Pleasure vs Reality Principle

In Freudian psychology, the reality principle is the psychoanalytic concept describing circumstantial reality compelling a man or a woman to defer instant gratification. The reality principle is the factual governor of the actions taken by the ego. Unlike the morality principle it does not always oppose the pleasure principle of the Id.

In infancy and early childhood, the Id rules behavior by obeying only the pleasure principle. Maturity is learning to endure the pain of deferred gratification, when reality requires it; thus, the psychoanalytic psychologist Sigmund Freud proposes that “an ego thus educated has become ‘reasonable’; it no longer lets itself be governed by the pleasure principle, but obeys the reality principle, which also, at bottom, seeks to obtain pleasure, but pleasure which is assured through taking account of reality, even though it is pleasure postponed and diminished”

Strategy of this work, dynamism, continuity and fluidity

Describe yourself!

Frau Ärztin  is a leading junior in the fields of surgery and women health . She is recommended as "really bright, nice to deal with, and on the ball", "very hard-working and a first class brain" and having "an eye for detail and really gets to the heart of the issue". This "efficient and focused barrister” displays an“amazing attention to detail” and a “fine understanding of difficult and tricky concepts".  Frau Ärztin is recommended as “an expert on very technical and scientific points” and “those that instruct hier comment on her accessibility as well as the experience, knowledge, leadership and insight he brings to bear on a matter".


Frau Ä is exceptionally clever, analytical and incisive, a calm and unflappable, 


sharp, knifelike, incisive, penetrating, penetrative


Obsession: finest woman, first-class brain, competent surgeon


Strength and capacity of mind, sense of duty, mastery of seamanship, humanity, persistence, foresight


To be part of the solution, we might start by examining the illnesses our community, region or country has, and listing these under two headings, Preventable and Unpreventable. 


To attempt to cure diseases we should have prevented; we will continue to facilitate unnecessary suffering, incur massive unnecessary spending, and continue to beg for more funds, pleading that lack of funds rather than our inability to plan is responsible for our poor performance.

Academic Discourse and Critical Consciousness

Sharing a discourse,
Hirsch: means not only sharing a tongue but also sharing amass of contextual knowledge that renders the tongue significant. In its broadest outlines, this in the definition of "literacy". That is identified as "cultural". That is, the ability to read, write and speak -to use languane- is contingent upon possession - of the cultural knowledge that renders the language significant, that is identified as "cultural", shape situation for its appropiate use, and so on. There is, in fact, no such thing as simple literacy at all according to these assumptions; every form of literacy is a particular cultural literacy.




Transdisciplinary academic vocabulary
Composition study, how much od the cultural content should be supplied by the teacher from the traditional academic store and how much should come from students' knowledge, of the treasure of other, nonacademic cultural literacies.


Discourse community, knowledge sharing


Concensus, dealing with diversity


Human don't make truth, they discover it.




The foolishness of pretending that one can be a traditional philosopher with access to the transcendent truth of timeless texts.






the need of authority

Ultimate goal: communicating wisdom

Qualities of mentor: experienced, committed, trusted friend and advisor.

DOING is vastly more influential than TALKING

The luckiest people in the world are those who are doing something that they think is important and that everyone else thinks is important. (K.Graham)

Einstein's German World

The word "genius" in German has a special overtone, even a tinge of the demonic, a mysterious power and energy; a genius-whether artist or scientist- is considered to have a special vulnerability, a precariousness, a life of constant risk and often close to troubled turmoil.


Read also! How economics shapes science!

I feel I'm just a beginner.
Irony: Together and Apart

Good morning. I am delighted to be here. I would like to acknowledge Tom Curley, who is just stepping down as Associated Press president and CEO after a lifetime of distinguished service in journalism. A warm thanks to Kathleen Carroll, too.

It is important for the IMF to maintain a good, open, dialogue with all members, especially the United States - our largest shareholder. You, the media, play an indispensible role in this engagement.

I come this morning with a simple message: the global economy needs a strong US economy and strong US economic leadership.

Time and again over the last century, we have seen that US leadership has been indispensible - bringing people together around shared values and an abiding vision of human potential, and economic potential too.

We saw this with the Marshall Plan after the Second World War. We saw it during and after the Cold War. And we saw it with the US driving the global economy over the past half century.

The result has been a more prosperous world. A more peaceful world. A better world.
Today, we stand at yet another moment in history, where the United States, working closely with its partner nations, can help lead the world to a better future.
These are trying times. The global economy is trying to emerge from the deepest and most painful economic crisis since the Great Depression. At the same time, the world is growing smaller and more interconnected by the day, meaning that economic disruption in one country can touch people all across the globe.
With this in mind, let me talk about three things this morning:
• First, where we stand in terms of the global economy.
• Second, why the United States, in particular, needs to be engaged.
• Third, why cooperation is so vital, and why I believe the IMF is especially valuable.


Global economy
Let me begin with the global economy. It’s fair to say that things are looking a bit better than they did even a few months ago. We can see some signs of thaw - welcome signs after the longest, hardest, winter in a generation. We see this in Europe, with some encouraging signs of financial stabilization. We see this here in the United States, with some encouraging signs of stronger growth and employment.
But we should not delude ourselves into a false sense of security.
The recovery is still very fragile. The financial system in Europe is still under heavy strain. Debt is still too high, public and private. Stubbornly high unemployment is straining the seams of society. Rising oil prices have the potential to do a lot of damage.
What is crucial at this point is that policymakers use the breathing space to finish the job, and not lapse into complacency or insularity.
Remember, we are here because of courageous policy actions, not blind luck. I’m thinking about the coordinated actions taken through the G20, in which the United States played a leading role. I’m thinking of the bold actions taken by major central banks to restore calm, including the Fed in this country and the ECB in Europe.
So what should be done to keep things on course? I see three broad dimensions.
First, it’s about stability. We must ensure financial calm. And here, I welcome the decision by the Europeans to strengthen their firewall, which should help stop contagion. And this should support a stronger global firewall, achieved in part by increasing the IMF’s resources.
More generally, we also need a stronger and safer financial sector that puts societal interest ahead of its own financial gain. This means better, and more coordinated, regulation. We’ve already come some distance here. The nations of the world, including the United States, have joined forces to strengthen global regulatory standards for banks through the Basel III process. We now need effective implementation, in a coordinated manner, of what has been agreed and more agreement on the outstanding areas - including regulation of derivatives and the shadow banking system, and effective resolution of banks with cross border operations.
Second, it’s about growth. In the short run, what matters most for growth is demand. But we should not ignore the supply side either, especially to keep growth strong and steady.
Boosting growth means using monetary policy to support activity, especially with no real signs of inflation among the advanced economies.
It also means using fiscal policy to support activity wherever possible. Yes, most countries need to bring down debt over time, and yes, some countries under pressure have no choice but to cut deficits today. But a global undifferentiated rush to austerity will prove self defeating. Countries like the United States with low costs of borrowing should not move too quickly.
But let’s not be too complacent either - total US public debt already exceeds 100pc of GDP. The country needs a stronger push to fix its public finances in the years ahead, including by curbing the growth of entitlement spending and raising more revenue.
In the United States also, the recovery is being held back by the burden of household debt. Some of the statistics here are staggering - for example, about 1.5m mortgages are seriously delinquent. More must be done to ease that burden. I’m thinking of actions to encourage mortgage writedowns and ease refinancing - and the US administration has recently proposed new measures with those objectives. Aggressively implementing these measures can help avoid costly foreclosures, improve household finances, and boost consumption.
Remember, banks were helped so they could lend more; homeowners should be helped so they can spend more.
Third, it’s about jobs. Nothing enriches like gainful employment, so jobs must be a priority. This is a daunting challenge. Over 200m people across the world today can’t find work. That includes nearly 13m people right here in the United States. The plight of young jobseekers throughout the world is especially painful.
Growth must also become more inclusive, so that everybody benefits from rising tides. This is important all over the world, not least in the hopeful yearnings associated with the Arab Spring.


A world of interconnections
Americans might ask themselves: why should what happens in the rest of the world concern us? Don’t we have our own problems?
The answer is simple: in today’s world, we cannot afford the luxury of staying in our own mental backyards.
Think about it. When I was growing up, the world was a simpler place. Your livelihood depended pretty much on what was happening around you, in your own community, in your own country.
No longer. Today, a densely-woven web of interconnections zigzags across the globe. Since 1980, the volume of world trade has increased fivefold. By the time of the crisis, global capital flows were more than triple the level of 1995.
These connections are everywhere. As just one small example, think about how cars are made. A modern car needs up to 40,000 different parts, and the loss of a single part can bring the global supply chain to a standstill. So when a deadly earthquake in Japan knocked some parts out of commission, suburban American auto dealers started running out of cars.
On a larger scale, it’s fair to say that the story of the global financial crisis is really the story of global 
interconnections.
Perhaps more than any other country, the United States is intertwined in this global nexus, affecting - and being affected by - developments all across the world.
This is mainly due to its dominant financial sector. Our analysis shows that foreign banks hold about $5.5 trillion of US assets, while American banks have $2.5 trillion of foreign assets. These are big numbers, showing that banking illnesses can be easily transmitted across borders. As we have so painfully seen, illnesses that come from the financial sector can be especially virulent - with large, widespread, and immediate effects.
The United States is also heavily integrated into the global trade network. It accounts for 11pc of global trade.
These connections are particularly strong with Europe. About a fifth of US exports go to Europe. And while two-thirds of EU trade is internal to the union, exports to the United States account for almost a fifth of the remainder.
Before the crisis, US S&P 500 companies were earning 20pc of their profits in Europe. Five of the top 10 overseas markets for US investment are in Europe. European-owned companies in the United States employ about 3.5m people.
So if the European economy falters, the American recovery and American jobs would be in jeopardy. So America has a large stake in how Europe fares - and how the world fares.
Cooperation and the IMF
This brings me to a larger point - integration poses great risks, but it also promises great rewards. Heightened global cooperation is the key.
History has shown us that when nations face common challenges in a spirit of solidarity, everybody wins. When nations pull apart in acrimony, going their own way and seeking their own advantage, everybody loses.
As Ralph Waldo Emerson said: “The reason why the world lacks unity, and lies broken and in heaps, is because man is disunited with himself."
In the middle of the last century, two visionaries saw this clearly - an American named Harry Dexter White and Englishman called John Maynard Keynes. Having lived through the hardship and devastation of the first half of the century - when countries pulled apart and sometimes tore each other apart - they were determined to build a better world. I’m talking about the founders of the IMF.
The idea behind the IMF was simple: if countries worked together in the common interest and helped each other in times of need, then everyone would prosper together.
If this idea was important in 1944, it is equally important today.


So what is the IMF?
It is an economic club and a giant credit union, where the 187 member countries cooperate with one single mandate - global financial stability. We act as a conduit for countries to pool resources and provide a lifeline to members in need.
The IMF has been in the trenches from the start, helping our members overcome all kinds of challenges, great and small.
When the European nations clutched onto the Marshall Plan to climb back to economic health and vitality after a devastating war, we were there.
When the newly independent countries in Africa and Asia sought to find their footing in the postwar years, full of hope and optimism, we were there.
When Latin American countries struggled to break free from a morass of debt in the 1980s, we were there.
When the Berlin Wall came crashing down, and new nations stepped over the rubble into a bright new world, trying to build institutions from the bottom up, we were there.
And when the global economy almost collapsed three short years ago, we were there too.
Today, the world needs the IMF more than ever. Why? We can provide a circle of protection against global turbulence, and help members adjust to changing circumstances with minimal disruption.
But to do this effectively in today’s world, we need more resources. As I said earlier, now that the Europeans have moved first with their firewall, the time has come to increase our firepower. The ratio of Fund quotas to world GDP is significantly lower today than in the past. Sixty years ago, it was as much as three to four times higher. We’ve a lot of ground to make up.
As you know better than me, there is a great tradition in rural America - a tradition of “barn raising”, whereby neighbours all band together to build barns. Barns were large, costly, and hard to build, but absolutely essential for farming. The lesson is simple: together, the community can accomplish what the individual cannot, and everybody benefits. We should think of pooling our global resources in precisely these terms.
I must also point out that the IMF is a good investment for all our members, including the United States. Your money is not drawn upon until needed. Your money earns interest. Your money is used prudently - our programs always carry rigorous conditions to ensure their effectiveness.
No member country has ever lost money by contributing to IMF resources - and I assure you that will not change on my watch.
One last point: as the tectonic plates shift in the global economy - with dynamic emerging markets like Brazil, Russia, India and China assuming an ever-greater role - these changes are also being reflected at the IMF. Our members have approved reforms to increase the quota share of these countries. Now countries must implement these reforms, and we are urging all to make progress by the time of our Annual Meetings later this year.
Even with these reforms, the United States will retain its leadership role as our largest shareholder.


Conclusion
Let me leave you with three thoughts.
First, cooperation can deliver. Over the course of the 20th century, we saw what can be accomplished when the global community pulls together, especially when the United States takes a leading role. Now is another moment for US economic leadership.
Second, in a world riven by an infinity of interconnections, the ideal of cooperation is as urgent as when John F Kennedy said: “Geography has made us neighbours, history has made us friends, economics has made us partners, and necessity has made us allies."
The time has come for the nations of the world to stand together again in the face of a major economic challenge, and with the US as a lead partner.
Third, the IMF was founded more than half a century ago for precisely this purpose. We are here to serve our members - including the United States of America.
Support us. Use us. Work with us.
Thank you.


themostpowerfulisthemostindependent

Five crucial aspects of wise reasoning: willingness to seek opportunities to resolve conflict; willingness to search for compromise; recognition of the limits of personal knowledge; awareness that more than one perspective on a problem can exist; and appreciation of the fact that things may get worse before they get better.

Being pursuer...

One of the most often overlooked aspects of leadership is the need for pursuit. Great leaders are never satisfied with traditional practice, static thinking, conventional wisdom, or common performance. In fact, the best leaders are simply uncomfortable with anything that embraces the status quo. Leadership is pursuit – pursuit of excellence, of elegance, of truth, of what’s next, of what if, of change, of value, of results, of relationships, of service, of knowledge, and of something bigger than themselves. In the text that follows I’ll examine the value of being a pursuer…
Here’s the thing – pursuit leads to attainment. What you pursue will determine the paths you travel, the people you associate with, the character you develop, and ultimately, what you do or don’t achieve. Having a mindset focused on pursuit is so critical to leadership that lacking this one quality can sentence you to mediocrity or even obsolescence. The manner, method, and motivation behind any pursuit is what sets truly great leaders apart from the masses. If you want to become a great leader, become a great pursuer.
A failure to embrace pursuit is to cede opportunity to others. A leader’s failure to pursue clarity leaves them amidst the fog. Their failure to pursue creativity relegates them to the routine and mundane. Their failure to pursue talent sentences them to a world of isolation.  Their failure to pursue change approves apathy. Their failure to pursue wisdom and discernment subjects them to distraction and folly. Their failure to pursue character leaves a question mark on their integrity. Let me put this as simply as I can – you cannot attain what you do not pursue.

Smart leaders understand it’s not just enough to pursue, but pursuit must be intentional, focused, consistent, aggressive, and unyielding. You must pursue the right things, for the right reasons, and at the right times. Perhaps most of all, the best forms of pursuit enlist others in the chase. Pursuit in its purest form is highly collaborative, very inclusive and easily transferable. Pursuit operates at greatest strength when it leverages velocity and scale.
I also want to caution you against trivial pursuits – don’t confuse pursuit with simple goal setting. Outcomes are clearly important, but as a leader, it’s what happens after the outcome that you need to be in pursuit of. Pursue discovery, seek dissenting opinions, develop your ability unlearn by embracing how much you don’t know, and find the kind of vision that truly does see around corners. Don’t use your pursuits to shift paradigms, pursue breaking them. Knowing what not to pursue is just as important as knowing what to pursue.
It’s important to keep in mind that nothing tells the world more about a leader than what or who they pursue – that which you pursue is that which you value. If you message to your organization you value talent, but don’t treat people well and don’t spend time developing the talent around you, then I would suggest you value rhetoric more than talent. Put simply, you can wax eloquent all you like, but your actions will ultimately reveal what you truly value.
Lastly, the best leaders pursue being better leaders. They know to fail in this pursuit is nothing short of a guarantee they’ll be replaced by those who don’t. All leaders would be well served to go back to school on what I refer to as the art and science of pursuitology.
What’s been the best thing you’ve pursued? What pursuit has led you astray. Thoughts?




Open dialogs with those who confront you, challenge you, stretch you, and develop you. Remember that it’s not the opinion that matters, but rather the willingness to discuss it with an open mind and learn.

Keep your eyes & ears open and your mouth shut and you’ll be amazed at how your level or organizational awareness is raised. Read between the lines.

Meaningful relationship and strong mentorship

The elements:

formal, informal, professional mentorship
http://aats.org/multimedia/files/Mentoring-Modern-Surgeon-ACS.pdf

People in England want something to read, the French something to taste, the German something to think about. Tucholsky.

Blue collar, blue scrubs

Miserable existence

Old Joke among surgery residents: If you're only on call every other night, you miss half the good cases. (and you can't learn how to take out an appendix by reading a book)