to have a supportive environment where his efforts are acknowledged.

Jane: Doesn't that apply to everyone? Are there any specific recommendations you can offer to make his life easier?

Vashti: Opportunities for hands-on learning will benefit his educational progress. Additionally, fostering a growth mindset and teaching him to embrace challenges as learning opportunities will help him overcome obstacles with confidence.

Jane: Those are valuable suggestions for anyone. Anything else?

Vashti: As I peer into his future, I sense a strong bond between John and his friends. His ability to connect with others and empathize will make him a supportive and cherished friend as an adult. Teach him to be cautious of those who might take advantage of his kindness. And don't believe any neuropsychological evaluation that says his IQ is less than 110 .

Jane: OK. What's the diagnosis?

Vashti: ADHD with hyperactivity. The standard of care is medication and therapy.

Jane: Thank you for your time and insights.

Vashti: You're welcome. Remember, John's journey is shaped by his genetic endowment, your socioeconomic status, and his environment. All these will benefit from therapy and medication.

Jane: That cannot possibly work, but at least you have a solution. Thank you, Vashti.

---

And that's the story of John. With the support of medication and the fortune teller, he rapidly improved in his social and academic work. John is now in medical school, planning to become a pediatric neurologist.

Thesis: Modern predictive assessments, especially in neuropsychology, may have limited accuracy and might not be fundamentally different from ancient practices of fortune-telling.

What do you think?

1. Some of the introduction is adapted from my post on Babylonian professions.

2. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC27288/ Indian J Palliat Care. 2020 Oct-Dec; 26(4): 551–552. Published online 2020 Nov 19. doi: 10.4103/IJPC.IJPC_222_19

PMCID: PMC7888435PMID: 33623324

3. https://ishayirashashem.substack.com/p/poem-your-child-needs-an

4. Yes, statistics aren't perfect, but they are treated as authoritative. Witness the popularity of polygenic screening in rationalist circles.

Modern medicine has saved many lives and is far superior to astrology in most respects. I am not convinced that the same is true for neuropsychological assessments, particularly in the field of making individual predictions. See footnote 16.

5. Stephen Hawking in A Brief History of Time (1988):

A well-known scientist (some say it was Bertrand Russell) once gave a public lecture on astronomy. He described how the earth orbits around the sun and how the sun, in turn, orbits around the centre of a vast collection of stars called our galaxy. At the end of the lecture, a little old lady at the back of the room got up and said: "What you have told us is rubbish. The world is really a flat plate supported on the back of a giant tortoise." The scientist gave a superior smile before replying, "What is the tortoise standing on?" "You're very clever, young man, very clever," said the old lady. "But it's turtles all the way down!"

6. https://rabbisacks.org/covenant-conversation/noach/beyond-nature/

When a natural event does not accord with the current state of science, when it “breaks” the law, that is a sign that there is something wrong with the law. That is why Newton’s laws were replaced by those of Einstein. But when a human being breaks the law, when people rob or steal or deceive, the fault is not in the law but in the deed. So we must keep the law and condemn, and sometimes punish, the deed. Scientific laws allow us to predict. Moral laws help us to decide. Scientific laws apply to entities without freewill. Moral laws presuppose freewill. That is what makes humans qualitatively different from other forms of life.

So, according to the Torah, a new era began, centred not on the idea of natural goodness but on the concept of covenant, that is, moral law. Civilisation began in the move from what the Greeks called physis, nature, to nomos, law. That is what makes the concept of being “in the image of God” completely different in Genesis 1 and Genesis 9. Genesis 1 is about nature and biology. We are in the image of God in the sense that we can think, speak, plan, choose and dominate. Genesis 9 is about law. Other people are also in God’s image. Therefore we must respect them by banning murder and instituting justice. With this simple move, morality was born.

What is the Torah telling us about morality?

First, that it is universal. The Torah places God’s covenant with Noah and through him all humanity prior to His particular covenant with Abraham, and His later covenant with Abraham’s descendants at Mount Sinai. Our universal humanity precedes our religious differences. This is a truth we deeply need in the twenty-first century when so much violence has been given religious justification. Genesis tells us that our enemies are human too.

7. Example: Daniel had overcome his physical nature and so the lions respected him.

8. She heard this story on Kav Medah. Kav Medah is news you get on the telephone given by a Gerrer Chassid called "Jolofsky". In addition to news, he has some short shiurim, especially on Fridays before Shabbos, and sometimes interviews on subjects some of his listeners would find interesting. She heard this story in a shiur from Rav Elimelech Biderman, who is a very popular Hasidic speaker.

9. This is an example of how such a thing could work in modern times. It is not a part of nature and therefore cannot be scientifically proven for the individual. Big Technology studied human nature intensely to figure out how to make it as addictive as possible

10. Deuteronomy 18:10-12, thanks to Chabad.org

11. Deuteronomy 18:10-12

12. Moloch worship was a form of children sacrifice involving fire.

https://www.chabad.org/parshah/article_cdo/aid/4372130/jewish/The-Tragic-History-of-Molech-Child-Sacrifice.htm

13. They also provide quality time with children, 1:1 attention, and provide employment for psychologists. See my evaluation song. Linked in footnote 2.

14. Fictional parable.

15. The school psychologist, who had suggested John be evaluated, had given her a list of ten places where she could get John an evaluation.

This is what happened when Jane called the list of places that the school recommended.

1. Child Testing Center For America

Child Testing Center For America only tested children who already had an IEP.

2. Your Child Is The Best, Inc

Your Child Is The Best, Inc, wouldn't test John, because they only tested children who would not need an IEP.

3. Everyone Loves Chocolate And IQ Tests

Everyone Loves Chocolate And IQ Tests wouldn't test John, because John was allergic to nuts, and the chocolate had traces of nuts.

4. The Whole Entire Child Learning Center

The Whole Entire Child Learning Center wouldn't test any child who hadn't received a clean bill of health from the pediatrician. John had asthma.

5. Little Einstein Testing Solutions

Little Einstein Testing Solutions did not test children over age 6.

6. Gifted and Talented Children's Center

The Gifted and Talented Children's Center did not test children who were doing poorly in school.

7. No Queue For Your IQ

No Queue For Your IQ provided only IQ tests, but there was no waiting list. Jane didn't care about John's IQ.

8. We Are Cheap But We Do An Okay Job LLC

This one sounded interesting. She put John on the waiting list for We Are Cheap But We Do An Okay Job LLC, to be evaluated in a year and a half. For only $2,000, this was a bargain.

9. We Are Expensive But Also High Class: We Are Expensive But Also High Class had lots of availability, but they charged $1,000 an hour, for a six hour evaluation, and did not accept insurance.

10. The Educational Perfection Service Center

The Educational Perfection Service Center refused to tell Jane how much it would cost or when they could see John, but they reassured her that John was on the list.

16. Fisher EL, Zimak E, Sherwood AR, Elias J. Outcomes of pediatric neuropsychological services: A systematic review. Clin Neuropsychol. 2022 Aug;36(6):1265-1289. doi: 10.1080/13854046.2020.1853812. Epub 2020 Dec 13. PMID: 33307975.

Results: The final sources of data were 26 records, pertaining to a total of 974 children who received neuropsychological services. Parents were generally satisfied with services and reported high clinician empathy and increased level of knowledge, based on the evaluation. However, they reported less often that the neuropsychologist provided actual help. Informal home and school-based strategies were implemented more often than other types of recommendations. The research on changes in child symptoms and functioning was limited, but suggests improvements.

17. Donders, J. (2020). The incremental value of neuropsychological assessment: A critical review. The Clinical Neuropsychologist, 34(1), 56–87. https://doi.org/10.1080/13854046.2019.1575471

The preponderance of the evidence was strongly supportive with regard to the incremental value of neuropsychological assessment in the care of persons with mild cognitive impairment/dementia and traumatic brain injury. Evidence was moderately supportive with regard to stroke, epilepsy, multiple sclerosis, and attention-deficit/hyperactivity disorder. Participation in neuropsychological evaluations was also associated with cost savings.

18. Wikipedia: Metaculus is an American reputation-based, massive online prediction solicitation and aggregation engine. One of the focuses of Metaculus is predicting the timing, nature and impact of scientific and technological advances and breakthroughs.

19. The real Vashti was Nebuchadnezzar's granddaughter, and he was a Chaldean.