Manufacturing Madness and Illness
The chapters on ancient and modern religion are evidently documentation of schemes by which madness is manufactured. This chapter more directly addresses modern tactics of sociocognitive warfare, in particular those that are medical and technological. The chapter on new age religion, in particular, involves overlap here, since illusion technologies used extensively in PsyOps, with religious overtones, are covered there. The use of hypnotic and brainwashing methodologies is also ubiquitous.
(Note that Ezra Pound disseminated pro-Nazi propaganda on Italian radio from 1941 to 1943 - I don't know the details, and his motivation might have been smokescreen.)
from http://www.buildfreedom.com/tl/rape3.htm:
THE CASE OF EZRA POUND
Ezra Pound was a poet, one of America's greatest - if not the greatest. He played a major role in the development of writers and poets, such as E.E. Cummings, T.S. Elliot, Robert Frost, Ernest Hemingway, James Joyce, and William Carlos Williams. He also studied politics, economics, banking, and monetary theory. He disapproved of war. During World War II, he hid a number of Jews from the Nazi exterminators; if discovered the penalty would have been death. He broadcast a series of talks on Italian radio aimed at Americans. He had wanted America to stay out of the war, and he said some uncomplimentary things about President Franklin D. Roosevelt. He also stated some of his political and monetary ideas. He was accused of being a traitor. [FDR confidant and Soviet agent Alger Hiss secured an indictment for treason from the Department of Justice. -AMPP Ed.] At the end of the war he was imprisoned in an American concentration camp near Pisa, Italy for six months without trial. Then he was transferred to America where he was declared insane and imprisoned in a mental hospital in Washington D.C. for thirteen years. After which the treason charges, for which he had never stood trial, were dropped, and he was released. He returned to Italy, where he lived until his death in 1972.
The reason he was not tried seems to be that his prosecutors didn't have a case that would hold up in court and/or they were afraid that he would repeat in court what he had said over the radio in Italy. Wendell Muncie, M.D., one of the psychiatrists involved in his "sanity hearing," said that Pound's insanity consisted of three factors: his passion for the U.S. Constitution, his espousal of the Confucian ethic, and his desire for world peace. No formal diagnosis of Pound's supposed "insanity" has been found. His captors in Washington openly admitted that Pound was a political prisoner. A Congressional investigation started in 1957 and completed in 1958 exposed the inadequacy of the case against Pound and led to his release.
Here are some extracts from Pound's radio talks:
- "I think an alliance with Stalin's Russia is rotten." (January 29, 1942)
- "Liberty is not a right but a duty." (March 8, 1942)
- "Sovereignty inheres in the right to issue money. And the American sovereignty belongs by right to the people, and their representatives in Congress have the right to issue money and to determine the value thereof. And 120 million, 120 million suckers have lamentably failed to insist on the observation of this quite decided law. ... Now the point at which embezzlement of the nation's funds on the part of her officers becomes treason can probably be decided only by jurists, and not by hand-picked judges who support illegality." (April 9, 1942)
- Quotes read by Pound: 1. "'I believe that banking institutions are more dangerous to our liberties than standing armies.' -- Thomas Jefferson.
2. 'I have two great enemies, the southern army in front of me and the financial institutions in the rear. Of the two, the one in the rear is the greatest enemy.' -- Abraham Lincoln.
3. 'The money power preys upon the nation in times of peace and conspires against it in times of adversity. It is more despotic than monarchy, more insolent than autocracy, more selfish than bureaucracy; it denounces as public enemies all who question its methods, or throw light upon its crimes.' -- William Jennings Bryan." (July 26, 1942)- Back to Pound's own words: "Wars in old times were made to get slaves. The modern implement of imposing slavery is debt." (March 25, 1943)
- "The phase of the usury system which we are trying to analyze is more or less Patterson's perception that the Bank of England could have benefit of all the interest on all the money that it creates out of nothing. ... Now the American citizen can, of course, appeal to his constitution, which states that Congress shall have power to coin money or regulate the value thereof and of foreign coin. Such appeal is perhaps quixotic." (March 30, 1943)
- "That text is known to them that have the patience to read it, possibly one one-hundredth of one percent of the denizens. They forget it, all save a few Western states. I think somebody in Dakota once read it. The Constitution." June 30, 1943)
from WorldNetDaily, 2004-Nov-24:
Attempt to stop mandatory mental screening fails
Congressman pushed language requiring parental consentAn attempt by Rep. Ron Paul, R-Texas, to add language to the omnibus spending bill in Congress to require parental consent for any mental-health screening done to children with federal money has failed.
The language was proposed to blunt the effect of a program proposed by the New Freedom Commission on Mental Health, which President Bush established in 2002. The New Freedom Initiative recommends screening not only for children but eventually for every American.
As WorldNetDaily reported, in September Paul attempted to have the program removed from Labor, HHS and Education Appropriations Act. His amendment failed the House of Representatives by a vote of 95-315.
The language he hoped to have added to the omnibus bill, which passed on Saturday, was:
"None of the funds made available for State Incentive Grants for Transformation should be used for any programs of mandatory or universal mental-health screening that performs mental-health screening on anyone under 18 years of age without the express, written permission of the parents or legal guardians of each individual involved."
Though Paul had support from House leadership for the language, senators who were part of the conference committee overseeing the final bill did not want it added.
"We believe the drug companies and the psychiatric establishment convinced Sens. Arlen Specter and Bill Frist to block it," said Kent Snyder, executive director of the Paul-founded Liberty Committee. "We are extremely disappointed that the conference committee ultimately rejected Dr. Paul's language and that it was not added to the omnibus spending bill."
Critics of the mental-health screening plan say it is a thinly veiled attempt by drug companies to provide a wider market for high-priced antidepressants and antipsychotic medication, and puts government in areas of Americans' lives where it does not belong.
Snyder says Paul won't give up on thwarting the screening and will take up the issue again in January when the new Congress convenes.
from NewsMax, 2004-Nov-11, by Dave Eberhart:
Doctors Group Opposes Mandatory Mental Health Tests for Kids
Under new law being considered, the federal government would require that every child in America undergo psychological screening and receive recommended treatment, including drug therapies.
Next week the Senate re-convenes to consider an omnibus appropriations bill that includes funding for grants to implement mandatory universal mental health screening for almost 60 million children, pregnant women, and adults through schools and pre-schools.
But officials of the respected Association of American Physicians & Surgeons (AAPS) decry what they see as “a dangerous scheme that will heap even more coercive pressure on parents to medicate children with potentially dangerous side effects.”
One of the most “dangerous side effects” from anti-depressants commonly prescribed to children is suicide, regarding which AAPS added, “Further, even the government’s own task force has concluded that mental health screening does little to prevent suicide.”
The bill would fund initiatives of the “New Freedom Commission on Mental Health,” including a program designed to subject every school age child in the country to psychological testing and recommendations for treatment. The House has already voted to appropriate $20 million for the plan, and the Senate will be considering whether to bump it up to $44 million.
Last September, AAPS lifetime member Rep. Ron Paul, M.D., R-Tex., tried to stop the plan by offering an amendment to the Labor, HHS, and Education Appropriations Act for FY 2005. The amendment received 95 “yes” votes, but it failed to pass.
Paul tells NewsMax: “At issue is the fundamental right of parents to decide what medical treatment is appropriate for their children. The notion of federal bureaucrats ordering potentially millions of youngsters to take psychotropic drugs like Ritalin strikes an emotional chord with American parents, who are sick of relinquishing more and more parental control to government.
“Once created, federal programs are nearly impossible to eliminate. Anyone who understands bureaucracies knows they assume more and more power incrementally. A few scattered state programs over time will be replaced by a federal program implemented in a few select cities. Once the limited federal program is accepted, it will be expanded nationwide. Once in place throughout the country, the screening program will become mandatory.
“Soviet communists attempted to paint all opposition to the state as mental illness. It now seems our own federal government wants to create a therapeutic nanny state, beginning with schoolchildren. It’s not hard to imagine a time 20 or 30 years from now when government psychiatrists stigmatize children whose religious, social, or political values do not comport with those of the politically correct, secular state.
“American parents must do everything they can to remain responsible for their children’s well-being. If we allow government to become intimately involved with our children’s minds and bodies, we will have lost the final vestiges of parental authority. Strong families are the last line of defense against an overreaching bureaucratic state.”
“Congressman Paul and several of his colleagues will never give up,” adds an AAPS spokesperson. “He and his colleagues have drafted a letter to Chairman Ralph Regula, chairman of the House Subcommittee on Labor, Health and Human Services, Education Appropriations, asking for his help.”
The letter states in part:
“We respectfully request that the following language be included in the final committee report on the Labor, Health and Human Services, and Education Appropriations bill for fiscal year 2005, or any report accompanying an omnibus bill containing the Labor, Health and Human Services, and Education appropriations for fiscal year 2005:
‘None of the funds made available for State incentive grants for transformation should be used for any programs of mandatory or universal mental-health screening that performs mental-health screening on anyone under 18 years of age without the express, written permission of the parents or legal guardians of each individual involved.’”
By way of background: in April 2002, President George W. Bush created the New Freedom Commission on Mental Health. Its objective was to enhance mental health services to those in need.
Among other things, the commission concluded that there is a need to search for mental disorders – especially in children – and the best way to do this was with mandatory mental health screening for everyone, starting with preschoolers.
According to the Commission's 2003 report: “Quality screening and early intervention should occur in readily accessible, low-stigma settings, such as primary health care facilities and schools.”
The report goes on to say: “...the extent, severity, and far-reaching consequences make it imperative that our Nation adopt a comprehensive, systemic approach to improving the mental health status of children.”
However, critics of the plan suggest that the random testing of millions of people makes little sense to anyone but the drug companies that will stand to profit from the potential customers.
The New Freedom Commission’s proposed treatment programs are based on the Texas Medication Algorithm Project (TMAP). TMAP, which was first used in Texas in 1996 and has since expanded to other states, is a set of very specific medication recommendations – most of them new, expensive, psychotropic drugs.
Despite the criticisms, the White House has remained solid behind the testing initiative, noting that the commission found that schools are in a “key position” to influence the phenomena of young children being “expelled from preschools and childcare facilities for severely disruptive behaviors and emotional disorders.”
But detractors are just as adamant that “problem” children in schools are readily identifiable, making the universal testing an unnecessary tool that does nothing but infringe on a parent’s right to make decisions regarding their child’s welfare.
from New Standard News, 2004-Jun-27, by Christopher Getzan:
White House May Be Planning Nationwide Program to Diagnose, Drug Kids
A new plan by the Bush administration to test the nation's public school population for mental disorders and treat them with controversial drugs has raised an alarm among some medical science watchdogs and members of the mental health community.
The White House is expected to announce a mental health and disability initiative that recommends the screening and treatment of the country's K-12 students. The plan is based on a Texas program a government whistleblower has called "a Trojan horse" for pharmaceutical companies.
As first reported by bmj.com, the website for the medical news weekly the British Medical Journal, the plan is derived from findings by the President's New Freedom Commission on Mental Health, a committee of doctors and mental health care professionals established in 2002. Published by the New Freedom Initiative (NFI), the report recommends states start testing for and treating mental disorders as early as possible, focusing on students, who can be easily accessed in the public school system.
The mental health component of the plan is based on the Texas Medication Algorithm Project (TMAP), which was engineered during Bush's tenure as governor. An algorithm is a flow chart that helps psychiatrists identify and medicate a patient's condition.
The New Freedom Initiative reported that "despite their prevalence, mental disorders often go undiagnosed," and recommended a screening program for "consumers of all ages," including pre-school children. The commission found that schools are in a "key position" to influence the phenomena of young children being "expelled from preschools and childcare facilities for severely disruptive behaviors and emotional disorders." To do so, the NFI said that "state-of-the-art treatments" were in order, and praised TMAP for showing "results in better consumer outcomes."
The American Psychiatric Association, which itself receives some funding from drug companies, has hailed the commission's conclusions as a sound preventative approach to dealing with mental illness.
Critics of the plan, however, point to strong connections between the New Freedom Commission on Mental Health and the pharmaceutical industry, and they contend that the plan will be a financial boon to drug companies while compromising the mental health of the nation's children.
Holistic mental health advocate David Oaks, director of MindFreedom, a coalition of groups that campaigns for people diagnosed with psychiatric disabilities, says the issues of child mental health are not only more complicated than just testing for disorders and putting kids on drugs, but also colored by powerful societal pressures and millions of dollars in drug revenues. Oaks says the president's plan amounts to little more than "No child left undrugged."
"It's very unimaginative. The idea sounds good: get help for the kids," Oaks said. "But the mental health machine tends to label, label, label." The labeling, said Oaks, all too often stigmatizes children as "abnormal."
"We're not happy to say the least," said Patricia Weathers, president of Ablechild: Parents for Label and Drug Free Education. "It's going to increase the drugging of children."
Oaks says he believes the template for the NFI's plan originates in the kind of extreme treatments misdiagnosed patients suffered in "the back wards" of clinics and asylums of the past, like forced drugging or electroshock therapies.
"This [has] been going on for years," said Oaks. "The psychiatric model [of the past] has been mainstreamed. And now, the system's coming for all of us."
Labeling, says Weathers, places a great deal of stress on families to raise a "normal" child. "It's almost like a parent is beaten down. You want [your child] in a mainstream school, not in a special needs school."
Weathers said her own son was dismissed from the public educational system because of her refusal to continue to drug him at the school system's request after school officials diagnosed him as having ADHD.
"Parents are losing their children" to drugging and labeling regimens, she says. "We need to look at the underlying causes, and not be so quick to think a child has mental problems.
"Instead of saying [a child is] having trouble reading, and giving him an educational resource, they say, `oh well, he's ADD'," she said. In the case of her son, Weathers said he had physical conditions, among them anemia, that may have been hindering his educational progress.
Criticism of the NAI plan, or at least the blueprint for it, has not been limited to the grassroots. In 2002 Allen Jones, a former investigator for the Office of the Inspector General in Pennsylvania, had been looking into the propriety of an off-the-books account that originated within the Pennsylvania Department of Mental Health. According to Jones, when he went to the New York Times and bmj.com with accusations that the drug company Janssen may have been attempting to influence the formation of a TMAP-style test and treat plan, he was told to "quit swimming upstream." When he refused to quiet down, he was fired, he added.
In a whistleblower report posted on the Law Project for Psychiatric Rights' website, Jones elaborated on his charges, and explained that during its pilot stage, TMAP was packed with doctors who had strong ties to the drug industry. Jones said that ties to the drug companies gave them a financial incentive to recommend expensive, brand name drugs, rather than cheaper comparable medicines.
Jones also writes that a number of the New Freedom Initiative for Mental Health Commission members were linked to TMAP's founding or are advocates for the program's expansion in states like Maryland and Ohio.
The NFI plan, said Jones, "doesn't have the Orwellian goal of drugging the populace for a political purpose; it's the Orwellian goal of drugging the populace for an economic purpose."
Nationally, pharmaceutical companies have been generous in doling out campaign contributions to the former Texas governor and his party. According to the Center for Responsive Politics, the pharmaceutical industry has given President George W. Bush $764,274 so far this election cycle, making the president the number one recipient of campaign donations of either party from the pharmaceutical industry.
Number two and three respectively are New Jersey Congressman Mike Ferguson and North Carolina Senator John Burr, each of whom are situated on the Committee on Energy and Commerce Subcommittees on Health, which oversees mental health and research, biomedical programs, Medicaid, and food and drug policies. Presumptive Democratic Presidential candidate John Kerry has also received campaign contributions from the industry, with just over $149,000 in donations.
This mix of money and politics is hardly helpful for members of the mental health issues community and their advocates, said Oaks. Instead, he said, "Imagine the whole environmental movement funded by the oil industry."
from Texas Straight Talk, 2004-Sep-13, by Ron Paul:
Forcing Kids Into a Mental Health Ghetto
A presidential initiative called The ``New Freedom Commission on Mental Health'' has issued a report recommending forced mental health screening for every child in America, including preschool children. The goal is to promote the patently false idea that we have a nation of children with undiagnosed mental disorders crying out for treatment.
One obvious beneficiary of the proposal is the pharmaceutical industry, which is eager to sell the psychotropic drugs that undoubtedly will be prescribed to millions of American schoolchildren under the new screening program. Of course a tiny minority of children suffer from legitimate mental illnesses, but the widespread use of Ritalin and other drugs on youngsters who simply exhibit typical rambunctious, fidgety, and impatient behavior is nothing short of criminal. It may be easier to teach and parent drugged kids, but convenience is no justification for endangering them. Children's brains are still developing, and the truth is we have no idea what the long-term side effects of psychiatric drugs may be. Medical science has not even exhaustively identified every possible brain chemical, even as we alter those chemicals with drugs.
Dr. Karen Effrem, a physician who strongly opposes mandatory mental health screening, warns us that ``America's children should not be medicated by expensive, ineffective, and dangerous medications based on vague and dubious diagnoses.'' She points out that psychiatric diagnoses are inherently subjective, as authors of the diagnostic manuals admit. She also is concerned that mental health screening could be used to label children whose attitudes, religious beliefs, and political views conflict with the secular orthodoxy that dominates our schools.
The greater issue, however, is not whether youth mental health screening is appropriate. The real issue is whether the state owns your kids. When the government orders ``universal'' mental health screening in schools, it really means ``mandatory.'' Parents, children, and their private doctors should decide whether a child has mental health problems, not government bureaucrats. That this even needs to be stated is a sign of just how obedient our society has become toward government. What kind of free people would turn their children's most intimate health matters over to government strangers? How in the world have we allowed government to become so powerful and arrogant that it assumes it can force children to accept psychiatric treatment whether parents object or not?
Parents must do everything possible to retain responsibility and control over their children's well-being. There is no end to the bureaucratic appetite to rule every aspect of our lives, including how we raise our children. Forced mental health screening is just the latest of many state usurpations of parental authority: compulsory education laws, politically-correct school curricula, mandatory vaccines, and interference with discipline through phony ``social services'' agencies all represent assaults on families. The political right has now joined the political left in seeking the de facto nationalization of children, and only informed resistance by parents can stop it. The federal government is slowly but surely destroying real families, but it is hardly a benevolent surrogate parent.
from the Wall Street Journal, 2004-Dec-31, p.A3, by Sara Schaefer-Muñoz:
Eli Lilly Documents Are Linked To Prozac Concerns
WASHINGTON -- The Food and Drug Administration is reviewing internal Eli Lilly & Co. documents that suggest the antidepressant Prozac may be linked to violent behavior, according to a U.K. medical journal.
The documents -- part of a 1994 civil suit against Eli Lilly, the maker of Prozac -- had disappeared during the 10-year-old case, the medical journal said. After recently receiving the documents through an anonymous sender, the British Medical Journal gave them to the FDA, according to an article in the Jan. 1 issue of the publication.
A spokeswoman for the FDA declined to comment.
Morry Smulevitz, a communications manager for Eli Lilly, said the company couldn't comment because it hadn't seen copies of the documents cited in the journal article. He said the company is "committed to the public disclosure of all clinical trial data to ensure that health-care professionals and families have all the information they need to make informed decisions about all of Lilly's medicines."
According to the British Medical Journal, the documents appear to suggest a link between Prozac, which is known generically as fluoxetine, and suicide attempts and violence. The documents were being used in the case of Joseph Wesbecker, who in 1989, while being treated with Prozac, went on a shooting spree at his workplace, the Standard Gravure printing plant in Louisville, Ky. He killed eight people before killing himself. The jury found in favor of the drug maker, but Eli Lilly later disclosed it had settled with the plaintiffs during the trial.
One of the internal company documents cited in the article, dated Nov. 8, 1988, and titled "Activation and Sedation in Fluoxetine Clinical Trials," found 38% of patients reported "new activation" -- symptoms of which include agitation and aggressiveness -- compared with 19% of placebo patients. According to the article, the FDA clinical reviewer responsible for approving fluoxetine said he was never given this and other data.
The British Medical Journal event is the latest twist in a debate over possible side effects of antidepressants. In 1990, Martin Teicher, chief of a laboratory at McLean Hospital in Massachusetts, wrote a paper describing six patients who experienced "intense, violent suicidal thoughts" after taking Prozac. But in 1991, an FDA advisory committee -- after examining the Teicher paper as well as evidence from Eli Lilly -- concluded there was "no credible evidence" that Prozac caused suicide.
Why medications that are supposed to treat depression could, in rare cases, have the opposite effect remains a mystery. One theory is that the drugs could give patients more energy before lifting their depression, allowing them to act on a suicidal impulse. Another theory holds that the antidepressants could cause a state of agitation and restlessness. In March, the FDA called for a label warning for several antidepressants that urged doctors to watch patients closely for signs of increasing depression or suidical thoughts.
Another area of intense scrutiny this year has been the effect of antidepressants on young people. This fall, the FDA directed manufacturers to place a "black box warning" -- the strongest it uses -- on antidepressants saying that the drugs increase the risk of suicidal thoughts and behaviors in young people.
from the Washington Post, 2004-Dec-27, p.A11, by Rick Weiss:
'Ecstasy' Use Studied to Ease Fear in Terminally Ill
For some, the diagnosis comes out of the blue. For others, it arrives after a long battle. Either way, the news that death is just a few months away poses a daunting challenge for both doctor and patient.
Drugs can ease pain and reduce anxiety, but what about the more profound issues that come with impending death? The wish to resolve lingering conflicts with family members. The longing to know, before it's too late, what it means to love, or what it meant to live. There is no medicine to address such dis-ease.
Or is there?
This month, in a little-noted administrative decision, the Food and Drug Administration gave the green light to a Harvard proposal to test the benefits of the illegal street drug known as "ecstasy" in patients diagnosed with severe anxiety related to advanced cancer.
The drug, also known as 3,4-methylenedioxymethamphetamine, or MDMA, has been referred to by psychiatrists as an "empathogen," a drug especially good at putting people in touch with their emotions. Some believe it could help patients come to terms with the biggest emotional challenge of all: the end of life.
The FDA's approval puts the study on track to become the first test of a psychedelic substance since 1963 at Harvard, where drug guru Timothy Leary lost his teaching privileges after using students in experiments with LSD and other hallucinogens.
It also marks a milestone for a small but increasingly effective movement favoring a more open-minded attitude toward the therapeutic potential of psychedelic drugs, virtually all of which have been criminalized and disparaged for decades as medically useless.
Already, MDMA is being tested for its ability to reduce symptoms of post-traumatic stress disorder. And two U.S. studies are looking at the usefulness of psilocybin -- the active ingredient in "magic mushrooms" -- in terminally ill cancer patients and in people with obsessive-compulsive disorder.
In the coming year, advocates also hope to submit to the FDA an application to test psilocybin and LSD as treatments for a debilitating syndrome known as cluster headaches.
That would be a fitting birthday present for Albert Hofmann, the chemist who discovered both compounds while working for the Swiss drug company Sandoz and who turns 99 in January, said Rick Doblin, president of the Multidisciplinary Association for Psychedelic Studies. The Sarasota-based nonprofit has organized and funded much of the new research.
Hofmann, who has expressed support for clinical studies such as the one being planned at Harvard, has referred to LSD as his "problem child" -- a reference to his belief that despite its widespread abuse, the mind-altering drug has the potential to help some people.
Although they vary in their chemical structures and specific effects, many psychedelic drugs work on the parts of the brain that regulate serotonin -- the same brain chemical that is the target of many FDA-approved antidepressants. That does not indicate that the drugs are necessarily safe; indeed, they all carry some medical and psychiatric risk.
Yet even scientists who have been vocal about those risks have expressed at least guarded support for the idea that, in the company of a therapist and with proper medical monitoring, moderate doses might benefit some people.
"When taken under adverse circumstances by ill-prepared individuals, there are substantial psychological risks," said Charles Grob, a psychiatrist at Harbor-UCLA Medical Center in Los Angeles. "But when taken in the context of carefully structured and approved research protocols and facilitated by individuals with expertise, adverse effects can be contained to a minimum."
Grob is leading an FDA-approved study in which terminally ill cancer patients are being given psilocybin to see whether it can help them sort through emotional and spiritual issues. He said the patients take a "modest" dose of synthetic psilocybin, equivalent to two or three illicit mushrooms. They spend the next six hours or so in a comfortable setting with a psychiatrist -- talking, thinking and sometimes listening to music with headphones.
"So far they have had very impressive results in terms of amelioration of anxiety, improvement of mood, improved rapport with close family and friends and, interestingly, significant and lasting reductions in pain," Grob said of the first few patients to enroll. "These are extraordinary compounds that seem to have an uncanny ability to reliably induce spiritual or religious experiences when taken in the right conditions."
Promising results have also been reported at the University of Arizona from a 10-person study of psilocybin for obsessive-compulsive disorder, which locks people into repetitive thoughts and actions. And Charleston, S.C., psychiatrist Michael Mithoefer has seen no complications in any of the five patients who have enrolled in his 20-person study of MDMA for victims of violence struggling with post-traumatic stress disorder.
With the FDA's Dec. 17 approval of the Harvard MDMA protocol -- and permission in hand from ethics review boards at Harvard and the nearby Lahey Clinic, where patients will be recruited -- the only remaining hurdle is getting a special license from the Drug Enforcement Administration. A dozen subjects with less than 12 months to live will get either low or moderate doses of MDMA during two sessions a few weeks apart, along with counseling and a variety of psychological tests before and after treatment.
The approach has its doubters.
"Even in antiquity, some groups thought it was especially important to take whatever their local psychedelic was -- including alcohol -- when confronting mortality, whether it's to see into the hereafter, improve spiritual growth or just numb yourself to the reality," said Joanne Lynn, president of the Washington-based Americans for Better Care of the Dying and director of RAND Health, a science and policy research center. But drugs can be disorienting, she said.
"It's sometimes poetic, sometimes majestic, but often mundane work to wrap up one's life," Lynn said. "I think it's unlikely there's a pill that will make that go away."
John Halpern, associate director of substance abuse research in the biological psychiatry lab at Harvard's McLean Hospital, who will lead the MDMA study there, agreed that it is not for everyone. But creating a sense of connection with something greater than oneself "may be helpful" for many facing death, he said.
Halpern emphasized the differences between his study and the freewheeling experiments conducted by Leary in the 1960s.
"This is not about hippy dippy Halpern trying to turn on the world. I'm not looking at this as a magic bullet," he said. "But for a lot of people, the anxiety about death is so tremendous that there is no way to get their arms around the problems that were ongoing in their family. This could be a substantial contribution to the range of palliative care strategies we're trying to develop for people facing their death."
Laura Huxley, widow of the author and metaphysical pioneer Aldous Huxley, said her husband asked for -- and she provided -- a dose of LSD as he lay dying in 1963. "He wanted to be aware," the 93-year-old supporter of the new research said last week. "It's a very important moment."
Leary took a wide array of psychedelics in the weeks leading up to his death from cancer in 1996. Some suspect the drugs clouded rather than sharpened his perceptions, but he died with a positive attitude.
"It's kind of interesting really," he said of dying, talking to a friend in his final days. "You should try it sometime."
from The Japan Times, 2004-Dec-7, by Yumi Wijers-Hasegawa:
EXPERTS GRAPPLE FOR REASONS
Males more prone to commit crimes but whys elude[Opening paragraphs of article skipped. They survey the demographic evidence of male predominance (roughly 4:1) among violent criminals. -AMPP Ed.]
Besides sociological explanations, endocrinologists say the disproportionately high number of male perpetrators of violent crimes is caused to some extent by chemical influences stemming from the physical environment.
According to research by Akira Fukushima, professor emeritus at Sophia University and a criminal psychologist who examined CT brain scans of juvenile criminals, males who display sudden, violent behavior often have brain abnormalities that may have formed in the womb or shortly after birth.
One of his research subjects was the ringleader of a group aged 15 to 18 who abducted and held a high school girl for 41 days in the home of one of the youths in Tokyo's Adachi Ward in 1998, repeatedly raping her and eventually beating her to death, as the parents living in the house did nothing.
Chemical substances are suspected causes of brain abnormalities, particularly endocrine disrupters -- chemicals that mimic the functions of hormones and may trigger, suppress or impair behavioral development and growth of the immune system.
Fukushima's research shows endocrine disrupters can be passed from a mother to an embryo or to a newborn via breast milk, and the substances tend to damage boys' brains more than those of girls. The reasons for this are being investigated.
Another mystery is why male babies are more vulnerable than females to synthetic chemicals such as progestational hormones, which are given to women who repeatedly miscarry. These chemicals can reportedly super-masculinize boys and make them aggressive.
Yoichiro Kuroda, the principal investigator in a project titled the Effects of Endocrine Disrupters on the Developing Brain, under the government's CREST (Core Research for Evolutional Science and Technology) program, believes polychlorinated biphenyls (PCBs) and glufosinate can hamper the development and activity of the brain.
PCBs are "mock hormones" -- endocrine disrupters that cause neural development defects by disrupting gene functions and neural-network formation in kids -- resulting in lower IQ scores and hyperactive tendencies, he said.
Glufosinate, widely used in the U.S. as a super herbicide for herbicide-resistant genetically modified crops, is like a "mock neurotransmitter" that has an aggressive effect on brains, he said.
If an embryo or a baby is exposed to the chemical, it can affect behavior, as it disturbs gene functions that regulate the developing brain, he said.
A decade ago, the late Toshiko Fujii, a one-time professor of medicine at Teikyo University, conducted research in which she found that the main component of this GMO-compatible herbicide had adverse effects on the brains of baby rats.
"Male rats often fight one another, but female rats are peaceful," Kuroda said in explaining Fujii's research.
"But female rats born from mothers that were given high doses of glufosinate became aggressive and started to bite each other -- in some cases until one died. That report sent a chill through me."
He said there is a considerable possibility that fetuses and babies are also affected by the substance, and since it is widely assumed that males are more aggressive to begin with, it is possible they are more affected than females.
"The chemical industry has not been considering this kind of risk on the developing human brain, which is a fragile, fine chemical machine," he said.
Morita of the NPO Empowerment Center said she fears social attitudes toward violence worldwide are changing in a way that places greater weight on the idea of "might makes right."
"Comprehensive, systematic research on the fundamental reasons behind violence and male behavior" is needed to change both individual and social attitudes toward violence, especially when it takes on a criminal nature, she said.
Note regarding the following item: there is a movie, Equilibrium (Kurt Wimmer, 2002), that dramatizes a vision of the future implied by technologies such as the vaccine discussed in the item.
from the Utne Reader, 2004-Aug-19, by Brendan Themes:
The Ultimate Anti-Drug
Biotech corporations are formulating the drug to end all drugs -- a vaccine against the "disease" of drug-induced euphoriaA vaccine with no legitimate medical use might give anyone pause, which is good, because a pause is exactly what is needed with the latest anti-drug scheme, an unprecedented, 1984-esque vaccination against drug-induced pleasure. Pharmaceutical corporations are currently developing "vaccines" that prevent "euphoria" from drugs such as heroin, cocaine, and nicotine, and a government-convened panel of scientists in the UK is considering "a radical scheme:" the vaccination of children against such euphoria. Though these scientists stress the vaccine will be used only on children that are "at risk" for drug abuse, they did not specify what criteria will be used to determine such a fundamentally arbitrary designation.
Vaccines work on the principal that the diseases they prevent are patently undesirable: no one in their right mind would actually want to contract polio, meningitis, or tetanus. Moreover, vaccines are mainly used against contagious diseases whose spread could be significantly checked by wholesale vaccination. The logic of vaccination is simply to keep everyone safe from something that nobody wants. Anti-drug vaccination, however, differs from this very legitimate medical practice in several crucial ways. First of all, some people, even knowing the risks involved, might want to experience the euphoria that addictive drugs can provide. The undesirability of recreational drugs effects, then, cannot be assumed for the vaccine's recipient. Moreover, these recreational drugs act on the very same neurological mechanisms that regulate natural feelings of euphoria, meaning that anti-drug vaccines may easily remove a person's capability to experience any kind of high, drug-induced or otherwise. The alterations made to the brain by such vaccines would be irreversible, posing a serious threat against the recipient's individual freedoms and mental health. Additionally, heroin belongs to the opiate family, which is used for legitimate pain-relief purposes. A vaccine that blocks the effects of heroin may also block the effects of prescribed pain-killers, providing doctors and patients with fewer resources in the fight against pain.
Drug addiction is certainly a problem, and informed adults have the right to take an anti-euphoria vaccine if they so desire. But the widespread encouragement of such vaccines goes well beyond issues of public health; it extends into the realm of outright mind control. Moreover, there are already numerous legitimate resources for the treatment of drug addiction, many of which could benefit from more funding and more attention. It has long been the stuff of dystopian science fiction, but a society in which pleasure is government-regulated is now becoming alarmingly more plausible.
from the Boston Globe, 2004-Jul-2, by Jessica E. Vascellaro:
Kennedy ties up drug bill
WASHINGTON -- A bill banning schools from coercing parents into putting their children on psychotropic drugs, passed with near-universal support in the House, is being tied up in a Senate committee by Senator Edward M. Kennedy, who contends it requires more study.
Supporters of the bill, which sailed through the House 425 to 1, said it will help prevent an epidemic of children on drugs like Ritalin and Prozac, and that Kennedy is being influenced by his longstanding ties to health and pharmaceutical associations, which contend the bill will discourage the diagnosis of mental illnesses that could be easily treated.
The Child Medication Safety Act has sat in the Senate Committee on Health, Education, Labor, and Pensions all year. Proponents say Senate leaders never told them why the bill had not come up for a vote, but this week Kennedy, who is the committee's ranking member, confirmed to the Globe that he is seeking to delay its consideration.
''This is a complex question that demands a serious study," Kennedy, Democrat of Massachusetts, said in a statement. ''Until we know the extent of the problem, any further action is unwarranted."
The bill was prompted by complaints from parents that school officials were threatening to keep their children out of class unless they took behavior-altering medication. About 11 million schoolchildren and adolescents took prescription drugs for mental health in 2002, and the number is rising.
The bill denies federal funds to schools that fail to implement a policy to ''protect children and their parents from being coerced into administering a controlled substance in order to attend school, and for other purposes," such as extracurricular activities.
Among the drugs it targets are behavioral drugs such as Adderall and Ritalin and antidepressants such as Prozac and Paxil. Prozac is the only antidepressant approved by the Federal Drug Administration for people under 18, and the FDA is expected this summer to release a study on whether antidepressants increase the risk of suicide.
If the bill fails to make it onto a tight Senate scheduled squeezed by two national conventions and an August recess, it would have to return to the House next year.
Representative Max Burns, Republican of Georgia and sponsor of the bill in the House, said that he will meet with the House leadership next week to explore ways to pressure the Senate to bring the bill to the floor.
''It's hard to be optimistic because it has been there for over a year," he said. ''[But] we need to find a way to shake this bill loose."
Kennedy's office said that it is important to separate the roles of schools and doctors but that any legislation limiting schools' ability to push for treatment of children with mental-health issues should wait until further study of the benefits and detriments of psychiatric drugs.
Libby Nealis, director of public policy for the National Association of School Psychologists, said that her organization has been fighting the law and is confident that it will not pass.
Nealis called the bill a ''knee-jerk reaction to anecdotal stories" and said it would deter schools from discussing crucial mental health information with parents.
The battle over schools' role in recommending psychiatric drugs has been fought on the state level for years. Nine states have already passed or introduced legislation prohibiting schools from threatening to limit children's participation in classes or activities if they do not go on medication.
Personal stories have sparked political activism. Sheila Matthews of New Canaan, Conn., said she was told by a school psychologist that her son had attention deficit disorder and that psychiatric drugs was his only alternative. In response, she helped found Parents for Label & Drug Free Education, an organization advocating parents' rights to refuse medical treatment for their children. Ablechild now has almost 200 members and has launched a petition supporting the bill.
Matthews said that she has frequently contacted Kennedy's office about the bill and believes his appeal for research is a cover for his support for health and pharmaceutical groups. Since 1999, Kennedy has received $171,601 in campaign contributions from health professionals and $97,050 from the pharmaceutical and health-product industry, according to the Center for Responsive Politics.
But Dr. Harold Koplewicz, director of the New York University Child Study Center, said Kennedy's opposition is warranted: The bill would undermine the detection of children with mental health problems, a pressing concern when 80 percent of cases go undetected.
''There is no medicine in all of pediatrics that has been tested as many times as Ritalin," he said. ''We have definitive evidence that it's an effective treatment."
The greater danger comes not from overmedication but from failing to detect mental problems in children. ''We are doing a horrible job, and this bill will encourage less identification," he said. ''This bill is offensive."
from the Associated Press, 2004-Jul-24, by Bruce Shipkowski:
Maker of Schizophrenia Medicine Clarifies Risks
TRENTON, N.J., July 24 -- The maker of a popular medicine for schizophrenia has notified doctors that it had minimized potentially fatal safety risks and had made misleading claims about the drug in promotional materials.
Janssen Pharmaceutica Products LP sent a two-page letter to health care professionals to clarify the risks of Risperdal, Carol Goodrich, a spokeswoman for the Johnson & Johnson subsidiary, said on Saturday.
The letter stems from a directive issued last year by the Food and Drug Administration, which told several makers of anti-psychotic drugs to update their product labels.
Janssen complied in November 2003, but the FDA determined that the company's promotional materials still minimized the risk of strokes, diabetes and other potentially fatal complications. The agency also said Janssen made misleading claims that the medication was safer in treating mental illness than similar drugs.
The Miami Herald reported on Saturday that several boys in Florida developed lactating breasts after taking Risperdal.
The drug, which is prescribed to more than 10 million people worldwide, was cited in a federal lawsuit filed earlier this month by a doctor who contends that children have been harmed and even killed by the misuse of drugs that he blames on the aggressive marketing by drug manufacturers.
"The FDA did not think we had [initially] provided enough information, so that is why further notification was done," Goodrich said.
Risperdal is the leading drug used to combat schizophrenia and other types of psychotic disorders, bringing Janssen about $2.1 billion in annual sales. The drug was first marketed about eight years ago.
from the British Medical Journal, 2003-Dec-20, by Thomas Szasz:
The psychiatric protection order for the "battered mental patient"
Thomas Szasz, emeritus professor of psychiatry1
1 Department of Psychiatry, Upstate Medical University, State University of New York, Syracuse, NY 13210, USA
Correspondence to: 4739 Limberlost Lane, Manlius, New York, NY 13104, USA tszasz@aol.com
Psychiatric patients are routinely treated against their will. Legally enforceable psychiatric protection orders would protect patients from coercive psychiatric interventions
The avowed desires of patients and doctors conflict more often in psychiatry than in any other branch of medicine. People known as "mental patients" are routinely subjected to "diagnostic" and "therapeutic" interventions against their will. Many such people see being committed (sectioned) and treated against their will as a personal violation—a "psychiatric abuse"—and want to protect themselves from future involuntary psychiatric hospitalisation and treatment. At present former psychiatric patients, even when legally competent, have no means to defend themselves from such a contingency.
Mental health laws—reflecting the point of view of psychiatrists and society—protect (or are said to protect) mentally ill patients from the dangers they pose, because of their illness, to themselves and others. Many mental patients view—and have always viewed—psychiatrists as posing a danger to them. Respect for the self defined interests of such patients requires that the law protect them from further unwanted psychiatric interventions.
The psychiatric protection order
Courts recognise the validity of "psychiatric wills" (psychiatric advance directives) only when they prospectively authorise treatment; courts do not recognise them when the "psychiatric testator" rejects psychiatric "help."1 To remedy this defect, especially when patients are released into the community after a period of involuntary treatment for mental illness, I propose a new legal safeguard: the psychiatric protection order. Such an order, similar to the protection order used in domestic conflicts, would make it a criminal offence to impose involuntary psychiatric interventions on people protected by the order.
In free societies only psychiatric patients are routinely treated against their will. (Public health laws explicitly serve the interests of the public, not the therapeutic needs of particular persons.) Competent patients with uraemia are not treated against their will and can use a "medical will" to protect themselves from undergoing dialysis. If psychiatry were like any other medical specialty competent patients with schizophrenia would not be treated against their will and could protect themselves with a psychiatric will from being treated.2 But they cannot: neither psychiatrists nor the courts recognise the validity of the psychiatric will. Mental health laws trump psychiatric advance directives.
Not by coincidence the history of psychiatric interventions forcibly imposed on patients is long and depressing. In a letter he wrote to me in 1988 Karl Menninger summarised the history of psychiatry with these sad words: "Added to the beatings and chainings and baths and massages came treatments that were even more ferocious: gouging out parts of the brain, producing convulsions with electric shocks, starving, surgical removal of teeth, tonsils, uteri, etc."3 To this list Menninger might have added the use of straitjackets, tranquillising chairs, confining chairs, cold baths, emetics, purgatives, Metrazol shock, inhalations of carbon dioxide, and neuroleptic drugs.
Freedom from enforced psychiatry
From the beginnings of the specialty, psychiatric patients have had no opportunity to free themselves from their protective-oppressive relationship with psychiatrists. In this brief paper I focus on a single issue: the desire of some psychiatric patients to free themselves, once and for all, from what they regard as an abusive relationship with the psychiatric profession. The Anglo-American legal system has always denied this option to these patients. This denial resembles the denial of slaves' opportunity, in a slave society, to leave their master; of the wife's opportunity, in traditional marriage, to leave her husband; and of citizens' opportunity, in the modern totalitarian state, to leave their country and its rulers. These people may enjoy all manner of benefits and privileges, but they cannot, without the permission of the repressive authority, leave the system for good.
The English and American legal systems maintain the fiction that the relationship between a family member responsible for committing a "loved one" and the incarcerated individual—as well as that between psychiatrists and involuntarily detained patients—is always one of "care" and "treatment." It can be otherwise only in "unfree," "totalitarian" countries; such was the case in the Soviet Union and is now the case in China. That self serving rationalisation is at the core of the problem facing us.
Anglo-American law assumes, as a matter of fact, that the relationship between a person and a legal agent of the state is adversarial. Justice Potter Stewart of the US Supreme Court famously remarked: "To force a lawyer on a defendant can only lead him to believe that the law contrives against him."4 The law student is taught the duties and roles of both prosecuting attorney and defence attorney. Both jobs are legitimate and proper.
In contrast Anglo-American psychiatry assumes, as a matter of law and psychiatry, that the relationship between a person and a psychiatric agent of the state is therapeutic. Forcing psychiatrists on mental patients is routine practice, and the patient who protests is likely to be given a diagnosis of paranoia. The medical student is taught only the duties and roles of the psychiatrist making diagnoses and providing treatment. The psychiatrist has no other legitimate duties or roles; only the job of the coercive psychiatrist is legitimate and proper. The psychiatrist who tries to help the coerced "patient" to reject the patient role is ostracised, or worse.
The gatekeepers: the family
We are hypocrites if we ignore who the parties are that support the enactment of mental health laws and deny patients the option of rejecting psychiatric services. Everywhere the supporters of mental health laws are psychiatrists and the relatives of so called mental patients. In the United States the relatives are now also in control of a powerful lobby, the National Alliance of the Mentally Ill, that legitimises the abuse of family members (mainly adult children) as the care of "loved ones." Organisations of former psychiatric patients—who call themselves "victims of psychiatric abuse"—are not among the parties clamouring for more psychiatric coercions or "services."
People subjected to involuntary psychiatric hospitalisation and treatment often feel victimised in much the same way as do wives (less often husbands) who are abused by their spouses. Until recent times women had no effective protection from their abusers, whom the law defined as their protectors. In many parts of the world women are still in that situation. Similarly, in the days of Dickens children were not protected from abuse by their parents.
We in the West now recognise that the family is not just the primary locus of affection, care, and security for its members: it is all too often also the source of the most insidious danger to their physical and spiritual wellbeing. We acknowledge this unhappy fact and accordingly speak of "battered" children, spouses, parents, and grandparents. In the conflicts that often arise between adults living together as married couples or lovers, legal separation, divorce, and the so called protection order exemplify the legal system's acknowledgment of the problem and the need for legally sanctioned and enforceable mechanisms to remedy it. A protection order mandates physical separation between the parties and makes it a criminal offence for the denominated threatener to impose their mere presence on the threatened person. I suggest that we similarly acknowledge the unhappy fact of "battered mental patients" and the need to protect them from their batterers. In the absence of a protection order the power relations between psychiatrist and involuntary patient will continue to generate "psychiatric abuse," rationalised as protection and treatment. Indeed, it is precisely because psychiatrists reject advance psychiatric directives authorising abstinence from further treatment (a request that non-psychiatric doctors accept) that makes a legal mechanism such as the psychiatric protection order necessary.
Legalise "divorce" between psychiatrists and patients
Psychiatrists object to efforts to treat patients as responsible moral agents and cite the prevention of harm as a basic social mandate of psychiatry. Typically, they argue that people who would have committed suicide but for their involuntary detention would thereby have been deprived of the option of changing their minds once they had recovered from depression. A similar argument could be made against last wills or, indeed, any decision that profoundly affects one's future, such as marriage or having children. The standard psychiatric justification for "therapeutic" coercion either ignores the familiar conflict between liberty and security or, more often, equates (involuntary) psychiatric treatment with ("true") freedom.5 Elsewhere I have examined and discussed this and related problems in great detail and proposed reconciling psychiatry with liberty.6 7
Human memory is notoriously short and selective. We have forgotten that until recently—even in the United Kingdom and the United States—people could not divorce. In some countries women still cannot divorce their husbands. For a long time the law, supported by religion, ranked the sanctity of marriage more highly than the need to protect the wife from her abusive husband and so prohibited divorce. To make matters worse, the law deprived her of her voice.
The history of the "marriage" between mad people and their doctors shows a similar pattern. Since the beginning of mad doctoring in the 18th century, the law, supported by medicine (psychiatry), has ranked the "health" of mad people more highly than the need to protect them from the abusive psychiatrist and prohibited them from divorcing their psychiatrist. This is still the case. (The psychiatrist is free to leave the patient, typically by forcibly "marrying" the patient to another psychiatrist.) And again the law deprived, and still deprives, the victim of his or her voice. Only writers were, and are, willing to face the realities of psychiatry, illustrated for example by James Thurber's miniature masterpiece, The Unicorn in the Garden.8
Summary points
Many psychiatric patients are denied the right to refuse treatment they don't want
"Psychiatric wills" are recognised by courts only when patients use them to authorise treatment, not when they use them to reject the possibility of treatment
Like protection orders that protect wives from abusive husbands, "psychiatric protection orders" would protect patients from coercive psychiatric interventions
Doctors, politicians, and journalists assert that mental illnesses are real diseases and that psychiatrists are regular doctors. If that were true there would be no need for psychiatric protective orders.
Competing interests: None declared.
References
- Szasz T. Liberation by oppression: a comparative study of slavery and psychiatry. New Brunswick, NJ: Transaction, 2002.
- Szasz T. The psychiatric will: a new mechanism for protecting persons against "psychosis" and psychiatry. Amer Psychol 1982;37: 762-70.[ISI]
- Thurber J. The unicorn in the garden [1940]. In: Fables for our time. New York: Harper & Row, 1968.
from The Guardian, 2004-Jan-31, by Lauren Slater:
Into the cuckoo's nest
Thirty years ago psychiatry was rocked by the revelation that nine sane volunteers had faked hearing voices and fooled thier way on to locked wards. Has diagnosis improved since? Psychologist Lauren Slater repeats the experiment
excerpted from Opening Skinner's Box by Lauren Slater
In 1972, David Rosenhan, a newly minted psychologist with a joint degree in law, called eight friends and said something like, "Are you busy next month? Would you have time to fake your way into a mental hospital and see what happens?"
Surprisingly, so the story goes, all eight were not busy the next month, and all eight - three psychologists, one graduate student, a paediatrician, a psychiatrist, a painter and a housewife - agreed to take the time to try this treacherous trick, along with Rosenhan himself, who could hardly wait to get started. Pseudopatient Martin Seligman says, "David just called me up and said, 'Are you busy next October?' "and I said, 'Of course I'm busy next October', but by the end of the conversation he had me laughing and saying yes."
First, there was training. Rosenhan instructed his confederates very, very carefully. Five days prior to the chosen date, they were to stop shaving, showering and brushing their teeth. And then they were, on the appointed date, to disperse to different parts of the country, east to west, and present themselves at various psychiatric emergency rooms. Some of the hospitals Rosenhan had chosen were posh and built of white brick; others were state-run gigs with urine-scented corridors and graffiti-scratched walls. The pseudopatients were to present themselves and say words along these lines: "I am hearing a voice. It is saying thud." Rosenhan specifically chose this complaint because nowhere in psychiatric literature are there any reports of any person hearing a voice that contains such obvious cartoon angst.
Upon further questioning, the eight pseudopatients were to answer honestly, save for name and occupation. They were to feign no other symptoms. Once on the ward, if admitted, they were immediately to say that the voice had disappeared and that they now felt fine. Rosenhan then gave his confederates a lesson in managing medication, how to avoid swallowing it by slipping it under the tongue, so it could later be blurted back to the toilet bowl.
The pseudopatients practised for a few days. Much of the practice was, admittedly, passive, letting entropy and odour wend their way in. Their hair grew out and clumped. Their breath got a greenish tinge.
The day that Rosenhan departed for one of Pennsylvania's state hospitals was brilliant. The sky was a frosty, pre-winter blue, the trees like brushes dipped in paint, turned upward and wet with colour. Rosenhan pulled into the parking lot. The psychiatric hospital had gothic buildings, every window caged. Orderlies in pale blue smocks floated on the grounds.
Once in the admissions unit, Rosenhan was led to a small white room. "What is the problem?" a psychiatrist asked.
"I'm hearing a voice," Rosenhan said, and then he said nothing else.
"And what is the voice saying?" the psychiatrist questioned, falling, unbeknown to him, straight into Rosenhan's rabbit hole.
"Thud," Rosenhan said, smugly, I imagine.
"Thud?" the psychiatrist asked. "Did you say thud?"
"Thud," Rosenhan said again.
The psychiatrist probably scratched his head. He could have been confused, bemused. The problem is, we don't know what exactly happened in any of the admitting rooms because Rosenhan has neglected to give any detailed reports. We do know that each pseudopatient, Rosenhan included, said that the voice was of the same sex as he or she, that it had been bothering the pseudopatient to some extent, that he or she had come to the unit on the advice of friends who had heard that "this was a good hospital".
Rosenhan was led down a long hallway. Across the country, the eight other pseudopatients were also being admitted. Rosenhan must have been scared, exhilarated. He was a journalist, a scientist at the apex, putting his body on the line for knowledge. He was taken to a room and told to undress.
Someone inserted a thermometer into his mouth, wrapped a black cuff around his arm, pressed on his pulse and read it: normal, normal, normal. Everything was normal, but no one seemed to see. He said, "You know, the voice isn't bothering me any more", and the doctors just smiled.
"When will I get out?" we can imagine Rosenhan asked, his voice perhaps rising now, some panic here - what had he done, my God.
"When you are well," a doctor answered, or something to this effect. But he was well: 110 over 80, a pulse of 72, a temperature that hovered in the mid-zone of moderate, homeostatic, a machine well greased. It didn't matter. He was diagnosed with paranoid schizophrenia and kept for many days.
There was a glassed-in office, which Rosenhan came to call the "bull pen". Inside, nurses flurried about, busy as a blizzard, pouring cherry-red medicines into plastic cups. Rosenhan cooperated absolutely. He "took" the pills three times a day and then rushed to the bathroom to spit them back out. He comments on how all the other patients were doing this, too, and how no one much cared so long as they were well behaved.
Psychiatric patients are "invisible ... unworthy of account", Rosenhan writes. He describes a nurse coming into the dayroom, unbuttoning her shirt and fixing her bra. "One did not have the sense that she was being seductive," Rosenhan reports. "Rather, she didn't notice us." He saw patients being beaten. He describes how one patient was severely punished simply because he said to a nurse, "I like you." Rosenhan does not describe the nights, which must have been long, lying in that narrow bed while orderlies with flashlights did 15-minute checks. Did he miss his wife, Molly? Did he wonder how his two toddlers were getting on? That world must have seemed so far away, even though it was no more than 100 miles; this is what science teaches us.
Rosenhan and his confederates were given some therapy, and when they told of the joys, satisfactions and disappointments of an ordinary life - remember, they were making nothing up save the original complaint - all found that their pasts were reconfigured to fit the diagnosis: "This white 39-year-old male ... manifests a long history of considerable ambivalence in close relationships ... affective stability is absent ... and while he says he has several good friends, one senses considerable ambivalence in those relationships."
In 1973, Rosenhan wrote in Science, one of the field's most prestigious journals, "Clearly, the meaning ascribed to his verbalisations ... was determined by the diagnosis, schizophrenia. An entirely different meaning would have been ascribed if it were known that the man was 'normal'."
The strange thing was, the other patients seemed to know that Rosenhan was normal, even while the doctors did not. One young man, coming up to Rosenhan in the dayroom, said "You're not crazy. You're a journalist or a professor." Another said, "You're checking up on the hospital."
Rosenhan followed all orders while in hospital, asked for privileges, helped other patients to deal with their problems, offered legal advice, probably played his fair share of ping pong, and took copious notes, which the staff labelled as "writing behaviour" and saw as part of his paranoid schizophrenic diagnosis. And then one day, for a reason as arbitrary as his admission, he was discharged.
Rosenhan's paper describing his findings, On Being Sane In Insane Places, was published in Science, where it burst like a bomb on the world of psychiatry. Early in the article, Rosenhan lays it on the line. He claims that diagnosis is not carried within the person, but within the context, and that any diagnostic process that lends itself so readily to massive errors of this sort cannot be a very reliable one. The paper generated a flood of fluorescent missives:
Most physicians do not assume that patients who seek help are liars; they can therefore, of course, be misled ... It would be quite possible to conduct a study in which patients trained to simulate histories of myocardial infarction would receive treatment on the basis of history alone (since a negative electrocardiogram is not diagnostic) but it would be preposterous to conclude from such a study that physical illness does not exist, that medical diagnoses are fallacious labels, and that "illness" and "health" reside only in doctors' heads.
The pseudopatients did not behave normally in the hospital. Had their behaviour been normal, they would have walked to the nurses' station and said, "Look, I am a normal person who tried to see if I could get into the hospital by behaving in a crazy way or saying crazy things. It worked and I was admitted to the hospital, but now I would like to be discharged from the hospital."
And my favourite:
If I were to drink a quart of blood and, concealing what I had done, come to the emergency room of any hospital vomiting blood, the behaviour of the staff would be quite predictable. If they labelled and treated me as having a peptic ulcer, I doubt I could argue convincingly that medical science does not know how to diagnose that condition.
Robert Spitzer, one of the 20th century's most prominent psychiatrists and a severe critic of Rosenhan, wrote a 1975 article in the Journal Of Abnormal Psychology, in response to Rosenhan's findings. "Some foods taste delicious but leave a bad aftertaste. So it is with Rosenhan's study," he said. In a footnote, he writes, "Rosenhan has not identified the hospitals used in this study because of his concern with confidentiality and the potential for ad hominem attack. However, this does make it impossible for anyone at these hospitals to corroborate or challenge his account of how the pseudopatients acted and how they were perceived." Spitzer later says, in a phone conversation with me, "And this whole business of thud. Rosenhan uses that as proof of how ridiculous psychiatrists are because there had never been any reports before of 'thud' as an auditory hallucination. So what? As I wrote, once I had a patient whose chief presenting complaint was a voice saying, 'It's OK, it's OK.' I know of no such report in the literature. This doesn't mean there isn't real distress."
I don't want to challenge Spitzer, but a voice saying, "It's OK" sounds pretty OK to me.
Spitzer pauses. "So how is David Rosenhan?" he finally asks.
"Actually, not so good," I say. "He's lost his wife to cancer, his daughter Nina in a car crash. He's had several strokes and is now suffering from a disease they can't quite diagnose. He's paralysed."
That Spitzer doesn't say, or much sound, sorry when he hears this reveals the depths to which Rosenhan's study is still hated in the field, even after 30 years. "That's what you get," he says, "for conducting such an inquiry."
Spitzer wrote two entire papers devoted to dismantling Rosenhan's findings, totalling 33 pages of dense, extremely cogent prose. "Did you read my responses to Rosenhan?" he asks. "They're pretty brilliant, aren't they?"
Spitzer argues many, many things. At root, he is arguing for the validity of psychiatry, and its diagnostic practices, as sound scientific, medical procedures. "According to Rosenhan," he writes, "all the patients were diagnosed at discharge as 'in remission'. A remission is clear. It means without signs of illness. Thus all of the psychiatrists apparently recognised that all of the pseudopatients were, to use Rosenhan's term, 'sane'."
Reading Spitzer's articles and the letters following Rosenhan's publication, I find myself swayed, as in a tennis match. On the one hand, the study was flawed. If I drank a quart of blood and if I vomited it in the ER ... which must mean psychiatry really is no different from its supposedly more medical kin. But wait a minute - in the blood scenario, I wouldn't be held for 52 days, and besides, blood is not thud .
For me, psychiatric illness is absolutely real. Just two years after Rosenhan presented his findings, I, a mawkish 14-year-old, entered an east coast psychiatric institution with all sorts of symptoms. I saw the glassed-in nurses' station, the candy stripers pushing chrome carts, the lunatic manic with sweat runnelling down his face, the woman named Rosa, found in the bathroom, neck bunched in a noose. I saw some things.
In Rosenhan's study, the staff beat patients and woke them with, "You motherfucking son of a bitch", and this in private as well as public facilities. I was in a semi-public facility and no staff ever swore at me. It is true that the psychiatrist in charge of my case spent very little time with me, but actually I remember him in crisp detail, because I liked him so much. His name was Dr Su, and he had a little broom of a moustache, and for some odd reason he often had a baseball mitt with him. We used to meet in a small office and he would lean forward, look at the cuts on my arms - like little lips these cuts were, because I kept them fresh and open with stolen shards. He would look at the cuts and say with true feelings, "It's such a shame, Lauren. It's such a shame you have to hurt yourself."
Rosenhan's experiment, like, perhaps, any piece of good art, is prismatic, powerful and flawed. You can argue with it, as in all of the above. Nevertheless, there are, it seems to me, some essential truths in his findings. Labels do determine how we view what we view. Psychiatry is a fledgling science, if it is a science at all, because to this day it lacks firm knowledge of practically any physiological basis for mental illness, and science is based on the body, on measurable matter. Psychiatrists do jump to judgment - not all of them, but a lot of them - and they can be pompous, probably because they're insecure. In any case, Rosenhan's study did not help this insecurity. The experiment was greeted with outrage, and then, at last, a challenge. "All right," said one hospital, its institutional chest all puffed up. "You think we don't know what we're doing? Here's a dare. In the next three months, send as many pseudopatients as you like to our emergency room and we'll detect them. Go ahead."
Now, Rosenhan liked a fight. So he said, "Sure." He said in the next three months he would send an undisclosed number of pseudopatients to this particular hospital, and the staff were to judge, in a sort of experimental reversal, not who was insane, but who was sane. One month passed. Two months passed. At the end of three months, the hospital staff reported to Rosenhan that they had detected, with a high degree of confidence, 41 of Rosenhan's pseudopatients. Rosenhan had, in fact, sent none. Case closed. Match over. Psychiatry hung its head.
Since Rosenhan, psychiatry has tried admirably to locate the physiological origins of mental disease - mostly in vain. Much of the current research is a knowing or unknowing response to Rosenhan's challenge and to the inherent anxieties it raises in "soft" scientists. Spitzer says, "I'm telling you, with the new diagnostic system in place, Rosenhan's experiment could never happen today. [In the 1970s, Spitzer and a group of colleagues completely revised the Diagnostic and Statistical Manual on Mental Disorders, or DSM for short, tightening the diagnostic criteria, taking away from it signs of subjectivity and psychobabble.] You would not be admitted and in the ER they would diagnose you as deferred." (Deferred, by the way, is a special category that allows clinicians to do just that, officially put off a diagnosis due to lack of information.) "No," repeats Spitzer, "that experiment could never be successfully repeated. Not in this day and age."
I decide to try.
Many things are the same. The sky is a poignant blue. The trees are turning, each scarlet leaf like a little hand falling down on our green autumn lawn.
"You're what?" my husband says to me.
"I'm going to try it," I say. "Repeat the experiment exactly as Rosenhan and his confederates did it, and see if I get admitted."
"Excuse me," he says, "don't you think you have your family to consider?"
"It'll never work," I say, thinking of Spitzer. "I'll be back in an hour."
"And suppose you're not?"
"Come get me," I say.
I do my preparations. I don't shower or shave for five days. I call a friend with a renegade streak and ask if I can use her name in lieu of my own, which might be recognised. The plan is to use her name and then have her, later, with her licence, get the records so that I can see just what has been said. This friend, Lucy, says yes. She should probably be locked up. "This is so funny," she says.
I spend a considerable portion of time practising in front of my mirror. "Thud," I say, and crack up, no pun intended. "I'm, I'm here ..." - and now I feign a worried expression, crinkled crow's-feet at my eyes - "I'm here because I'm hearing a voice and it's saying thud", and then, each time, standing in front of this full-length mirror, smelly and wearing a floppy black velvet hat, I start to laugh. If I laugh, I'll obviously blow my cover. Then again, if I don't laugh, and if I tell the whole truth about my history save for this one little symptom, as Rosenhan and company did in the original experiment, well, then I might really go the way of the ward. There is one significant difference in my re-test setup. None of Rosenhan's folks had any psychiatric history. I, however, have a formidable psychiatric history that includes lots of lock-ups, although, really, I'm fine now.
I kiss the baby goodbye. I kiss my husband goodbye. I haven't showered for five days. My teeth are smeary. I am wearing paint-splattered black leggings and a T-shirt that says, "I hate my generation."
"How do I look?" I say.
"The same," my husband says.
I drive there. I have chosen a hospital miles out of town with an emergency room set up specifically for psychiatric issues. I have also chosen a hospital with an excellent reputation, so factor that in. It is on a hill. It has a winding drive. In order to enter the psych ER, you must stand in front of a formidable bank of doors in a bustling white hallway and press a buzzer, at which point a voice over an intercom calls out, "Can I help you?"
I say, "Yes."
The doors open. They appear to part without any evidence of human effort, to reveal a trio of policemen sitting in the shadows, their silver badges tossing light. On a TV mounted high in one corner, someone shoots a horse - bang! - and the bullet explodes a star in the fine forehead, blood on black fur.
"Name?" a nurse says, bringing me to a registration desk.
"Lucy Schellman," I say.
"And how do you spell Schellman?" she asks.
I'm a terrible speller and I hadn't counted on this little hurdle; I do my best. "S-H-E-L-M-E-N," I say.
The nurse writes it down, studying the idiosyncratic spelling. "That's an odd name," she says. "It's plural."
"Well," I say, "it was an Ellis Island thing. It happened at Ellis Island."
She looks up at me and then scribbles something I cannot see on the paper. I'm worried she's going to think I have a delusion that involves Ellis Island so I say, "I've never been to Ellis Island - it's a family story."
"Race," she says.
"Jewish," I say. I wonder if I should have said protestant. The fact is, I am Jewish, but I'm also paranoid - not as a general rule, of course, but at this particular point - and I don't want the Jewish thing used against me. Of what am I so scared? No one can commit me. Since Rosenhan's study - in part because of Rosenhan's study - commitment laws are far more stringent, and so long as I deny homicidal or suicidal urges, I'm a free woman. I am in control.
I don't feel in control, though. At any moment someone might recognise my gig. As soon as I say, "Thud", any well-read psychiatrist could say, "You're a trickster. I know the experiment." I pray the psychiatrists are not well-read.
This emergency room is eerily familiar to me. I have been in many that were just like this, but that was a long time ago. Still, the smells bring me back: sweat and fresh cotton and blankness. I feel no sense of triumph, just sadness, for there is real suffering somewhere here.
I am brought to a small room that has a stretcher with black straps attached to it. "Sit," the ER nurse tells me, and then in walks a man, closing the door behind him - click click.
"I'm Mr Graver," he says, "a clinical nurse specialist, and I'm going to take your pulse."
A hundred per minute. "That's a little fast," says Mr Graver. "I'd say it's on the very high side of normal. But, of course, who wouldn't be nervous, given where you are and all. I mean, it's a psych ER. That would make anyone nervous." And he shoots me a kind, soft smile. "Say," he says, "can I offer you a glass of spring water?" And before I can answer, he's jumped up, disappeared, only to re-emerge with a tall, flared glass, almost elegant, and a single lemon slice of the palest white-yellow. The lemon slice seems suddenly so beautiful to me, the way it flirts with colour but cannot quite assume it.
He hands me the glass. This, also, I had not expected - such kindness, such service. Rosenhan writes about being dehumanised. So far, if anyone's dehumanised here, it's Mr Graver, who is fast becoming my own personal butler.
I take a sip. "Thank you so much," I say.
"Anything else I can get you? Are you hungry?"
"Oh no no," I say. "I'm fine really."
"Well, no offence but you're obviously not fine," says Mr Graver, "or you wouldn't be here. So what's going on, Lucy?" he asks.
"I'm hearing a voice," I say.
He writes that down on his intake sheet, nods knowingly. "And the voice is saying?"
"Thud."
The knowing nod stops. "Thud?" he says. This, after all, is not what psychotic voices usually report. They usually send ominous messages about stars and snakes and tiny hidden microphones.
"Thud," I repeat.
"Is that it ?" he says.
"That's it," I say.
"Did the voice start slowly, or did it just come on?"
"Out of the blue," I say, and I picture, for some reason, a plane falling out of the blue, its nose diving downward, someone screaming. I am starting, actually, to feel a little crazy. How hard it is to separate role from reality, a phenomenon social psychologists have long pointed out to us.
"So when did the voice come on?" Mr Graver asks.
"Three weeks ago," I say, just as Rosenhan and his confederates reported.
He asks me whether I am eating and sleeping OK, whether there have been any precipitating life stressors, whether I have a history of trauma. I answer a definitive no to all of these things: my appetite is good, sleep normal, my work proceeds as usual.
"Are you sure?" he says.
"Well," I say, "as far as the trauma goes, I guess when I was in the third grade, a neighbour named Mr Blauer fell into his pool and died. I didn't see it, but it was sort of traumatic to hear about."
Mr Graver chews on his pen. He's thinking hard.
"Thud," Mr Graver says. "Your neighbour went thud into his pool. You're hearing 'thud'. We might be looking at post-traumatic stress disorder. The hallucination could be your memory trying to process the trauma."
"But it really wasn't a big deal," I say. "It was just ..."
"I would say," he says, and his voice is gaining confidence now, "that having a neighbour drown constitutes a traumatic loss. I'm going to get the psychiatrist to evaluate you, but I really suspect that we're looking at post-traumatic stress disorder with a rule out of organic brain damage, but the brain damage is way far down the line. I wouldn't worry about that."
He disappears. He is going to get the psychiatrist. My pulse goes from 100 beats a minute to 150 at least - I can feel it - for surely the psychiatrist will see right through me or, worse, he will wind up being someone I know from high school, and how will I explain myself?
The psychiatrist enters the little locked room. He is wearing baby-blue scrubs and has no chin. He looks hard at me. I look away. He sits down, and then he sighs. "So you're hearing 'thud'," he says, scratching the chinless chin. "What can we do for you about that?"
"I came here because I'd like the voice to go away."
"Is the voice coming from inside or outside your head?" he asks.
"Outside."
"Does it ever say anything other than thud, like, maybe, kill someone, or yourself?"
"I don't want to kill anyone or myself," I say.
"What day of the week is it?" he asks.
Now, here I run into another problem. It's actually a holiday weekend, so my sense of time is a little thrown off. Sense of time is one way psychiatrists judge whether a person is normal or abnormal. "It's Saturday," I say, I pray.
He writes something down. "OK," he says. "So you're experiencing this voice in the absence of any other psychiatric symptoms."
"Do I have post-traumatic stress disorder," I ask, "like Mr Graver suggested?"
"There's a lot we don't know in psychiatry," the doctor says, and suddenly he looks so sad. He rubs the bridge of his nose, his eyes momentarily closed. With his head bowed, I can see a small bald spot on the dome of his scalp, and I want to say, "Hey. It's OK. There's a lot we don't know in the world." But instead I say nothing and the psychiatrist looks sad, and baffled, and then says, "But the voice is bothering you."
"Sort of, yeah."
"I'm going to give you an antipsychotic," he says, and as soon as he says this the sadness goes away. His voice assumes an authoritative tone; there is something he can do. "I'm going to give you Risperdal," he says. "That should quiet the auditory centres in your brain."
"So you think I'm psychotic?" I ask.
"I think you have a touch of psychosis," he says, but I get the feeling he has to say this, now that he's prescribing Risperdal. It becomes fairly clear to me that medication drives the decisions, and not the other way around. In Rosenhan's day, it was pre-existing psychoanalytic schema that determined what was wrong; in our days, it's the pre-existing pharmacological schema, the pill. Either way, Rosenhan's point that diagnosis does not reside in the person seems to stand.
"But do I appear psychotic?" I ask.
He looks at me. He looks for a long, long time. "A little," he finally says.
"You're kidding me," I say, reaching up to adjust my hat.
"You look," he says, "a little psychotic and quite depressed. And depression can have psychotic features, so I'm going to prescribe you an antidepressant as well."
"I look depressed?" I echo. This actually worries me, because depression hits closer to home. I've had it before and, who knows, maybe I'm getting it again and he sees it before I do. He writes out my prescriptions. The entire interview takes less than 10 minutes. I am out of there in time to eat Chinese with the real Lucy Schellman, who says, "You should've said 'thwack' instead of 'thud', or 'bam bam'. It's even funnier." Later on, I fill my prescriptions at the all-night pharmacy. And then, in the spirit of experimentation, I take the antipsychotic Risperdal, just one little pill, and I fall into such a deep, charcoal sleep that not a sound comes through, and I float, weightless, in another world, seeing vague shapes - trees, rabbits, angels, ships - but as hard as I peer, I can only wonder what is what.
It's a little fun, going into ERs and playing this game, so over the next eight days I do it eight more times, nearly the number of admissions Rosenhan arranged. Each time, I am denied admission, but, strangely enough, most times I am given a diagnosis of depression with psychotic features, even though, I am now sure, after a thorough self-inventory and the solicited opinions of my friends and my physician brother, I am really not depressed. (As an aside, but an important one, a psychotic depression is never mild; in the DSM, it is listed in the severe category, accompanied by gross and unmistakable motor and intellectual impairments.)
I am prescribed a total of 25 antipsychotics and 60 antidepressants. At no point does an interview last longer than 12 and a half minutes, although at most places I needed to wait an average of two and a half hours in the waiting room. No one ever asks me, beyond a cursory religious-orientation question, about my cultural background; no one asks me if the voice is of the same gender as I; no one gives me a full mental status exam, which includes more detailed and easily administered tests to indicate the gross disorganisation of thinking that almost always accompanies psychosis. Everyone, however, takes my pulse.
I call back Robert Spitzer at Columbia's Institute for Biometrics.
"So what do you predict would happen if a researcher were to repeat the Rosenhan experiment in this day and age?" I ask him.
"The researcher would not be admitted," Spitzer replies.
"But would they be diagnosed? What would the doctors do about that?"
"If they only said what Rosenhan and his confederates said?" he asks.
"Yeah," I say.
"They would be given a diagnosis of deferred."
"OK," I say. "Let me tell you, I tried this experiment. I actually did it."
"You?" he says, and pauses. "You're kidding me." I wonder if I hear defensiveness edging into his voice. "And what happened?" he says.
I tell him. I tell him I was not given a deferred diagnosis, but almost every time I was given a diagnosis of psychotic depression plus a pouch of pills.
"What kind of pills?" he asks.
"Antidepressants, antipsychotics."
"What kind of antipsychotics?" he asks.
"Risperdal," I say.
"Well," Spitzer says - and I picture him tapping his pen against the side of his skull - "that's a very light antipsychotic, you know?"
"Light?" I say. "The pharmacological rendition of low-fat?"
"You have an attitude," he tells me, "like Rosenhan did. You went in with a bias and you found what you were looking for."
"I went in," I say, "with a thud, and from that one word a whole schema was woven and pills were given, despite the fact that no one really knows how or why the pills work or really what their safety is."
Spitzer clears his throat. "I'm disappointed," he says, and I think I hear real defeat, the slumping of shoulders, the pen put down. "I think," he says slowly, and there is a raw honesty in his voice now, "I think doctors just don't like to say, 'I don't know'."
"That's true," I say, "and I also think the zeal to prescribe drives diagnosis in our day, much like the zeal to pathologise drove diagnosis in Rosenhan's day, but, either way, it does seem to be more a product of fashion, or fad."
I am thinking this: in the 1970s, American doctors diagnosed schizophrenia in their patients many times more than British doctors did. And now, in the 21st century, diagnoses of depression have risen dramatically, as have those of post-traumatic stress disorder and attention deficit hyperactivity disorder. It appears, therefore, that not only do the incidences of certain diagnoses rise and fall depending on public perception, but also the doctors who are giving these labels are still doing so with perhaps too little regard for the DSM criteria the field dictates.
Here's what's different: I was not admitted. I was mislabelled, but not locked up. Here's another thing that's different: every single medical professional was nice to me. Rosenhan and his confederates felt diminished by their diagnoses; I, for whatever reason, was treated with palpable kindness. One psychiatrist touched my arm. One psychiatrist said, "Look, I know it's scary for you, it must be, hearing a voice like that, but I really have a feeling that the Risperdal will take care of this immediately." In his words, I heard my words, the ones I, as a psychologist, often use with patients: You have this. The medication will do this. I speak such words not to promenade my power, but just to do something, to bring a balm. If we can only fix a mystery in space - Atlantic blue depression, the haziness of happiness and where on the continuum it lies - if we can only pin these things down for just the time it takes a neuron to pulse, well then maybe we could get our hands and heads around emotion. I believe this is what drove the psychiatrists I saw, not pigheadedness. One psychiatrist, upon handing me my prescription, said, "Don't fall through the cracks, Lucy. We want to see you back here in two days for a follow-up. And you know we're here 24 hours a day, for anything you need. I mean that. Anything."
I felt so guilty then, so touched. "Thank you so much," I said. "I can't tell you how much your kindness means."
"Be well," he said.
Three weeks have passed since my last ER debacle, and out of the blue my daughter has developed an obsession with Band-Aids. Her dolls have many hurts not visible to the human eye. I come home at the end of the day and find Band-Aids applied to the exposed floor joists, the kitchen cabinets, the walls, as though the walls themselves are wounded. Our house hurts, and it is old. In the night it creaks. My daughter cries. Sometimes she cries for no reason at all, except, I think, that there are thuds we cannot capture, and when this knowledge dawns on her she throws herself to the floor and screams, "I just want to go to the zoo!" I comfort her, then, with Band-Aids. The Band-Aids soothe, even though we don't know just what or where her wound is.
Rosenhan used the results of his study to discredit psychiatry as a medical specialty. But are there not many, many diseases or wounds in our country's pain clinics, oncology centres, paediatric wards, where etiology, pathogenesis, even label itself, are hazy? Does the woman have fibromyalgia or Epstein-Barr virus? Does the person have epilepsy or a brain tumour too small to be detected? For a time, Rosenhan himself was suffering from a mysterious disease that could be given many names, depending on the practitioner.
I'd like very much to help Rosenhan, who is still in a west coast hospital, paralysed, even his vocal cords. I'd like to tell him that I redid his study and had a grand old time, because I think it would please him to know this. I would like to visit. "I don't think now would be a good time," Jack, his son, says. "He still can't talk and he's very tired."
But it's not talking I'm after. I'd just like to see him. I picture, right now, a nurse bathing him. I don't even know the man, but I have an unreasonable fondness for him. I'm partial to jokesters, to adventures, to people in pain. As an ex-mental patient, I'm impressed with anyone who cares to understand the intricacies of that distant world. So I would bring Rosenhan gifts, this essay, an apple, a watch with a face large enough to see the swirl of time and, from my daughter, boxes and boxes of Band-Aids
· David Rosenhan recently recovered from his illness and returned to his post as emeritus professor of law and psychology at Stanford University.
This is an edited extract from Opening Skinner's Box: Great Psychological Experiments Of The 20th Century, by Lauren Slater, published on Monday by Bloomsbury at £16.99. To order a copy for £14.99 (plus UK p&p), call 0870 066 7979.
from http://ernie.educ.ualberta.ca/ddc/ICAD/digests/holocaust.html:
Date: Thu, 22 Jun 95 13:21 CDT
From: ANNE M DONNELLAN
Subject: Re: FWD>RE>holocaust research
Some of my previous message was lost in cyberspace:
To those who might feel surprise that Italy, too, might have killed disabled children. The J. of the American Psychiatric Association published a series of articles on euthanasia in 1941-42. It was a debate between Foster Kennedy and Leo Kanner. Kennedy felt we should follow the Nazi agenda in terms of euthanasia for the disabled population here and the editors of the Journal agreed. In fact the editors saw that if this "procedure" was ever to be available in the future it was necessary to change parental responses to the idea of euthanasia. The role of the psychiatrist was to deal with the morbid attachment that the parents had to their disabled kids. Fortunately, the US entered the war between the two issues of the Journal so there was no great support for following Nazi agendas - at that time at least.
(The following item also appears in the Indoctrination chapter.)
ADHD drugs' long-term effects examined
WASHINGTON (Reuters) -- Drugs given to children to treat attention deficit hyperactivity disorder could have long-term effects on their growing brains, studies on rats suggest.
Several studies published on Monday show that rats given a popular ADHD drug were less likely to want to use cocaine later in life, but also often acted clinically depressed and behaved differently from rats give dummy injections.
While rats are different from humans, the studies suggest that doctors should watch children for long-term effects, too.
In the United States between 3 percent and 5 percent of children are diagnosed with attention deficit disorder, marked by reduced ability to concentrate, difficulty in organizing and impulsive behavior.
Patients are commonly prescribed stimulants but the practice is sometimes controversial.
William Carlezon of McLean Hospital and Harvard Medical School in Boston and colleagues raised two groups of rats. One was given Ritalin, known generically as methylphenidate, during the rat equivalent of pre-adolescence, while the other was given a salt water injection.
When they matured, the rats were tested for "learned helplessness" -- how quickly they gave up on behavioral tasks under stress.
"Rats exposed to Ritalin as juveniles showed large increases in learned-helplessness behavior during adulthood, suggesting a tendency toward depression," Carlezon said in a statement.
But rats, which generally like cocaine, were less likely to eat it if they had been give Ritalin.
Carlezon said he did not believe the effects were specific to Ritalin, made by Swiss drug giant Novartis. It could instead be a general effect of stimulant drugs, many of which act by increasing the activity of a key message-carrying chemical called dopamine.
Higher dopamine levels could affect the way brain cells cement their connections during development, Carlezon wrote in the December 15 issue of the journal Biological Psychiatry.
A team at the University of Texas Southwestern Medical Center at Dallas found that adult rats were less responsive to rewarding stimuli and reacted more to stress if they had been given methylphenidate as youngsters.
A third study done by a team at Finch University of Health Sciences/The Chicago Medical School found changes in how dopamine neurons responded to methylphenidate.
"These three studies remind us how limited our knowledge is of the neurochemical and functional characteristics of the human brain during childhood and adolescence and on the effects of psychotropic drugs on brain development," Dr. Thomas Insel, Director of the National Institute of Mental Health, wrote in a commentary.
from the Boston Globe, 2004-Jan-6, by Carey Goldberg:
Brain mapping may guide treatment for depression
For the first time, researchers have mapped what happens in the brain when a patient recovers from depression using cognitive behavioral therapy, a common form of psychological treatment aimed at breaking the bad habits of thought that bring people low.
The changes in the pattern of brain activity are quite different from those observed when patients recover with antidepressant drugs, and in some areas, even opposite, according to findings reported yesterday.
The mapping may provide a first step toward using brain scanning to determine which patients should receive antidepressants and which should receive psychological training, a decision that is now often based on trial and error, said Dr. Helen Mayberg, the study's senior author.
"This experiment lays the groundwork for looking for different markers that will help to optimize the treatment for a given individual; that's the really cool part," said Mayberg, a professor of psychiatry and neurology who conducted the study while at the University of Toronto but recently moved to Emory University in Atlanta.
Researchers also predict that the study could help raise the public standing of cognitive behavioral therapy, a series of lessons that trains patients to recognize their negative thoughts -- "I'm worthless" or "it's hopeless" -- and combat them with facts.
More highly directed and shorter-term than ordinary talk therapy, the psychological practice is already solidly established and is routinely paid for by insurance companies, but it tends to get much less attention than antidepressant drug therapy.
The scanning study's importance is "that you can see such a solid physical finding from a psychological treatment," said Dr. Bruce M. Cohen, president of McLean Hospital in Belmont. He was not involved in the research.
More broadly, Cohen added, the findings represent "one more step toward answering the question: What is happening in the brain when it's depressed? What happens when you change the way you think or take a drug and change the way you feel?"
Mayberg and colleagues used a brain-scanning technique called positron emission tomography to analyze for 15 to 20 sessions the brain metabolism of 14 subjects whose depression lifted considerably after cognitive behavioral therapy.
They found, among other things, that some areas in the cortex -- the outer rind of the brain associated with higher functions, such as thinking -- appeared to become less active, seemingly because patients learned to ruminate and worry less. With antidepressants, those regions became more active.
In essence, Mayberg said, depression stems from a malfunction not in a single spot in the brain, but in a network or circuit of brain connections. The study, published in this month's Archives of General Psychiatry, helps to contrast the two main approaches to fighting it.
"The network can reset itself via inputs working from a bottom-up perspective -- that, I think, is how drugs work -- while cognitive therapy works by influencing top-down inputs, turning down rumination and worry areas," said Dr. Zindel Segal, a University of Toronto psychiatry professor who worked on the study.
"Top-down" cognitive therapy begins with the cortex and its higher thinking functions; "bottom-up" drug therapy begins with the deeper, more primitive parts of the brain such as the brain stem and limbic system, which affect emotions and basic bodily functions. Each eventually affects the other through a complex network that remains little understood. An estimated one-fifth of Americans suffer from prolonged depression at some point.
Insurance companies generally pay for cognitive therapy, which costs between $50 and $100 per session, but they sometimes only cover the talk therapy.
Studies have shown that cognitive therapy is not only at least as effective as antidepressant drugs for some patients, but that many are less susceptible to relapse, said Aldo Pucci, president of the National Association of Cognitive-Behavioral Therapists.
Patients typically attend an average of 16 sessions, replete with homework, and come away with new skills that last much longer.
The therapy works, Segal said, by helping patients become aware of their negative "self-talk" and how it interacts with their mood. For example, he said, if patients have thoughts like "I'm unattractive," they are more likely to accept that thought as fact. Cognitive therapy helps them "develop a capacity to talk back to this depressive propaganda."
There are no national statistics available on how many people perform or undergo cognitive therapy, Pucci said, but his nine year old association already has 5,000 members.
"We maintain that for the overwhelming majority of people who are depressed, it's their thinking that causes their depression, not some biochemical problem," he said. The study, he said, "just supports what we've already been saying." Cognitive behavioral therapy "doesn't need the support, but certainly we'll take it," he said.
In fact, the study does not address the origins of depression, but it did suggest a basic aspect of antidepression therapy that surprised Mayberg: Drugs and cognitive therapy appear to operate on two different tracks, with no "final common pathway," she said.
from the Washington Post, 2001-Oct-19, p.C1, by Don Oldenburg:
That Way Madness Lies
Panic Carries Its Own Threat Of ContagionAfter the attack on Pearl Harbor in 1941, Californians became convinced that a Japanese invasion of their state was imminent. Reports multiplied: Japanese bombers are in the skies; enemy subs are off the coast of Santa Barbara. All rumors and false alarms.
In 1962 at a North Carolina textile factory, a worker reported being bitten by a poisonous insect and becoming sick. Within a week, 62 other workers claimed they too had been bitten, and exhibited symptoms of rashes and nausea. The bug didn't exist.
When Orson Welles broadcast the 1938 dramatization of H.G. Wells's novel "The War of the Worlds," radio listeners who missed the fantasy's disclaimer truly believed invading Martians were gassing New Jersey and New York. Thousands fled their homes with wet towels over their faces, traffic jams clogged streets, and frantic callers clogged telephone lines.
Public hysteria -- the contagion of panic spread by rumor and false alarms -- is more dangerous than the real problem, and America is on the verge of it, mental health authorities say.
"There is a general feeling among a lot of people of extreme fear bordering practically on panic," says Gloria Leon, a University of Minnesota psychology professor who specializes in the study of people in disasters.
Jeffrey Mitchell, president of the nonprofit International Critical Incident Stress Foundation in Ellicott City, says terrorism's most potent impact is that fear spreads far beyond the act of violence, making people irrational and obsessive -- unless appropriate steps are taken. "When there's the possibility it can hit anywhere," such as with anthrax-laden powder in the mail, he says, "it can start driving the population into a frenzy."
Social psychologists who study crowd behavior have long known that beliefs, misinformation and fears can spread through a society the way a computer virus dominoes from one online system to the next.
"Rumor is a function of ambiguity and importance," says Fredrick Koenig, a professor of social psychology at Tulane University who specializes in rumors. "Obviously this situation is important and critical. And the ambiguity is very big -- we don't know who it is, where it's going to hit next or where it is coming from. The authorities don't seem to understand very much about it, so we're getting confusing messages. You have no structure in terms of answers: What to do? How should we react? What's going to happen next? When you have this kind of vagueness, you get rumor behavior."
Fear and hysteria spread primarily among like-minded people -- at the office, after church, at meetings, anywhere people talk informally -- and from anxiety-confirming reports in the media. "It is amplified," says Koenig. "You see Tom Brokaw coming unglued, it is contagious."
The challenge facing people is to avoid seeing danger where it doesn't exist, say psychologists. During the flu epidemic of 1918-19, which killed 550,000 Americans, rumors made the devastation even worse. "There were stories going around that bachelors and pregnant women were more susceptible," Koenig says. People wore useless gauze masks.
Today "people do not want to get into a hijacked airplane, though chances of getting hit by an automobile is more likely," he says. "Now with the anthrax thing . . . we are noticing white powder where we didn't notice it before. We are noticing 'flulike symptoms' where before it was just a cold or a hangover. There's going to be more and more of that in this state of anxiety."
Koenig cites the case of a Pittsburgh woman who called 911 to report a man with a plastic bag on his head standing near a mailbox.
Leon has studied the psychological fallout of the world's largest nuclear accident, at Chernobyl in 1986. Nine years after the deadly explosion in the former Soviet Union, residents of a village that continuously tested as radiation-free believed firmly at the first symptom of illness other than a common cold that they were dying of radiation-caused cancer.
Leon says she saw similar irrationality when CNN interviewed a man from Indiana after the attacks on New York and Washington. The man was convinced terrorists would attack his small town next.
The key to avoiding public panic is reliable information -- and how it's delivered, the psychologists say.
Leon thinks intense coverage of terrorism is leading to fears that don't match the risks. "We're hearing so much in the media and from public officials," she says. "I said from day one I wish the folks in Washington would have some psychologists or information-management people working with them so they could get a clear message across without unduly alarming the public."
The FBI's Oct. 11 alert that another terrorist attack was possible "over the next several days" shot public anxiety through the roof with its vagueness. The news that some 600 suspects had been detained helped to comfort a shellshocked public, says Leon, but the added detail that 200 others were still at large did not.
"That kind of statement gets people really upset," she says. "The statement could've been that we're still looking for suspects. Some of the things that Attorney General Ashcroft is saying makes it sound like there's going to be a terrorist under every bed."
The rash of anthrax hoaxes are spawned by the same problem, she adds. "Whenever you get a very dramatic event, there are individuals who have their own problems and issues who would never have thought of an anthrax hoax unless so much was out there about it," she says. "These kinds of scares wind down when it is no longer in the news."
Koenig says public panic is spreading because communications from the government seem confused and inconsistent. Without structured and trustworthy information from the nation's leadership, Koenig expects increased absenteeism, false symptom reports and hoaxes. "The best way to stop a rumor is to tell the truth immediately," he says. "If someone said, 'Look, you are not going to die from anthrax; we've got it all under control,' if they could say that, there wouldn't be any problem. But they can't say that."
Chalsa Loo, a clinical psychologist in Honolulu who has worked with victims of post-traumatic stress disorder, recommends that the administration not push the vigilance button incessantly, as it has done. "A realistic amount of hyper-vigilance is healthy because it allows the individual to be watchful," she says. But too much "can immobilize the individual and cause that person to go into denial or be so anxious that they become dysfunctional."
The public also needs to regain its perspective, says Mitchell. While even one death from an anthrax attack is outrageous, it still is a tiny percentage of the U.S. population. "People need to calm down," he says.
"People need to see that . . . if authorities keep responding rapidly and appropriately to the threat, what's going to happen, eventually, is this episode will be behind us."
It has happened that way before. With its Navy crippled from the attack on Pearl Harbor, the United States suffered many losses for a long time before it pulled together its wartime resources, says Mitchell. "We got our butts kicked. It didn't happen fast but we came out of that."
from the Wall Street Journal via OpinionJournal.com, 2004-Nov-12:
The Plots Thicken
"The most trusted man in America" becomes a conspiracy theorist.When Walter Cronkite talked on CNN last month about Osama bin Laden's scary pre-election video, yet another cat leapt out of the conspiracy-theory bag. "I'm a little inclined to think," Mr. Cronkite told host Larry King, "that Karl Rove, the political manager at the White House, who is a very clever man, he probably set up bin Laden to this thing."
It's not clear whether this was a tasteless joke or a stray filament of wishful thinking; Mr. King probed no further. Yet the comment was a reminder that conspiracy theorizing--formerly confined to the realms of alien abduction kooks and grassy-knoll debaters--is edging ever closer to the mainstream. Like it or not.
While the most notable examples now appear to be election-inspired and coming from the left, the direction may not be that significant. Experts who study conspiracy phenomena tend to agree on one thing: that at any given time people whose party is out of power are the most receptive to theories--about computer hackers in Florida, mind-controlling pro-Bush psychics, Osama "October Surprises"--that address their frustrations. In fact, the majority of all conspiracy theories seem to grow out of a sense of helplessness. The particular impulse that gave birth to a Web article like "Royal Conspiracy: Princess Diana Names Her Killer" by Uri Dowbenko may be wacko. Yet who can fault ordinary people who would prefer an explanation featuring palace assassins over a verdict that underlined the randomness of cruel fate?
Yasser Arafat probably wasn't poisoned, but it's no surprise if perpetually discombobulated Palestinians want to think he was. The otherwise lucid actor Will Smith has espoused the belief that AIDS is part of a plot to strike down black people. That's a classic example, says Tim Melley, the University of Miami (Ohio) professor who wrote "Empire of Conspiracy: The Culture of Paranoia in Postwar America." Many conspiracists function like sociologists at first, he notes, "identifying patterns of inequity . . . that have effects on society"--and then they jump to blame everything on a deliberate plan. "It's comforting. It provides an explanation that explains why your group is down and out."
Mr. Melley suspects that whatever form conspiracy theories take, they'll be intruding more into our consciousness in the future. For better or worse, he says, the major media are losing their authority as arbiters of the truth. The proliferation of alternative news sources on the Web and talk radio, for instance, reflects and feeds the notion that what the media powers-that-be are telling us is not the real story. Add to that the bombardments of ubiquitous advertising, and you get what Mr. Melley calls "agency panic," where "people are worried about their own ability to control themselves, worried that someone has gotten into their head and manipulated their desire."
So far, most Americans still have an internal meter that instantly registers the difference between questions worth exploring and questions, like Mr. Cronkite's, that are coming from places they definitely don't need to visit. University of Florida law professor Mark Fenster, the author of "Conspiracy Theories: Secrecy and Power in American Culture," has detected almost no belief in various 9/11 conspiracy scenarios. And many of the election-period charges, he says, can be attributed to normal "partisan political rhetoric."
If that's true, a lot of the disorienting plot chaff should begin to disappear soon from plain view. Screeching about the liberal media conspiracy or the Perpetual Hidden Government now headed by Mr. Bush and his international co-conspirators should recede back into the Web. There, at least, the exposure to "agency panic" is voluntary.
from the Associated Press, 2002-Jul-5, by Lauran Neergaard:
Lawsuit After Prozac Arrives in Mail
WASHINGTON (AP) - Someone sent free boxes of once-a-week Prozac to south Florida depression patients - people who don't take regular Prozac and hadn't even discussed trying the new version with their doctors.
It's not clear how many patients got the unsolicited Prozac, which came to light when one furious recipient filed an invasion-of-privacy lawsuit this week against her doctors, her pharmacy and Prozac maker Eli Lilly & Co.
Lilly is investigating and apologized Wednesday for the incident. The Food and Drug Administration is watching closely.
The case - apparently the first time a powerful prescription drug has been mailed, much like laundry detergent samples are - surprised medical experts who warned that unsolicited drug mailings are dangerous and may be illegal.
``I'm incredulous,'' said drug safety expert Michael Cohen of the nonprofit Institute for Safe Medication Practices. ``It's a dangerous precedent. You might have (people) other than the patient picking it up out of the mailbox and taking it. It could be a child.''
Laws governing prescription-writing and pharmacy practices vary by state. The drugstore chain Walgreens maintains it properly filled prescriptions from doctors' offices and mailed them for free because it had ``coupons'' from Lilly to provide reimbursement. The Florida woman's doctors aren't talking.
Lilly issued a statement late Wednesday saying it was inappropriate to mail medicine to patients without their request.
``To the extent Lilly personnel may have participated in this program, Lilly apologizes to those patients affected by it,'' said spokeswoman Debbie Davis. ``We are investigating this matter vigorously and if company policies were violated, Lilly will take appropriate action.''
The FDA - which regulates prescription medicines, their makers and their marketing - is monitoring the case to see whether it needs to intervene.
``Although the acts of prescribing and providing the drug likely come under state jurisdiction, FDA intends to keep an eye on this case because of the promotion issues it may raise,'' said spokesman Larry Bachorik.
The Broward County, Fla., woman, identified in court documents only as S.K., this week sued her doctors, Walgreens and Lilly, charging invasion of privacy and improper medical practice.
``Dear Patient,'' reads a letter accompanying the pills that was signed by her local doctors. ``We are very excited to be able to offer you a more convenient way to take your antidepressant medication.
``For your convenience, enclosed you will find a FREE one-month trial of Prozac Weekly,'' the letter continues, before cautioning patients to stop their regular antidepressant one day before starting the once-a-week version.
``It really upset me,'' S.K. said in a telephone interview arranged by one of her attorneys, Stephen Sheller of Philadelphia.
She said her grandchildren might have opened and swallowed the mailed drug, and anyone seeing her mail would learn she had depression, which she keeps private. ``Then I started to think, 'Wait a minute, how did they know to send them to me?'''
S.K. said her doctor maintains the office physicians signed a blank form letter provided by a Lilly salesman. S.K.'s medical records show no Prozac prescription, said fellow attorney Gary Farmer Jr. of Fort Lauderdale.
Representatives for the doctors' office, Holy Cross Medical Group, did not return calls seeking comment.
The lawsuit charges that Walgreens must have allowed access to patient prescription records, providing Lilly with a list of antidepressant users. S.K. said she tried Prozac once years ago ? the prescription was filled by a Walgreens in Massachusetts, she contends ? but had a bad side effect and switched to a competing drug that she has used ever since.
Walgreens didn't allow anyone access to patient records and properly filled prescriptions from doctors' offices for all the Prozac it mailed, said Michael Polzin from the chain's Deerfield, Ill., headquarters.
He wouldn't say how many samples Walgreens mailed, or how much the Lilly coupons reimbursed the pharmacy for the drugs. A month's supply of Prozac Weekly costs about $63 wholesale.
``How would we know the patient didn't know the prescription was coming?'' Polzin asked.
from US News & World Report, 1997-Mar-31, by John Leo:
Boy, girl, boy again
John was an 8-month-old infant when his penis was destroyed in botched surgery [routine circumcision, actually -AMPP Ed.]. On the advice of doctors at Johns Hopkins Hospital, his parents decided to change him into a girl so he might one day have a normal sex life. His testicles were removed, a rough version of a vagina was created, and "John" was raised as "Joan."
This is a famous case in sexual medicine, if medicine is the correct term for what was done. One reporter who covers such matters calls it the "Wolf Man of Sexology," meaning that the case is as central to sex and gender research as Sigmund Freud's "World Man" case is to Freudian psychology. It has been cited over and over in psychological, medical, and women's studies textbooks as proof that, a part from obvious genital differences, babies are all born as sexual blank slates--male and female attributes are invented and applied by society.
Now all those texts will have to be rewritten. More than 30 years after "John" became "Joan," word finally comes that the change was a failure from the start. "No support exists" for the blank-slate theory "that individuals are psychosexually neutral at birth." This conclusion is reported in the Archives of Pediatric and Adolescent Medicine by Milton Diamond, a sexologist, and Keith Sigmundson, a psychiatrist.
The young Joan picked trucks and a machine gun as toys, frequently ripped off her dresses, and imitated her father shaving. Despite the lack of a penis, she insisted on urinating standing up. Thrown out of the girl's bathroom at school, she moved to the boys' lavatory and used a urinal. At 12, she received hormones to make her breasts grow, but she hated her breasts and refused to wear a bra.
Everything clicked. Therapists couldn't persuade Joan to accept her role as a girl, as theory said she should. Instead, she "felt like a trapped animal" and threatened suicide. When she was 14, her father tearfully told her she was a boy. "All of a sudden everything clicked," Joan said. "For the first time things made sense and I understood who and what I was." Joan had a mastectomy, got male hormone shots, and began living as a boy. At age 16, he bought a van with a bed and a bar and started to pursue girls. At 25, he married a woman with three children, and now at age 34 he is reportedly self-assured and content, though bitter that his castration means he can never have a child of his own.
Why was this disastrous experiment undertaken? One reason is that it's easier to construct a vagina than to reconstruct a penis. But another reason is just as obvious: It was a chance to prove a rising academic and feminist theory about gender. The doctor in charge of the case at Johns Hopkins was John Money, a psychologist and well-known figure in sexology who believed that almost all sex differences are culturally determined.
In December 1972, when Joan was about to turn 10 (and, as we now know, fiercely fighting her life as a female), Money reported at a scientific convention that John's change was an apparent success. Time magazine noted that "this dramatic case... provides strong support for a major contention of women's liberationists: that conventional patterns of masculine and feminine behavior can be altered. It also casts doubt on theory that major sex differences, psychological as well as anatomical, are immutably set by the genes at conception.
The John-Joan case is a classic example of how an untested idea, backed up by no evidence at all, can be used by well-meaning people to ruin someone's life. "It might have been the zeitgeist," Diamond said, referring to the "Flower-power, you-can-be-anything-you-wish" ethic of the 1960s and '70s. Though many attempts have been made to turn infants with damaged or ambiguous genitals into females, Diamond and Sigmundson say there is no known case where "a 46-chromosome, XY male,, unequivocally so at birth, has ever easily and fully accepted an imposed life" as a heterosexual female. Money has given no interviews, on the ground that John has not given written permission for him to speak.
On the broader issue of sexual differences, the pendulum that began to swing so strongly against disparities in the '60s and '70s is now swinging the other way. Since biology and male-female differences were used for so long to disparage women, feminists argued strongly that true distinctions didn't exist. On campus, the old debate over male and female characteristics mutated into "gender studies," based on the assumption that differences were either trivial or socially constructed by males to oppress women.
Daphne Patai, co-author of Professing Feminism, writes that some hard-line campus feminists believe that even morning sickness and the pain of childbirth are socially created by the patriarchy. She predicts that they will just shrug off the John-Joan case. "The whole point of being an ideologue is that new information doesn't disturb your worldview," she says.
Now, brain studies are showing many innate differences. As Diamond and Sigmundson write, "The last decade has offered much support for a biological substrate for sexual behavior." The John-Joan case may not be the last of its kind. But it looks like something left over from a different era.
from PDL 1999-Mar-28, from the San Francisco Chronicle, by Debra J. Saunders:
Lolita Nation
THE AMERICAN Psychological Association's Psychological Bulletin released a study of 59 other studies last year that concluded that college students who had been sexually abused as kids were ``slightly less well adjusted'' than other college kids. Authors Bruce Rind, Phillip Tromovitch and Robert Bauserman urged psychologists not to assume that sex between nonrelated adults and minors is abusive, as children often deem the experience to be positive. ``In short,'' they wrote, ``the self- reported effects data do not support the assumption of wide-scale psychological harm from CSA (child sexual abuse).''
The authors want to dump the term ``child sexual abuse'' when children consent to sex with adults. Better, the three argue, to call such relations ``adult-adolescent sex.'' Or when the ``willing encounter with positive reactions'' involves a 9-year-old and an adult, call it ``simply adult-child sex, a value neutral term.''
Last week radio talk show host Laura Schlessinger -- a.k.a. Dr. Laura -- began a crusade against the piece and the APA for printing it. She fears the piece is part of a concerted effort to get the APA to remove pedophilia from its list of mental disorders.
APA spokeswoman Rhea Farberman thinks that it is valid to criticize the piece. She reiterated the APA position that pedophilia is ``a mental disorder, extremely harmful to children, is illegal and should stay illegal.''
Farberman criticized Schlessinger, however, for making a big issue of the piece. Maybe that's because the APA showed appalling judgment in printing this pedophilia propaganda.
Schlessinger attacks the study's methodology. It would be the equivalent of asking women who had been raped 10 years ago how they feel today. Then, if most say they are fine, concluding that rape is ``not harmful, in fact it might be beneficial.'' Thus the authors culled through their data on college students, then said do away with the abuse term because 37 percent of males viewed their childhood sexual experiences as positive and that males viewed their childhood sexual experiences with adults more positively than females.
No surprise, the North American Man/Boy Love Association (NAMBLA) has posted the ``good news'' about the study on its Web page. ``On average, nearly 70 percent of males in the studies reported that as children or adolescents their sexual experiences with adults had been positive or neutral,'' it stated. And, ``The current war on boy- lovers has no basis in science.''
It's as if all the research about the trauma caused by adults having sex with children, all the testimony, all the tears, all the rage, never existed. Most boys liked it, or didn't mind it, which is the same to the three researchers. Some girls -- probably those they refer to as ``mature'' -- liked it, too.
Heterosexual pedophiles have been making the same argument for years. The little girls liked it. The little girls wanted it.
You expect that sort of cynical excuse from a cruel pervert, but you don't expect to read it in an APA journal.
The authors had argued that their mission was to differentiate between what childhood sexual experiences with adults are most harmful -- that it is important to contrast between ``the repeated rape of a 5-year-old girl by her father and the willing sexual involvement of a mature 15-year-old adolescent boy with an unrelated adult.'' Yet, they don't differentiate between boys' reactions to sex with a man and sex with a woman.
``Doesn't that make you suspicious that they have an agenda?'' Schlessinger asked.
As a matter of fact, it does.
Of course, what really makes me suspicious is any psychologist who thinks that a 9-year-old can consent to sex.
Child Molestation and the Homosexual Movement, by Steve Baldwin, from Regent University Law Review 2002-2003, is an alarming and quite convincing read (and fairly densely footnoted, though I haven't followed up the footnotes):
[...]
It is difficult to convey the dark side of the homosexual culture without appearing harsh. However, it is time to acknowledge that homosexual behavior threatens the foundation of Western civilization -- the nuclear family. An unmistakable manifestation of the attack on the family unit is the homosexual community's efforts to target children both for their own sexual pleasure and to enlarge the homosexual movement. The homosexual community and its allies in the media scoff at this argument. They insist it is merely a tactic to demonize the homosexual movement. After all, they argue, heterosexual molestation is a far more serious problem.
Unfortunately, the truth is stranger than fiction. Research confirms that homosexuals molest children at a rate vastly higher than heterosexuals, and the mainstream homosexual culture commonly promotes sex with children. Homosexual leaders repeatedly argue for the freedom to engage in consensual sex with children, and blind surveys reveal a shockingly high number of homosexuals admit to sexual contact with minors. Indeed, the homosexual community is driving the worldwide campaign to lower the legal age of consent.
[...]
Family Research Institute founder and psychologist Paul Cameron, reviewing more than nineteen different academic reports and peer reviewed studies in a 1985 Psychological Reports article, found that homosexuals account for between 25% and 40% of all child molestation. Sex researchers Freund, Heasman, Racansky, and Glancy, for example, in an 1984 Journal of Sex and Marital Therapy article, put the number at 36%. Erickson, Walbek, Sely, in a 1988 Archives of Sexual Behavior article, places it at 86% when the children being molested are male.
However, it should be noted that homosexuals account for only 2% of the population which statistically means that a child molester is ten to twenty times more likely to be homosexual than heterosexual. In other words, heterosexual molestations proportionally are a fraction compared to homosexual molestations. More recent studies confirm this statistic. In 2000, the Archives of Sexual Behavior published an article by seven sex researchers concluding that ``around 25-40% of men attracted to children prefer boys. Thus the rate of homosexual attraction is 6-20 times higher among pedophiles."
Sexual violence expert and professor of psychiatry Eugene Abel, in a 1987 study published by the Journal of Interpersonal Violence, concluded that homosexuals sexually molest young boys with an incidence that is five times greater than the molestation of girls.
[...]
from TownHall.com, 2003-Sep-24, by Michelle Malkin:
Hollywood's favorite child molester
One of the most popular movies currently playing at the box office, "Jeepers Creepers 2," is a teen horror flick directed by a stomach-turning registered sex offender who was convicted of molesting a 12-year-old-boy he targeted, groomed, seduced, and filmed in pornographic home videos.
Hollyweird strikes again.
The celebrity pervert's name is Victor Salva. The scheming Salva wrote children's books, participated in the Big Brother program, and worked at a San Francisco-area daycare center where he met his prey. He molested the victim, Nathan Winters, from the time the boy was 7.
Salva pleaded guilty in 1988 to five felony counts of child sex abuse; he served a measly 15 months of a pathetic three-year prison sentence. Winters' scars will last a lifetime.
Salva made Winters the star of his first feature film, "Clownhouse," a revolting low-budget movie about three murderous clowns who terrorize three young boys. (The movie won praise at Robert Redford's Sundance Film Festival.) While working on the project, Salva forced Winters to perform oral sex on the "critically acclaimed" director and captured the acts on tape. When police raided Salva's home, they found not only the sex videos of Salva and Winters, but also tapes of naked young men taking showers and a pornographic album of still photos.
After he was released on parole, convicted child molester Salva went on to write and direct the "critically acclaimed" 1995 movie "Powder," in which he worked with many young actors. Winters and his mother bravely went public to protest Salva's involvement. But his employers at Disney -- Disney! -- stood by him, as did liberal stars of the film, Mary Steenburgen and Jeff Goldblum. Also a staunch defender and patron of convicted child molester Salva's: director Francis Ford Coppola, whose company produced "Clownhouse" and the two Jeepers Creepers movies.
Convicted child molester Salva's saviors say their "talented" friend has paid his debt to society and should be left alone to express himself creatively and contribute positively to the movie industry. Separate the art from the artist, they preach. Just move on. That is patently impossible and irresponsible, however, when the director's "art" involves the continued sexual exploitation of -- and twisted obsession with -- young boys.
Consider the wretched plot of "Jeepers Creepers 2": An ancient demon dubbed "the Creeper" preys on teenage basketball players trapped in a broken-down bus on a rural highway. Convicted child molester Salva's camera lingers on the shirtless torsos of the boys, alive and dead. The boys, all buff and beautiful in that pedophilic Calvin Klein/Abercrombie and Fitch kind of way, sunbathe on the bus roof. The lascivious Creeper stalks and harvests his victims, devouring "certain parts of their anatomy while laminating the rest," in the words of one movie critic. This orgy of bare skin and blood splatter, the sophisticated artistes lecture us, is convicted child molester Salva's redeeming contribution to society.
Convicted child molester Salva and his corrupt Hollywood enablers gripe that he made a "single mistake" and doesn't deserve to be "slandered." The plain fact is that convicted child molesters such as Salva are enormously predisposed to reoffending. Sgt. Gary Primavera, the police officer who handled the Winters case, said: "Victor has every characteristic of a pedophile that I know of -- and I've worked with enough of them. There was no remorse. The only sadness on Victor's part was that he got caught."
It is an abomination that this man continues to enjoy a position of power and influence over young actors, making movies targeted to teens that indulge his dangerous sexual fetishes. The only thing safe and appropriate for convicted child molester Salva to direct are toilet bowl cleaner commercials.
Hollywood's greedy ghouls think otherwise. "Jeepers Creepers 2" has grossed nearly $40 million so far and remains in the top 10. Francis Ford Coppola's co-executive producer, Bobby Rock, glibly told the San Jose Mercury News last week: "The film did very well at the box office -- that's all that matters to us.''
Sick.
from TPDL 2001-Jan-16, from WorldNetDaily, by Joseph Farah:
Molestation as protected behavior
OK, that does it. I've seen everything, now. America has gone off the deep end. There's no other explanation for this kind of insanity.
Here's what has me shocked, mortified, shaking my head in disbelief, appalled and, nearly, speechless.
This from the Las Vegas Review-Journal: A narcotics detective suspected of molesting a 16-year-old boy won't be charged with any sex crimes by prosecutors, who said such action would be (are you ready for this?) "discriminatory toward homosexuals."
Detective Vinten Hartung (that's his name, folks, it's not a typo), 42, is still being investigated for two lesser charges of stalking and furnishing alcohol to a minor. But the big charge -- the felony -- of "soliciting a minor to engage in the infamous crime against nature" will be dropped. Neither will there be a federal felony charge of using the Internet to solicit a minor for sex.
"We in essence concluded neither the state nor the federal authorities are able to pursue the sexual offenses," said Clark County District Attorney Stewart Bell. "It discriminates against a class of people, and that's not allowed under the equal protection clause of the Constitution."
Do you believe these people?
Here are some more pertinent details: Hartung was placed on paid leave in November after the father of the 16-year-old boy complained that the detective would not leave his son alone. An investigation found that Hartung and the boy were, in the words of the newspaper, "involved in an intimate relationship after making contact in an America Online chat room."
Intimate relationship? A cop is chasing around a 16-year-old boy, plying him with alcohol, stalking him and molesting him. And in 2001 we call that an "intimate relationship."
Here's some more from the absolutely incredible newspaper report: "Prosecutors said they had to grapple with the fact that Nevada's law on soliciting a minor to engage in the infamous crime against nature makes it a felony to engage in homosexual sex with anyone under the age of 18, but the state's age of consent is 16."
Deputy District Attorney Doug Herndon said using the law "would be singling out homosexuals, which is bad. We don't want to do that." Herndon said the intent of the law is to go after pedophiles who solicit children. Well, guess what? That's exactly what this creep is -- a pedophile. The 16-year-old boy is a child.
Now, folks, do you see the problem with all these so-called anti-discrimination laws that are being enacted to "protect the rights of gays, lesbians and transgendered people." What they are doing, in effect and among other things, is legalizing child molestation.
The Vinten Hartung case is a prime example. This monster is on paid leave from the police department. Paid leave! In other words, he has been rewarded with a paid vacation for molesting this boy. There won't be any charges and he'll probably get his job back.
Do you think he and the 16-year-old boy will settle down together? Or do you suspect this pedophile will be back on AOL soliciting other kids, getting them intoxicated and molesting them?
What would you do now if this were your son? He's being stalked, intoxicated and molested by a police officer. You report the problem. An investigation shows your fears were justified. But the authorities say there is nothing they can, should or will do. What now?
In other words, the state -- in the form of an armed policeman -- is raping his kid and then turning around and saying it can't do anything about it because it would be discriminatory. Think of it. Put yourself in the father's place -- or the boy's.
I can tell you exactly where this kind of state-mandated insanity will lead: It will lead to street justice.
Just like our basic, common-sense framework of morality has been turned on its head, our justice system is totally upside-down. And this is a perfect example. All the right laws are on the books -- even new ones about using the Internet to prey on kids. But the problem is it is "discriminatory" to apply them.
Well, of course it is discriminatory. Anytime the law is applied it is discriminatory -- against criminals. What's wrong with that? That kind of discrimination is a good thing.
Now do you begin to understand why the Boy Scouts don't want homosexual scoutmasters in their ranks? It would be an invitation to this kind of sexual abuse. And, worse yet, the abusers might not even get prosecuted.
from Reuters, 2001-Feb-23, by Suzanne Rostler:
Abused Boys More Likely to Hurt Partner As Teens
NEW YORK (Reuters Health) - Teenage boys who were abused as children are more than three times as likely as other boys to use physical violence against someone they are dating, study findings show.
These boys are also nearly three times as likely to threaten to harm their dating partner, report researchers in the March issue of the Journal of the American Academy of Child and Adolescent Psychiatry. The findings underscore the need for services that can help children with histories of maltreatment, explain Dr. David A. Wolfe from the University of Western Ontario in Canada, and colleagues.
``Education and early intervention concerning healthy, non-abusive relationships through the school system may significantly reduce the incidence of domestic violence and, in future generations, child abuse and neglect,'' Wolfe told Reuters Health.
Children who have been physically, sexually or emotionally abused or neglected learn to adapt by avoiding close relationships, learning to distrust others and developing coping mechanisms such as fear and anxiety.
``Such behaviors are indeed adaptive in childhood (because children) get hurt less often but as they grow older these same behaviors lead to peer problems, learning difficulties and relationship violence as a victim, offender or both,'' Wolfe explained.
In the study, the researchers interviewed more than 1,400 boys and girls from 10 high schools in Canada.
One-third of the surveyed teens, who ranged in age from 14 to 19 years old, reported that they were abused as children. Girls with a history of abuse were more likely to be angry, depressed and anxious. They were also about ten times more likely to report post-traumatic stress-related problems compared with girls who had not been abused, and to engage in violent and non-violent delinquency. Boys with a history of abuse also had higher levels of depression and post-traumatic stress but they were less likely than girls exhibit delinquent behavior.
Their findings point to important gender differences that can result from abuse, the authors conclude. They also note that it is not clear how often teens who are violent or threatening in relationships continue that behavior into adulthood.
``Although abusive behavior toward dating partners in adolescence may not yet fully reflect adult-like patterns of violence, the transition from adolescent dating violence to adult abusive behavior warrants further investigation,'' the researchers conclude.
SOURCE: Journal of the American Academy of Child and Adolescent Psychiatry 2001;40:282-289.
from the San Francisco Chronicle, 2001-Nov-19, by David Bragi, special to SF Gate:
Kids On Drugs
The pressure's not from peers, it's from parents, teachers and doctors"There are some kids at my school who are, like, completely emotionless," said Tara (not her real name), a studious and outgoing high school student who lives in a prosperous East Bay suburb. She describes those among her friends and classmates who have been prescribed behavior-modification drugs to treat emotional disorders.
"Some of my friends are on Prozac. It's weird," she said. "There's a girl in one of my classes who's on Ritalin and Valium -- hello in there, echo, echo, echo, echo! Teenagers may have messed-up hormone stuff, but I'd rather be messed up than a dead-for-all-intents-and-purposes zombie Vulcan."
In today's instant-gratification society, such childhood experiences are fast becoming the norm. More and more, behavior-altering medication has become the treatment of choice for children who suffer from a wide variety of conditions, such as bipolar disorder, posttraumatic stress disorder and attention deficit/hyperactivity disorder (ADHD).
Visit your community's campuses and you are likely to find emotionally troubled students who are -- quite legally -- under the influence of drugs that, if sold on the street corner instead of in the pharmacy, would land the seller in prison.
A soon-to-be-released study by William Frankenberger, director of the Human Development Center & School Psychology Program at the University of Wisconsin-Eau Claire, reports on the controversy surrounding the use of stimulant medication to treat children with ADHD. A summary of the study's findings stated that "the issue of pharmacological treatments for ADHD is of importance because of the increasing use of stimulant medication by school-age children."
While noting that such drugs can be useful in improving an ADHD student's behavior, the study found that many young users suffered from a range of side effects, wanted to discontinue taking the medication and in some cases sold or gave away their pills. It also reported figures from the US Drug Enforcement Administration that production of Ritalin increased by 650 percent between 1990 and 1997; legal amphetamine (Dexedrine and Adderall) production increased by over 4,500 percent between 1993 and 2000, and those drugs were prescribed mostly to treat ADHD.
Various side effects of behavior-altering drugs can adversely affect young, growing minds and bodies. According to the study, children on stimulant medication often complain of tics, difficulty sleeping and loss of appetite. It also warned that, since the effects of combining different medications is often unknown, children taking more than one drug simultaneously may be vulnerable to unexpected side effects.
Frankenberger also noted that although psychiatrists tend to be aware of side effects, that information is apparently not filtering down to the family level. "Generally, parents know very little about potential side effects of stimulant medication," he said.
Parents may also be unaware of how their kids are using their meds. Some
of them may sell or give away their prescriptions to friends and classmates. Frankenbergers's study indicates that most middle and high school students were at least aware of the underground trade in prescription drugs.
"There's a bunch of kids who sell their meds -- all kinds, but especially mental ones," said Tara. "One of the med-dealer guys is in my study-hall class, and he told me about the ways that he siphons off his pills, and how much the bizarro druggies like them. They pay a lot of money for his anticonvulsant medicines and for his Prozac."
The Convenience Factor
Unfortunately, a docile child is also a convenient child for overwhelmed parents or overworked teachers. "Often, hyperactive and unruly kids are made worse by parents who themselves have a depressive or anxiety disorder or who just don't have the proper parenting skills to raise their children," said physician Ray Sahelian, a nutritional expert and author of the book Mind Boosters. "Hence, the easy way out is to place the kids on medicines."
"There's a girl I know who had family problems, alcoholic parents, and she was starting to act out, and they put her on Prozac," said Tara. "So much for that problem."
According to a July 17, 2001, Associated Press story by Matthew Daly, even schoolteachers and counselors, who are not supposed to practice medicine, have been known to encourage parents to medicate unruly children in order to keep them quiet in class. "There was a guy in one of my classes a couple years ago who was a troublemaker," said Tara. "Not horribly evil, but he'd mess around in class and get in trouble, and he was pretty loud sometimes -- though very funny -- and they put him on Ritalin and transferred him into special-ed classes. That was pretty much the last we saw of him."
In response to outcries from parents, in July the Connecticut state legislature unanimously passed a law prohibiting teachers, counselors and other school officials from recommending that a child be placed on psychiatric drugs.
"We have a tendency as a culture to take the easy and quick way out in terms of solving common medical problems," said Sahelian, "using drugs versus the healthier alternative of diet, exercise, improved communication between parents and children, promoting activities that the child enjoys and providing good mental and physical stimulation."
So, who is really being medicated here, the kids or the adults responsible for them? Are children with behavioral disorders such as ADHD being medicated largely for the convenience of school officials or parents, rather than the needs of the child? "This is an extremely important question," said Frankenberger. "Our studies have consistently demonstrated that students treated for ADHD with stimulants report the largest drug effect for them is that their teachers and parents like them better when [the children take] the medication."
Some Choose Alternatives
[Some of these alternatives - particularly yoga, meditation, and spirituality - are in most cases downright bad, madness in their own right, and many of the herbal medicines are downright scams. -AMPP Ed.]
Fortunately, not all parents accept the easy way out via medication. Some have even successfully bucked the system and developed original, alternative treatment methods, such as herbal medicines and meditation. Gwenny (only her first name is used here) is the mother of a child who had experienced difficulties dealing with grief and anger since he was a toddler. After he started attending school, child-welfare authorities forced her to medicate him, threatening to remove him from her custody if she refused.
After several years she finally convinced officials to back down, ceased all medications and temporarily removed him from school. "I homeschooled him for six months, taught him how to meditate and gave him a mantra: 'If I do this, what is going to happen?' He had no more significant incidents after being reenrolled in regular school at the beginning of the eighth grade. He is now twenty-one, has held a job for over five years and seems to be doing well."
Tara recalls a young friend who suffers from bipolar disorder. "He and his parents looked into alternative medicine, and he's a fully functional, generally happy person," she said. "He took Veratrum album, St.-John's-wort and SAM-e, and he did meditations and holistic stuff. Now he does yoga. He says he was pretty bad when he was on the psycho drugs, but he's so much better now. It's really amazing."
Frankenberger notes another case in which school authorities urged that a child be medicated for what they claimed was a case of ADHD. "The parents resisted, and he ended up being the class valedictorian in a large high school."
It is true that sometimes meditation isn't enough and medication is necessary -- but only sometimes. Medicating an emotionally disturbed child, even under a doctor's supervision, is potentially dangerous and should not be undertaken lightly. Parents and teachers need to take a close look at their own emotional needs and motives before making any fateful decisions. If they feel overwhelmed, better alternatives exist to simply drugging the child into obedience.
"I don't know if medications would have made any difference for me," said Jewel St. Michel, an adult who has struggled with ADHD all of her life, as have many of her relatives. "I know that the only real help for me has been self-knowledge, research and a retinue of nutritional supplements that have brought me to near normalcy in many ways."
St. Michel did not receive medication for her disorder as a child. "Most people rely on schools and TV and day care to raise their kids," she said. "If kids had a lot more family activity, more social outlets, more emotionally supportive, understanding resources in their lives -- maybe some kind of spiritual touchstone or family traditions to lean on -- I think they might be better equipped for dealing with ADD and whatever else their 'different' brain has in store for them."
from Reuters via MSNBC, 2001-Nov-11:
Ritalin may alter brain, study shows
Changes appear similar to those caused by amphetamineThe stimulant Ritalin, a drug used to help children with attention deficit hyperactivity disorder, may cause long-term changes in the brain, researchers reported on Sunday.
The changes look similar to those seen with other stimulants such as amphetamine and cocaine, at least in rats, the team at the University of Buffalo found.
"Clinicians consider Ritalin to be short-acting," Joan Baizer, a professor of physiology and biophysics who led the study said in a statement.
"When the active dose has worked its way through the system, they consider it `all gone.' Our research with gene expression in an animal model suggests that it has the potential for causing long-lasting changes in brain cell structure and function."
But Baizer said that Ritalin, known generically as methylphenidate, probably is not addictive in the way drugs of abuse are if it is used properly.
`NEED TO LOOK MORE CLOSELY'
"Children have been given Ritalin daily for many years, and it is extremely effective and beneficial, but it's not quite as simple as a short-acting drug," she said. "We need to look at it more closely."
High doses of amphetamine and cocaine have been found to switch on genes known as "immediate early genes" in brain cells. One of the genes, called c-fos, has been linked with addiction when it is activated in certain parts of the brain.
The researchers gave rat pups sweetened milk carrying methylphenidate in comparable doses and at similar times to what a child would get.
C-fos genes were activated in their brains in a pattern similar to that seen in cocaine and amphetamine use, the researchers told a meeting of the Society for Neuroscience in San Diego.
"These data do suggest that there are effects of Ritalin on cell function that outlast the short term and we should sort that out," Baizer said.
She said perhaps a gene chip - a microarray - could be used to see just which genes are turned on and off by methylphenidate.
from Insight Magazine, 2001-Sep-7, by Kelly Patricia O’Meara:
New Research Indicts Ritalin
A recent study reveals that the drug being prescribed to tens of millions of school-age children for a scientifically unproved mental disorder is more potent than cocaine.
Thirty years ago the World Health Organization (WHO) concluded that Ritalin was pharmacologically similar to cocaine in the pattern of abuse it fostered and cited it as a Schedule II drug — the most addictive in medical use. The Department of Justice also cited Ritalin as a Schedule II drug under the Controlled Substances Act, and the Drug Enforcement Agency (DEA) warned that “Ritalin substitutes for cocaine and d-amphetamine in a number of behavioral paradigms.”
Despite decades of official warnings and supporting research confirming the similarities of methylphenidate (Ritalin) and cocaine, tens of millions of children in the United States have been prescribed this psychotropic drug for a widely accepted yet scientifically unproved mental condition: attention-deficit/hyperactivity disorder (ADHD). Now a recently concluded study at the Brookhaven National Laboratory (BNL) not only confirms the similarities of cocaine and Ritalin, but finds that Ritalin is more potent than cocaine in its effect on the dopamine system, which many doctors believe is one of the areas of the brain most affected by drugs such as Ritalin and cocaine.
The outcome of this research was so surprising that team leader Nora Volkow, a psychiatrist who is associate laboratory director for life sciences at BNL, told the media that she and the team were “shocked as hell” at the results. “The data,” explains Volkow, “clearly show that the notion that Ritalin is a weak stimulant is completely incorrect.”
This revelation should be of no surprise to the medical and psychiatric communities, given the already documented warnings about methylphenidate by federal law-enforcement agencies and international organizations, but it is noteworthy on one level. Volkow’s newly released research reinforces what critics long have known — that the “medication” being prescribed for ADHD is not merely similar to cocaine but is in fact more potent. And the results raise further questions about the validity and repercussions of having an entire generation of children diagnosed with a “mental disorder” or “brain disease” which to date has no basis in physical science.
Volkow’s findings, published in the Journal of Neuroscience and reported in the Journal of the American Medical Association, may act as a wake-up call to parents, educators and lawmakers who have yet to address the question of whether ADHD is a real physical, medical or neurological disease that can be scientifically confirmed or is even confirmable. Because the ADHD diagnosis is the No. 1 reason for drugging school-age children, and Volkow’s research reconfirms that Ritalin isn’t just kid stuff, parents may want to re-evaluate their child’s treatment. The numbers alone are a telling sign of where the push to medicate is going.
According to the DEA, the number of prescriptions written for Ritalin since 1991 has increased by a factor of five (2.2 million) and about 80 percent of the 11 million prescriptions written for Ritalin are to “treat” ADHD. This means that nearly 9 million children have been prescribed the cocainelike “medication.”
Furthermore, according to a study published last February in the Journal of the American Medical Association, “Trends in the Prescribing of Psychotropic Medications to Preschoolers,” psychotropic medications have tripled in preschoolers ages 2 to 4 during a five-year period. More disturbing, say critics, given Volkow’s recent revelations, is that during the last 15 years the use of Ritalin increased by 311 percent for those ages 15 to 19 and 170 percent for those ages 5 to 14.
The most recent figures available reveal that in 1998 there were approximately 46 million children in kindergarten through grade 12. Twenty percent — one of every five children in school — have been doped with the mind-altering drug.
This can be good news only for investors in the Swiss-based pharmaceutical company Novartis, which makes Ritalin. For instance, if the number of children taking the drug increased fivefold, so did the drug company’s resultant profits and (presumably) stock value. In a June 28, 1999, article, “Doping Kids,” Insight estimated that Novartis generated an increase in its stock-market value of $1,236 per child prescribed Ritalin. Based on these evaluations, the drug company would have enjoyed an increased stock-market value of approximately $10 billion or more since 1991.
In fact, the number of children being prescribed the cocainelike drug is rising at such a rate that, while good for investors, if ADHD were based on science and were a communicable disease, the Centers for Disease Control and Prevention would consider it a major medical epidemic among America’s youth. In the meantime, prescriptions continue to increase even as researchers continue to focus on the effect of psychotropic drugs such as Ritalin rather than on how scientifically to verify or validate the diagnosis. And critics of this mass drugging have become convinced that is no accident.
Take neurologist Fred Baughman for example, who tells Insight, “Yes, they have proved and we’ve known for decades that Ritalin alters/damages/changes the brain. But with no evidence that ADHD is a disease we also know that these children are normal. All this research [from Volkow at BNL] says to me is that 9 million children diagnosed as having ADHD are being damaged by Ritalin just as with cocaine and every other psychotropic drug.”
“The point,” explains Baughman, “is that normal children are being drugged exactly like the Cali and Medellín cartels, but under the guise of medication to help and with all in the medical community being knowing participants. She [Volkow] found something very alarming about Ritalin and at the same time is writing like ADHD is a proven thing — that ADHD is a real disease. It just isn’t so. It’s pure propaganda and there never has been proof of a specific chemical [or] physical abnormality in children diagnosed with the alleged ADHD. None.”
Renay Tanner, an expert in human rights and psychiatry and a doctoral candidate in sociomedical sciences at Columbia University, tells Insight, “Volkow isn’t saying anything new. She’s just looked at the issue with a different technique. The important thing to remember is that no child ever has died from ADHD, yet a number of children have died from the ‘treatment,’ not to mention the brain damage, stunted growth and suicidal feelings they experience. One has to ask why children are being targeted for the myth of the chemical imbalance when no one can show that an alleged sufferer has a chemical imbalance and no one — certainly not the medical community — even knows what such a chemical imbalance might be.”
Tanner continues: “The brain is too complex and our understanding of it is too minimal to be giving children these drugs. We know the drugs cause harm to the brain but have yet to find any real evidence that they are helpful. Sure, the drugs may shut them up, and I suppose that’s good for the parents and teachers, but is it good for the children? I strongly believe that the federal government should remove the financial incentives from school districts as a kind of reward for the number of children put on these drugs. After all, why does the government do this? Is it good intentions gone bad or social policy with unintended consequences? At the most, Volkow’s research is excellent evidence that children should not be given Ritalin. One has to ask why this research wasn’t done before millions of children were put on a mind-altering drug.”
Despite Volkow’s revelations about Ritalin’s potency, critics don’t see changes in the status quo anytime soon. Beverly Eakman, founder of the National Education Consortium, a nonprofit corporation specializing in education law, and the author of Cloning of the American Mind, tells Insight, “The agenda is to dope as many kids as possible because it makes them more suggestible — more open to doing what normally they wouldn’t do.”
According to Eakman, “These drugs make children more manageable, not necessarily better. ADHD is a phenomenon, not a ‘brain disease.’ It is culture-caused, and what we need to focus on is that we are manufacturing drugs for diseases that don’t exist. Because the diagnosis of ADHD is fraudulent, it doesn’t matter whether a drug ‘works.’ You’ve got doctors being encouraged to prescribe these drugs whenever a complaint from a patient is too difficult or costly to diagnose. Why aren’t people up in arms about the fact that children are being forced to take a drug that is stronger than cocaine for a disease that is yet to be proven?”
Critics of the ADHD diagnosis have been asking this question for years, but the psychiatric community appears to have turned more and more to medicating. A closer look at what leaders in psychiatry are saying may prove helpful. In January, for example, National Institute of Mental Health (NIMH) Director Steve Hyman reported at the NIMH Advisory Council meeting that “we can make correct clinical diagnoses if the right kind of evaluation is available to children. When proper diagnosis is made, methylphenidate/Ritalin can be safe and effective.” Hyman warned: “We ignore mood disorders in children at our peril. Just because a child is in their seat doesn’t mean they are okay.”
Critics suggest that it also doesn’t mean that they aren’t okay, and that Hyman’s remarks only confirm that psychiatric diagnosis is subjective — that diagnosis of mental health depends upon who is looking.
from The Hartford Advocate, originally from Family Therapy Networker Magazine, by Rob Waters:
Generation Rx
Troubled kids are guinea pigs in a uncontrolled national drug experiment.In the fall of 1996, Nancy Spence, a New Milford receptionist, went into her son's bedroom after work and found a note scrawled on the wall. "Somebody help me, I want to die," it said.
Her son Brian was then 11 and in the fifth grade. He had been taking Ritalin against his will and under pressure from school officials since he was 6, and a combination of stimulants and antidepressants since he was 8. He'd been seen by a psychologist; by a psychiatrist and a family therapist; by a neurologist paid for by his school district; and by another psychiatrist in private practice. No mental health professional had seen him for more than a few visits, and nobody had formed much of a relationship with him.
They had variously diagnosed Brian with Attention-Deficit Hyperactivity Disorder, or ADHD, an unspecified mood disorder and Bipolar Disorder. They had tried putting him on Ritalin, extended-release Ritalin, Dexedrine, Ritalin plus the anti-depressant Wellbutrin and Wellbutrin plus the stimulant Cylert.
All of the drugs and drug combinations had produced side effects -- physical, psychological and social. In second grade, he had been teased at school for his noontime trips to the nurse's office for Ritalin, and he had also developed subtle tics, shaking his hands and jerking his shoulders and other parts of his body. In third grade, he'd started exploding in rage at home in the afternoons as the Ritalin wore off. On Dexedrine, tried as a substitute for Ritalin, he sleepwalked through the day like a zombie, his mother recalls.
At the time that he scrawled the note on his bedroom wall, Brian was still taking Wellbutrin, an antidepressant for adults. Its potential side effects, according to the Physician's Desk Reference, or PDR, include agitation, insomnia and an increased tendency toward seizures. It has never been approved by the Food and Drug Administration as a safe and effective treatment for any childhood psychological condition. He was also still on Cylert, a central nervous system stimulant approved by the FDA as a treatment for childhood ADHD even though the PDR notes that it is associated with some childhood deaths from liver failure and can stimulate tics and Tourette's syndrome.
On this drug regimen, Brian's tics had become much more pronounced. His head and shoulders jerked uncontrollably, and his mouth would make strange blowing sounds. Once, during lunch in the school cafeteria, his arm jumped up and smacked into someone next to him, and he hung his head in embarrassment as the kids around him laughed. He dreaded going to school and nearly every day, when he came home, he hid in his bedroom and cried.
"I felt like nobody liked me," Brian, now 14, remembers as he sits with his mother at their kitchen table in the waning light of a cold autumn afternoon. "Everything was just like -- like downpours."
He had pleaded for years to be allowed to stop taking the drugs, he says, partly because they had disturbed his still-developing sense of who he was. "They made me feel a lot different," he says, groping for words, " -- like, who I am and the way I felt inside."
After discovering her son's scrawled note, Nancy Spence took Brian back to a private psychiatrist he'd seen a couple of times before. She replaced the Wellbutrin with the adult antidepressant Zoloft, a Selective Serotonin Reuptake Inhibitor, or SSRI, that has also never received FDA approval for use with depressed children. Within a week, Nancy recalls, her son became crazed. He ran into the street ignoring traffic, threw lit matches around the house and imagined conversations that never occurred.
It was then, Nancy Spence says, that she finally faced questions that had worried her for years. Were these medications really helping her son? Should she continue to make him take them, or listen to his pleas and challenge the school and medical authorities who seemed so confident of their course?
*
In the decade since they vaulted into our consciousness, America's love affair with Prozac and other antidepressants has worked its way down the age ladder. Every day, these powerful drugs are prescribed by the thousands to children in a wide range of life circumstances.
According to IMS Health, a research firm that tracks prescription drug sales, nearly 2.98 million prescriptions for antidepressants were written for children and adolescents in 1999 -- more than 11,000 new prescriptions for children every weekday.
This runaway prescribing to children -- often as a substitute for therapy and in the absence of any other intervention -- has become an uncontrolled national experiment. Its subjects are being given unproven treatments more haphazardly, and with fewer practical and legal protections, than adults who volunteer to be paid subjects in the clinical trials of new drugs.
Why is this happening? The immediate causes are easy to name: a cultural romance with biological solutions to social problems; the virtual collapse of family therapy, or any long-term therapy, as an insurance benefit for middle-class families; pressure from managed-care companies that will not fund more than four to six therapy visits without a medication evaluation; harried teachers who pressure school districts to put bored and antsy boys on Ritalin; and the capitulation of overworked and worried parents who may be given a prescription by their child's pediatrician after a seven-minute evaluation.
The ultimate causes, however, lie deeper. In a culture addicted to drugs and quick fixes, but reluctant to confront children's pain, it has become easier and cheaper to medicate kids than to provide them with the time and attention they need from parents, teachers, therapists, mentors and coaches.
By default, this national drug treatment experiment is being carried out in large part by harried pediatricians and family doctors on the front lines -- doctors usually untrained in psychiatry or in treating childhood depression.
Researchers at Kaiser Permanente, the nation's largest health maintenance organization, for instance, recently found that 60 percent of the children ages 12 to 17 who were seen for depression at Kaiser Permanente clinics in Portland, Ore., in 1998 were prescribed antidepressants not by psychiatrists, but by pediatricians. Likewise, a survey presented in May 1999 to the Pediatric Academic Societies' annual meeting found that of nearly 600 pediatricians and family practitioners in North Carolina, 72 percent had prescribed antidepressants to children or adolescents. Nearly one-third had prescribed to children between the ages of 6 and 12. Yet only 8 percent of the doctors thought they were adequately trained in the management of childhood depression. A Clinton administration plan, announced last month, would limit the use of psychoactive drugs on preschoolers but would not affect school-age children.
Some doctors say they are uneasy about prescribing psychoactive drugs to kids, but do so because they doubt that the child's family can get around managed care's barriers to therapy. If he refers a child for therapy, says pediatrician and University of Michigan researcher Jerry Rushton, a health plan may refuse to pay or create months of delays, and parents may fail to follow up. "So sometimes you start them on the meds, and you wait and you hope."
Among poor children, often served by overworked doctors at public health clinics, psychiatric prescribing has been even more haphazard. Looking through the 1996 records of Michigan Medicaid patients, pediatrician Marsha Rappley of Michigan State University and her colleagues found 223 children, all under 3, who had been diagnosed with ADHD. Only one-quarter had received any psychological services. Nearly 60 percent had been medicated with 22 different psychoactive drugs. Medications were often piled on top of one another. In what amounted to medication roulette, one child under 3 had been given, over time, six different medications that affect central nervous system function.
How can children as young as 2 or 3 -- incapable of much self-awareness or cogent speech -- even be effectively diagnosed? With virtually no research on the effects of medicating them, what are clinicians using for guidance -- besides guesswork?
The pressure to medicate comes not only from the urgency physicians feel to do something, anything, for a suffering child. Managed care has transformed the landscape of American medicine. Although psychoactive meds have been given to children since the 1940s, child psychiatrist Joseph Woolston, the medical director of the children's psychiatric unit at Yale-New Haven Hospital, says the practice has skyrocketed over the past five years under managed care.
"The pressure to medicate children has increased enormously," says Woolston. "Every single day, we have at least one case where the managed care reviewer says to us, 'If you don't start the child on medications within 24 hours after admission, we will not fund another day of hospital.' "
Even more alarming, says Woolston, is the increasingly common practice of putting "probably tens of thousands of kids" on almost random combinations of psychoactive medications. "We're using them as guinea pigs, and we're not even keeping track of them. It's scary."
*
A strong proponent of medicating depressed children is Harold Koplewicz, M.D., director of New York University's Child Study Center. He argues that medication is often the only way to help children with what he considers biologically based, genetically inherited vulnerability to depression and other psychological disorders.
"I say that psychiatric illness is not caused by bad parenting. It is not that your mother got divorced, or that your father didn't wipe you the right way," says Koplewicz. He has written a book called It's Nobody's Fault, with a message many parents find appealing. "It really is DNA roulette: You got blue eyes, blond hair, sometimes a musical ear, but sometimes you get the predisposition for depression."
But what is the scientific basis for the faith that pharmaceuticals for depressed children are far more effective than therapy? So far, the research is unconvincing. At least 13 double-blind, controlled studies of tricyclic antidepressants, and two involving SSRIs, have failed to prove that these powerful drugs provide more than a marginal advantage over placebos when they are given to children.
The most often-cited child study, published in 1997 in the Archives of General Psychiatry, followed 96 severely depressed children who were given Prozac by researcher Graham Emslie of the University of Texas Southwestern Medical Center. After eight weeks, 56 percent of the children on Prozac showed some improvement according to the clinicians who saw them, compared with 33 percent of the kids in the placebo group.
But in their self-evaluations, the kids on Prozac felt they improved only modestly, and not much more than the kids who had taken placebos. And 70 percent of the kids on Prozac still had significant symptoms of depression at the end of the eight weeks.
The FDA has not yet approved the marketing or labeling of any of the SSRIs as safe and effective treatments for childhood depression. But drugs don't have to be proven, labeled or marketed as safe to be legally prescribed to children: Once a drug has cleared the FDA as a safe and effective treatment for one group of patients (in this case, depressed adults), doctors can legally prescribe it to anyone of any age for any reason. Most depressed children who are put on antidepressants receive them under this common practice, known as "off-label" prescribing.
Off-label prescribing to children is extremely troubling in light of cautionary research, published since the early 1990s, suggesting that some children suffer severe, life-threatening side effects on antidepressants and may be too young to alert their caregivers to their problems.
Since 1990, for instance, there have been reports of sudden cardiac arrest and death in seven children taking the older antidepressants desipramine and imipramine, according to a March 1997 report in the Journal of the American Academy of Child and Adolescent Psychiatry. And in the March 1991 issue of the same journal, researchers at the Yale Child Study Center described the cases of six children, ages 10 to 17, who became self-injurious or suicidal while being treated with Prozac for Obsessive-Compulsive Disorder. One 12-year-old boy had nightmares about killing his classmates and daydreamed about killing himself. A 14-year-old girl suffered a near-total breakdown on the drug, scratching her wrists with a knife, slamming a chair on her toes and becoming so violent and agitated she regularly had to be placed in restraints.
Not all side effects reveal themselves with such drama that adults take immediate notice. That makes them especially deadly for children, especially when combined with hurried psychiatric evaluations and poor or nonexistent monitoring. In June 1997, for instance, Matthew Miller, a 13-year-old from Overland Park, Kan., went with his parents to see a psychiatrist assigned through their HMO. According to his father, Mark, an advertising executive, Matthew had been moody and withdrawn for about nine months, since the family moved to a new neighborhood and Matthew started attending a new school. Despite the likelihood that Matthew's depression was situational rather than biological, therapy was not tried.
Instead, the HMO psychiatrist met twice with Matthew and his parents. Matthew had little to say, but his father says that he did tell the doctor that he would never consider suicide. After having Matthew take a computer evaluation, the doctor ruled out Attention-Deficit Disorder. According to Matthew's father, the doctor offered no other diagnosis, but gave the Millers a three-week supply of Zoloft for Matthew, telling them to call back in a week.
Matthew started on the drug the next morning. As the week went by, family members noticed he was becoming more nervous and agitated. On the morning of day seven, he could barely sit still in his seat and argued more than usual with his sister. Sometime that night, after taking his sixth or seventh capsule of Zoloft, 13-year-old Matthew went into his bedroom closet and hanged himself with a belt.
Stories as tragic and dramatic as these are rare. Perhaps more troubling, for the millions of children taking SSRIs, is preliminary evidence that they may affect the architecture of developing brains.
A study published in the January 1999 Journal of Child and Adolescent Psychopharmacology found that Prozac given to young rats caused permanent changes in brain cells. Administering the drug at a time when the brain is still plastic, cautioned authors Viola Wegerer, M.D., and her colleagues, "may trigger adaptive responses which are different from those seen in the mature brain and which may persist for long periods after the discontinuation of the treatment, maybe even for the rest of an individual's lifetime."
*
The research with young rats could be a warning signal, leading us to conclude that antidepressants should be prescribed to kids with utmost caution, and only when absolutely necessary. But therapists in private practice say managed care reviewers almost automatically suggest referring children out for a medication evaluation after four to six sessions, even when a child's distress seems clearly related to a parental divorce or other interpersonal problem.
"Managed care sees this as a cheap way to get rid of the problem," says Phoebe Cirio, a child psychologist in St. Louis. "They think of antidepressants as equivalent to antibiotics -- let's get in there and kill the germs."
When therapists resist the pressure to medicate, they run the risk of not being able to treat the child at all. In 1997, Mary Lou Sharrar, an Oakland, Calif., therapist, started working with a depressed 5-year-old girl. Her parents had recently separated and had joint physical custody. "She worried about whose house she was going to be at, what her mother's and father's moods would be," says Sharrar. "She felt abandoned by her parents."
After 10 or 12 sessions, Sharrar says, a managed care reviewer refused to authorize further sessions and suggested the girl go on Ritalin. "I said this is a depressed little girl, only 5 years old, and I didn't think Ritalin was the answer," Sharrar recalls. "And they said, 'In that case, let's consider antidepressants.' "
When Sharrar refused to refer the girl for medication, the insurance payments stopped, and the little girl's parents paid for only a few further sessions before withdrawing the girl from therapy.
In another case, Sharrar says, she saw a depressed teenage boy who was trying to come to terms with his gay identity while grappling with his parents' disapproval. Managed care reviewers told Sharrar they would not pay for more than 10 sessions unless the boy started taking antidepressants. Sharrar again refused medication, managed to get 12 sessions paid for the next year and then continued to see the boy without charge when his insurance and his parents refused to pay, providing him with the thing he most needed -- a supportive relationship.
"He had an attachment to me," says Sharrar. "He realized I was there for him."
But neither attachment nor the helpfulness of a long-term, caring relationship with an adult or mentor (well-established as factors in childhood resilience) is concrete enough for managed care. Ian Shaffer, the chief medical officer of ValueOptions in Falls Church, Va., readily concedes that his company requires therapists who treat children, like those who treat adults, to show quantifiable improvement.
"In any treatment where progress is not taking place, we need to ask what is the next step," Shaffer says. "And in disorders where medication has proven to be effective, we might suggest a medication evaluation to determine if they would be helpful."
*
Jan and Ed Perkins, a northern California couple, belong to an HMO that has prescribed three different medication combinations for their 11-year-old daughter, Amber, since she was 3. The Perkinses are grateful for the relief medications have provided, but they wonder how to help their daughter in the future and whether they've relied too much on the drugs.
By the time Amber was 2 1/2, they recall, she was throwing terrible tantrums and swearing at her parents. "Nothing we would do to comfort her would help," says Ed, a special education teacher, as he sits with Jan, a preschool director, in the living room of their cozy home in the foothills east of Oakland. "She would scream, she would grab things and throw things, she would kick the walls." A psychologist at their HMO, Kaiser Permanente, referred them to a parenting class. Nothing worked for long.
Family or individual therapy was not suggested. Instead, when Amber was 3 1/2, a Kaiser psychiatrist prescribed a combination of Ritalin and clonidine and diagnosed ADHD and other problems. The Perkinses -- minus Amber -- saw the psychiatrist every few weeks to report on how things were going.
"He prescribed the medications, but he wasn't really interested in seeing her on a regular basis. That's kind of the way Kaiser works," says Ed.
The drugs helped, Ed recalls, but not much. So the psychiatrist added a third drug, the tricyclic antidepressant imipramine, when Amber was 4, and she remained on that combination until she was 10. Last year a new psychiatrist prescribed Ritalin, an antiseizure medication and a newer antidepressant.
Amber says she is glad she is on the medications and has a tough time without them. On a warm autumn afternoon, she sprawls on the couch, her head leaning against her mother, her thin legs splayed across her father's lap. On medication, she says, "I can concentrate more. I can get my homework done -- sometimes," she laughs. "I don't know if I could keep from blowing up for one day without the medication."
But she, too, expresses confusion about who, in fact, she is. When things are going well, she says, she's not sure why. "Sometimes I think it's me and sometimes I think it's the medicine. It's pretty hard to tell."
*
Both Amber and her parents feel that medication for now is the best option. Brian Spence, the New Milford boy who scrawled a suicide message on his wall, felt differently: He had been pleading with his mother, Nancy, to let him get off drugs since he was 6 years old. His mother even agreed once, but when the school threatened to allow Brian to only attend a half day of school unless he took medication, she backed down.
When Brian began throwing lighted matches and imagining conversations, her ambivalence finally broke. "I decided I wanted him off all these medications," she says. "I wanted to know who Brian really was. It had been six years, and I'd had enough."
Brian's journey out of the uncharted world of medication took place with even less medical care and supervision than his six-year excursion into it. When Nancy called Brian's psychiatrist to ask for help, she never even got a call back. So she consulted books and tapered her son off Zoloft and Cylert over the course of three weeks. Within a week of stopping, Brian says, he began to feel his depression lift.
Brian no longer takes antidepressants or stimulants, but does take clonidine to control his tics. Sitting in his kitchen, listening to the rap group Wu-Tang Clan on his headset, he answers my questions haltingly at first. But after a while, the stocky teenager opens up a bit, raising his head from beneath his baseball cap to make occasional eye contact. Pushing the headphones off, he walks over to the kitchen cupboard and pulls three pill bottles off the shelf. "These medications," he says, "they made me uncomfortable to where I just didn't like me."
Today, Brian says, he feels happier and more in control of his life -- though his mother says he still copes with depression around the winter holidays. "I'm popular, I like school better and I like my life better," he says.
Thus, Brian opted out from a continuing role as an unwilling subject in this vast, national experiment. But he is an exception to the larger trend: In the years since Brian's journey began in 1991, more than 1 million more children have been placed on psychiatric medications. Every day, prescriptions are written for other depressed and troubled kids for drugs that affect the central nervous system, promote seizures, stunt growth and blunt sexual response. Children continue to be unwitting subjects in a national experiment whose final cost is still unknown.
The most central principle of medicine is "Do no harm." A cardinal principle of ethical research is that nobody should be exposed to severe risks when the potential benefits of a drug are marginal. Researchers have not come close to proving that these drugs are markedly better than therapy, or even placebo, for troubled children. Why, then, do we continue to treat so many of them as guinea pigs?
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The families interviewed for this piece have been given different names. Copyright 2000 Rob Waters and Family Therapy Networker Magazine, 7705 13th St. N.W. Washington, DC 20012. ETNetwork@aol.com. Reprinted [by Hartford Advocate -AMPP Ed.] by permission.
from the New York Times, 2002-Jul-7, by Gary Taubes:
What if It's All Been a Big Fat Lie?
If the members of the American medical establishment were to have a collective find-yourself-standing-naked-in-Times-Square-type nightmare, this might be it. They spend 30 years ridiculing Robert Atkins, author of the phenomenally-best-selling ''Dr. Atkins' Diet Revolution'' and ''Dr. Atkins' New Diet Revolution,'' accusing the Manhattan doctor of quackery and fraud, only to discover that the unrepentant Atkins was right all along. Or maybe it's this: they find that their very own dietary recommendations -- eat less fat and more carbohydrates -- are the cause of the rampaging epidemic of obesity in America. Or, just possibly this: they find out both of the above are true.
When Atkins first published his ''Diet Revolution'' in 1972, Americans were just coming to terms with the proposition that fat -- particularly the saturated fat of meat and dairy products -- was the primary nutritional evil in the American diet. Atkins managed to sell millions of copies of a book promising that we would lose weight eating steak, eggs and butter to our heart's desire, because it was the carbohydrates, the pasta, rice, bagels and sugar, that caused obesity and even heart disease. Fat, he said, was harmless.
Atkins allowed his readers to eat ''truly luxurious foods without limit,'' as he put it, ''lobster with butter sauce, steak with bearnaise sauce . . . bacon cheeseburgers,'' but allowed no starches or refined carbohydrates, which means no sugars or anything made from flour. Atkins banned even fruit juices, and permitted only a modicum of vegetables, although the latter were negotiable as the diet progressed.
Atkins was by no means the first to get rich pushing a high-fat diet that restricted carbohydrates, but he popularized it to an extent that the American Medical Association considered it a potential threat to our health. The A.M.A. attacked Atkins's diet as a ''bizarre regimen'' that advocated ''an unlimited intake of saturated fats and cholesterol-rich foods,'' and Atkins even had to defend his diet in Congressional hearings.
Thirty years later, America has become weirdly polarized on the subject of weight. On the one hand, we've been told with almost religious certainty by everyone from the surgeon general on down, and we have come to believe with almost religious certainty, that obesity is caused by the excessive consumption of fat, and that if we eat less fat we will lose weight and live longer. On the other, we have the ever-resilient message of Atkins and decades' worth of best-selling diet books, including ''The Zone,'' ''Sugar Busters'' and ''Protein Power'' to name a few. All push some variation of what scientists would call the alternative hypothesis: it's not the fat that makes us fat, but the carbohydrates, and if we eat less carbohydrates we will lose weight and live longer.
The perversity of this alternative hypothesis is that it identifies the cause of obesity as precisely those refined carbohydrates at the base of the famous Food Guide Pyramid -- the pasta, rice and bread -- that we are told should be the staple of our healthy low-fat diet, and then on the sugar or corn syrup in the soft drinks, fruit juices and sports drinks that we have taken to consuming in quantity if for no other reason than that they are fat free and so appear intrinsically healthy. While the low-fat-is-good-health dogma represents reality as we have come to know it, and the government has spent hundreds of millions of dollars in research trying to prove its worth, the low-carbohydrate message has been relegated to the realm of unscientific fantasy.
Over the past five years, however, there has been a subtle shift in the scientific consensus. It used to be that even considering the possibility of the alternative hypothesis, let alone researching it, was tantamount to quackery by association. Now a small but growing minority of establishment researchers have come to take seriously what the low-carb-diet doctors have been saying all along. Walter Willett, chairman of the department of nutrition at the Harvard School of Public Health, may be the most visible proponent of testing this heretic hypothesis. Willett is the de facto spokesman of the longest-running, most comprehensive diet and health studies ever performed, which have already cost upward of $100 million and include data on nearly 300,000 individuals. Those data, says Willett, clearly contradict the low-fat-is-good-health message ''and the idea that all fat is bad for you; the exclusive focus on adverse effects of fat may have contributed to the obesity epidemic.''
These researchers point out that there are plenty of reasons to suggest that the low-fat-is-good-health hypothesis has now effectively failed the test of time. In particular, that we are in the midst of an obesity epidemic that started around the early 1980's, and that this was coincident with the rise of the low-fat dogma. (Type 2 diabetes, the most common form of the disease, also rose significantly through this period.) They say that low-fat weight-loss diets have proved in clinical trials and real life to be dismal failures, and that on top of it all, the percentage of fat in the American diet has been decreasing for two decades. Our cholesterol levels have been declining, and we have been smoking less, and yet the incidence of heart disease has not declined as would be expected. ''That is very disconcerting,'' Willett says. ''It suggests that something else bad is happening.''
The science behind the alternative hypothesis can be called Endocrinology 101, which is how it's referred to by David Ludwig, a researcher at Harvard Medical School who runs the pediatric obesity clinic at Children's Hospital Boston, and who prescribes his own version of a carbohydrate-restricted diet to his patients. Endocrinology 101 requires an understanding of how carbohydrates affect insulin and blood sugar and in turn fat metabolism and appetite. This is basic endocrinology, Ludwig says, which is the study of hormones, and it is still considered radical because the low-fat dietary wisdom emerged in the 1960's from researchers almost exclusively concerned with the effect of fat on cholesterol and heart disease. At the time, Endocrinology 101 was still underdeveloped, and so it was ignored. Now that this science is becoming clear, it has to fight a quarter century of anti-fat prejudice.
The alternative hypothesis also comes with an implication that is worth considering for a moment, because it's a whopper, and it may indeed be an obstacle to its acceptance. If the alternative hypothesis is right -- still a big ''if'' -- then it strongly suggests that the ongoing epidemic of obesity in America and elsewhere is not, as we are constantly told, due simply to a collective lack of will power and a failure to exercise. Rather it occurred, as Atkins has been saying (along with Barry Sears, author of ''The Zone''), because the public health authorities told us unwittingly, but with the best of intentions, to eat precisely those foods that would make us fat, and we did. We ate more fat-free carbohydrates, which, in turn, made us hungrier and then heavier. Put simply, if the alternative hypothesis is right, then a low-fat diet is not by definition a healthy diet. In practice, such a diet cannot help being high in carbohydrates, and that can lead to obesity, and perhaps even heart disease. ''For a large percentage of the population, perhaps 30 to 40 percent, low-fat diets are counterproductive,'' says Eleftheria Maratos-Flier, director of obesity research at Harvard's prestigious Joslin Diabetes Center. ''They have the paradoxical effect of making people gain weight.''
Scientists are still arguing about fat, despite a century of research, because the regulation of appetite and weight in the human body happens to be almost inconceivably complex, and the experimental tools we have to study it are still remarkably inadequate. This combination leaves researchers in an awkward position. To study the entire physiological system involves feeding real food to real human subjects for months or years on end, which is prohibitively expensive, ethically questionable (if you're trying to measure the effects of foods that might cause heart disease) and virtually impossible to do in any kind of rigorously controlled scientific manner. But if researchers seek to study something less costly and more controllable, they end up studying experimental situations so oversimplified that their results may have nothing to do with reality. This then leads to a research literature so vast that it's possible to find at least some published research to support virtually any theory. The result is a balkanized community -- ''splintered, very opinionated and in many instances, intransigent,'' says Kurt Isselbacher, a former chairman of the Food and Nutrition Board of the National Academy of Science -- in which researchers seem easily convinced that their preconceived notions are correct and thoroughly uninterested in testing any other hypotheses but their own.
What's more, the number of misconceptions propagated about the most basic research can be staggering. Researchers will be suitably scientific describing the limitations of their own experiments, and then will cite something as gospel truth because they read it in a magazine. The classic example is the statement heard repeatedly that 95 percent of all dieters never lose weight, and 95 percent of those who do will not keep it off. This will be correctly attributed to the University of Pennsylvania psychiatrist Albert Stunkard, but it will go unmentioned that this statement is based on 100 patients who passed through Stunkard's obesity clinic during the Eisenhower administration.
With these caveats, one of the few reasonably reliable facts about the obesity epidemic is that it started around the early 1980's. According to Katherine Flegal, an epidemiologist at the National Center for Health Statistics, the percentage of obese Americans stayed relatively constant through the 1960's and 1970's at 13 percent to 14 percent and then shot up by 8 percentage points in the 1980's. By the end of that decade, nearly one in four Americans was obese. That steep rise, which is consistent through all segments of American society and which continued unabated through the 1990's, is the singular feature of the epidemic. Any theory that tries to explain obesity in America has to account for that. Meanwhile, overweight children nearly tripled in number. And for the first time, physicians began diagnosing Type 2 diabetes in adolescents. Type 2 diabetes often accompanies obesity. It used to be called adult-onset diabetes and now, for the obvious reason, is not.
So how did this happen? The orthodox and ubiquitous explanation is that we live in what Kelly Brownell, a Yale psychologist, has called a ''toxic food environment'' of cheap fatty food, large portions, pervasive food advertising and sedentary lives. By this theory, we are at the Pavlovian mercy of the food industry, which spends nearly $10 billion a year advertising unwholesome junk food and fast food. And because these foods, especially fast food, are so filled with fat, they are both irresistible and uniquely fattening. On top of this, so the theory goes, our modern society has successfully eliminated physical activity from our daily lives. We no longer exercise or walk up stairs, nor do our children bike to school or play outside, because they would prefer to play video games and watch television. And because some of us are obviously predisposed to gain weight while others are not, this explanation also has a genetic component -- the thrifty gene. It suggests that storing extra calories as fat was an evolutionary advantage to our Paleolithic ancestors, who had to survive frequent famine. We then inherited these ''thrifty'' genes, despite their liability in today's toxic environment.
This theory makes perfect sense and plays to our puritanical prejudice that fat, fast food and television are innately damaging to our humanity. But there are two catches. First, to buy this logic is to accept that the copious negative reinforcement that accompanies obesity -- both socially and physically -- is easily overcome by the constant bombardment of food advertising and the lure of a supersize bargain meal. And second, as Flegal points out, little data exist to support any of this. Certainly none of it explains what changed so significantly to start the epidemic. Fast-food consumption, for example, continued to grow steadily through the 70's and 80's, but it did not take a sudden leap, as obesity did.
As far as exercise and physical activity go, there are no reliable data before the mid-80's, according to William Dietz, who runs the division of nutrition and physical activity at the Centers for Disease Control; the 1990's data show obesity rates continuing to climb, while exercise activity remained unchanged. This suggests the two have little in common. Dietz also acknowledged that a culture of physical exercise began in the United States in the 70's -- the ''leisure exercise mania,'' as Robert Levy, director of the National Heart, Lung and Blood Institute, described it in 1981 -- and has continued through the present day.
As for the thrifty gene, it provides the kind of evolutionary rationale for human behavior that scientists find comforting but that simply cannot be tested. In other words, if we were living through an anorexia epidemic, the experts would be discussing the equally untestable ''spendthrift gene'' theory, touting evolutionary advantages of losing weight effortlessly. An overweight homo erectus, they'd say, would have been easy prey for predators.
It is also undeniable, note students of Endocrinology 101, that mankind never evolved to eat a diet high in starches or sugars. ''Grain products and concentrated sugars were essentially absent from human nutrition until the invention of agriculture,'' Ludwig says, ''which was only 10,000 years ago.'' This is discussed frequently in the anthropology texts but is mostly absent from the obesity literature, with the prominent exception of the low-carbohydrate-diet books.
What's forgotten in the current controversy is that the low-fat dogma itself is only about 25 years old. Until the late 70's, the accepted wisdom was that fat and protein protected against overeating by making you sated, and that carbohydrates made you fat. In ''The Physiology of Taste,'' for instance, an 1825 discourse considered among the most famous books ever written about food, the French gastronome Jean Anthelme Brillat-Savarin says that he could easily identify the causes of obesity after 30 years of listening to one ''stout party'' after another proclaiming the joys of bread, rice and (from a ''particularly stout party'') potatoes. Brillat-Savarin described the roots of obesity as a natural predisposition conjuncted with the ''floury and feculent substances which man makes the prime ingredients of his daily nourishment.'' He added that the effects of this fecula -- i.e., ''potatoes, grain or any kind of flour'' -- were seen sooner when sugar was added to the diet.
This is what my mother taught me 40 years ago, backed up by the vague observation that Italians tended toward corpulence because they ate so much pasta. This observation was actually documented by Ancel Keys, a University of Minnesota physician who noted that fats ''have good staying power,'' by which he meant they are slow to be digested and so lead to satiation, and that Italians were among the heaviest populations he had studied. According to Keys, the Neapolitans, for instance, ate only a little lean meat once or twice a week, but ate bread and pasta every day for lunch and dinner. ''There was no evidence of nutritional deficiency,'' he wrote, ''but the working-class women were fat.''
By the 70's, you could still find articles in the journals describing high rates of obesity in Africa and the Caribbean where diets contained almost exclusively carbohydrates. The common thinking, wrote a former director of the Nutrition Division of the United Nations, was that the ideal diet, one that prevented obesity, snacking and excessive sugar consumption, was a diet ''with plenty of eggs, beef, mutton, chicken, butter and well-cooked vegetables.'' This was the identical prescription Brillat-Savarin put forth in 1825.
It was Ancel Keys, paradoxically, who introduced the low-fat-is-good-health dogma in the 50's with his theory that dietary fat raises cholesterol levels and gives you heart disease. Over the next two decades, however, the scientific evidence supporting this theory remained stubbornly ambiguous. The case was eventually settled not by new science but by politics. It began in January 1977, when a Senate committee led by George McGovern published its ''Dietary Goals for the United States,'' advising that Americans significantly curb their fat intake to abate an epidemic of ''killer diseases'' supposedly sweeping the country. It peaked in late 1984, when the National Institutes of Health officially recommended that all Americans over the age of 2 eat less fat. By that time, fat had become ''this greasy killer'' in the memorable words of the Center for Science in the Public Interest, and the model American breakfast of eggs and bacon was well on its way to becoming a bowl of Special K with low-fat milk, a glass of orange juice and toast, hold the butter -- a dubious feast of refined carbohydrates.
In the intervening years, the N.I.H. spent several hundred million dollars trying to demonstrate a connection between eating fat and getting heart disease and, despite what we might think, it failed. Five major studies revealed no such link. A sixth, however, costing well over $100 million alone, concluded that reducing cholesterol by drug therapy could prevent heart disease. The N.I.H. administrators then made a leap of faith. Basil Rifkind, who oversaw the relevant trials for the N.I.H., described their logic this way: they had failed to demonstrate at great expense that eating less fat had any health benefits. But if a cholesterol-lowering drug could prevent heart attacks, then a low-fat, cholesterol-lowering diet should do the same. ''It's an imperfect world,'' Rifkind told me. ''The data that would be definitive is ungettable, so you do your best with what is available.''
Some of the best scientists disagreed with this low-fat logic, suggesting that good science was incompatible with such leaps of faith, but they were effectively ignored. Pete Ahrens, whose Rockefeller University laboratory had done the seminal research on cholesterol metabolism, testified to McGovern's committee that everyone responds differently to low-fat diets. It was not a scientific matter who might benefit and who might be harmed, he said, but ''a betting matter.'' Phil Handler, then president of the National Academy of Sciences, testified in Congress to the same effect in 1980. ''What right,'' Handler asked, ''has the federal government to propose that the American people conduct a vast nutritional experiment, with themselves as subjects, on the strength of so very little evidence that it will do them any good?''
Nonetheless, once the N.I.H. signed off on the low-fat doctrine, societal forces took over. The food industry quickly began producing thousands of reduced-fat food products to meet the new recommendations. Fat was removed from foods like cookies, chips and yogurt. The problem was, it had to be replaced with something as tasty and pleasurable to the palate, which meant some form of sugar, often high-fructose corn syrup. Meanwhile, an entire industry emerged to create fat substitutes, of which Procter & Gamble's olestra was first. And because these reduced-fat meats, cheeses, snacks and cookies had to compete with a few hundred thousand other food products marketed in America, the industry dedicated considerable advertising effort to reinforcing the less-fat-is-good-health message. Helping the cause was what Walter Willett calls the ''huge forces'' of dietitians, health organizations, consumer groups, health reporters and even cookbook writers, all well-intended missionaries of healthful eating.
Few experts now deny that the low-fat message is radically oversimplified. If nothing else, it effectively ignores the fact that unsaturated fats, like olive oil, are relatively good for you: they tend to elevate your good cholesterol, high-density lipoprotein (H.D.L.), and lower your bad cholesterol, low-density lipoprotein (L.D.L.), at least in comparison to the effect of carbohydrates. While higher L.D.L. raises your heart-disease risk, higher H.D.L. reduces it.
What this means is that even saturated fats -- a k a, the bad fats -- are not nearly as deleterious as you would think. True, they will elevate your bad cholesterol, but they will also elevate your good cholesterol. In other words, it's a virtual wash. As Willett explained to me, you will gain little to no health benefit by giving up milk, butter and cheese and eating bagels instead.
But it gets even weirder than that. Foods considered more or less deadly under the low-fat dogma turn out to be comparatively benign if you actually look at their fat content. More than two-thirds of the fat in a porterhouse steak, for instance, will definitively improve your cholesterol profile (at least in comparison with the baked potato next to it); it's true that the remainder will raise your L.D.L., the bad stuff, but it will also boost your H.D.L. The same is true for lard. If you work out the numbers, you come to the surreal conclusion that you can eat lard straight from the can and conceivably reduce your risk of heart disease.
The crucial example of how the low-fat recommendations were oversimplified is shown by the impact -- potentially lethal, in fact -- of low-fat diets on triglycerides, which are the component molecules of fat. By the late 60's, researchers had shown that high triglyceride levels were at least as common in heart-disease patients as high L.D.L. cholesterol, and that eating a low-fat, high-carbohydrate diet would, for many people, raise their triglyceride levels, lower their H.D.L. levels and accentuate what Gerry Reaven, an endocrinologist at Stanford University, called Syndrome X. This is a cluster of conditions that can lead to heart disease and Type 2 diabetes.
It took Reaven a decade to convince his peers that Syndrome X was a legitimate health concern, in part because to accept its reality is to accept that low-fat diets will increase the risk of heart disease in a third of the population. ''Sometimes we wish it would go away because nobody knows how to deal with it,'' said Robert Silverman, an N.I.H. researcher, at a 1987 N.I.H. conference. ''High protein levels can be bad for the kidneys. High fat is bad for your heart. Now Reaven is saying not to eat high carbohydrates. We have to eat something.''
Surely, everyone involved in drafting the various dietary guidelines wanted Americans simply to eat less junk food, however you define it, and eat more the way they do in Berkeley, Calif. But we didn't go along. Instead we ate more starches and refined carbohydrates, because calorie for calorie, these are the cheapest nutrients for the food industry to produce, and they can be sold at the highest profit. It's also what we like to eat. Rare is the person under the age of 50 who doesn't prefer a cookie or heavily sweetened yogurt to a head of broccoli.
''All reformers would do well to be conscious of the law of unintended consequences,'' says Alan Stone, who was staff director for McGovern's Senate committee. Stone told me he had an inkling about how the food industry would respond to the new dietary goals back when the hearings were first held. An economist pulled him aside, he said, and gave him a lesson on market disincentives to healthy eating: ''He said if you create a new market with a brand-new manufactured food, give it a brand-new fancy name, put a big advertising budget behind it, you can have a market all to yourself and force your competitors to catch up. You can't do that with fruits and vegetables. It's harder to differentiate an apple from an apple.''
Nutrition researchers also played a role by trying to feed science into the idea that carbohydrates are the ideal nutrient. It had been known, for almost a century, and considered mostly irrelevant to the etiology of obesity, that fat has nine calories per gram compared with four for carbohydrates and protein. Now it became the fail-safe position of the low-fat recommendations: reduce the densest source of calories in the diet and you will lose weight. Then in 1982, J.P. Flatt, a University of Massachusetts biochemist, published his research demonstrating that, in any normal diet, it is extremely rare for the human body to convert carbohydrates into body fat. This was then misinterpreted by the media and quite a few scientists to mean that eating carbohydrates, even to excess, could not make you fat -- which is not the case, Flatt says. But the misinterpretation developed a vigorous life of its own because it resonated with the notion that fat makes you fat and carbohydrates are harmless.
As a result, the major trends in American diets since the late 70's, according to the U.S.D.A. agricultural economist Judith Putnam, have been a decrease in the percentage of fat calories and a ''greatly increased consumption of carbohydrates.'' To be precise, annual grain consumption has increased almost 60 pounds per person, and caloric sweeteners (primarily high-fructose corn syrup) by 30 pounds. At the same time, we suddenly began consuming more total calories: now up to 400 more each day since the government started recommending low-fat diets.
If these trends are correct, then the obesity epidemic can certainly be explained by Americans' eating more calories than ever -- excess calories, after all, are what causes us to gain weight -- and, specifically, more carbohydrates. The question is why?
The answer provided by Endocrinology 101 is that we are simply hungrier than we were in the 70's, and the reason is physiological more than psychological. In this case, the salient factor -- ignored in the pursuit of fat and its effect on cholesterol -- is how carbohydrates affect blood sugar and insulin. In fact, these were obvious culprits all along, which is why Atkins and the low-carb-diet doctors pounced on them early.
The primary role of insulin is to regulate blood-sugar levels. After you eat carbohydrates, they will be broken down into their component sugar molecules and transported into the bloodstream. Your pancreas then secretes insulin, which shunts the blood sugar into muscles and the liver as fuel for the next few hours. This is why carbohydrates have a significant impact on insulin and fat does not. And because juvenile diabetes is caused by a lack of insulin, physicians believed since the 20's that the only evil with insulin is not having enough.
But insulin also regulates fat metabolism. We cannot store body fat without it. Think of insulin as a switch. When it's on, in the few hours after eating, you burn carbohydrates for energy and store excess calories as fat. When it's off, after the insulin has been depleted, you burn fat as fuel. So when insulin levels are low, you will burn your own fat, but not when they're high.
This is where it gets unavoidably complicated. The fatter you are, the more insulin your pancreas will pump out per meal, and the more likely you'll develop what's called ''insulin resistance,'' which is the underlying cause of Syndrome X. In effect, your cells become insensitive to the action of insulin, and so you need ever greater amounts to keep your blood sugar in check. So as you gain weight, insulin makes it easier to store fat and harder to lose it. But the insulin resistance in turn may make it harder to store fat -- your weight is being kept in check, as it should be. But now the insulin resistance might prompt your pancreas to produce even more insulin, potentially starting a vicious cycle. Which comes first -- the obesity, the elevated insulin, known as hyperinsulinemia, or the insulin resistance -- is a chicken-and-egg problem that hasn't been resolved. One endocrinologist described this to me as ''the Nobel-prize winning question.''
Insulin also profoundly affects hunger, although to what end is another point of controversy. On the one hand, insulin can indirectly cause hunger by lowering your blood sugar, but how low does blood sugar have to drop before hunger kicks in? That's unresolved. Meanwhile, insulin works in the brain to suppress hunger. The theory, as explained to me by Michael Schwartz, an endocrinologist at the University of Washington, is that insulin's ability to inhibit appetite would normally counteract its propensity to generate body fat. In other words, as you gained weight, your body would generate more insulin after every meal, and that in turn would suppress your appetite; you'd eat less and lose the weight.
Schwartz, however, can imagine a simple mechanism that would throw this ''homeostatic'' system off balance: if your brain were to lose its sensitivity to insulin, just as your fat and muscles do when they are flooded with it. Now the higher insulin production that comes with getting fatter would no longer compensate by suppressing your appetite, because your brain would no longer register the rise in insulin. The end result would be a physiologic state in which obesity is almost preordained, and one in which the carbohydrate-insulin connection could play a major role. Schwartz says he believes this could indeed be happening, but research hasn't progressed far enough to prove it. ''It is just a hypothesis,'' he says. ''It still needs to be sorted out.''
David Ludwig, the Harvard endocrinologist, says that it's the direct effect of insulin on blood sugar that does the trick. He notes that when diabetics get too much insulin, their blood sugar drops and they get ravenously hungry. They gain weight because they eat more, and the insulin promotes fat deposition. The same happens with lab animals. This, he says, is effectively what happens when we eat carbohydrates -- in particular sugar and starches like potatoes and rice, or anything made from flour, like a slice of white bread. These are known in the jargon as high-glycemic-index carbohydrates, which means they are absorbed quickly into the blood. As a result, they cause a spike of blood sugar and a surge of insulin within minutes. The resulting rush of insulin stores the blood sugar away and a few hours later, your blood sugar is lower than it was before you ate. As Ludwig explains, your body effectively thinks it has run out of fuel, but the insulin is still high enough to prevent you from burning your own fat. The result is hunger and a craving for more carbohydrates. It's another vicious circle, and another situation ripe for obesity.
The glycemic-index concept and the idea that starches can be absorbed into the blood even faster than sugar emerged in the late 70's, but again had no influence on public health recommendations, because of the attendant controversies. To wit: if you bought the glycemic-index concept, then you had to accept that the starches we were supposed to be eating 6 to 11 times a day were, once swallowed, physiologically indistinguishable from sugars. This made them seem considerably less than wholesome. Rather than accept this possibility, the policy makers simply allowed sugar and corn syrup to elude the vilification that befell dietary fat. After all, they are fat-free.
Sugar and corn syrup from soft drinks, juices and the copious teas and sports drinks now supply more than 10 percent of our total calories; the 80's saw the introduction of Big Gulps and 32-ounce cups of Coca-Cola, blasted through with sugar, but 100 percent fat free. When it comes to insulin and blood sugar, these soft drinks and fruit juices -- what the scientists call ''wet carbohydrates'' -- might indeed be worst of all. (Diet soda accounts for less than a quarter of the soda market.)
The gist of the glycemic-index idea is that the longer it takes the carbohydrates to be digested, the lesser the impact on blood sugar and insulin and the healthier the food. Those foods with the highest rating on the glycemic index are some simple sugars, starches and anything made from flour. Green vegetables, beans and whole grains cause a much slower rise in blood sugar because they have fiber, a nondigestible carbohydrate, which slows down digestion and lowers the glycemic index. Protein and fat serve the same purpose, which implies that eating fat can be beneficial, a notion that is still unacceptable. And the glycemic-index concept implies that a primary cause of Syndrome X, heart disease, Type 2 diabetes and obesity is the long-term damage caused by the repeated surges of insulin that come from eating starches and refined carbohydrates. This suggests a kind of unified field theory for these chronic diseases, but not one that coexists easily with the low-fat doctrine.
At Ludwig's pediatric obesity clinic, he has been prescribing low-glycemic-index diets to children and adolescents for five years now. He does not recommend the Atkins diet because he says he believes such a very low carbohydrate approach is unnecessarily restrictive; instead, he tells his patients to effectively replace refined carbohydrates and starches with vegetables, legumes and fruit. This makes a low-glycemic-index diet consistent with dietary common sense, albeit in a higher-fat kind of way. His clinic now has a nine-month waiting list. Only recently has Ludwig managed to convince the N.I.H. that such diets are worthy of study. His first three grant proposals were summarily rejected, which may explain why much of the relevant research has been done in Canada and in Australia. In April, however, Ludwig received $1.2 million from the N.I.H. to test his low-glycemic-index diet against a traditional low-fat-low-calorie regime. That might help resolve some of the controversy over the role of insulin in obesity, although the redoubtable Robert Atkins might get there first.
The 71-year-old Atkins, a graduate of Cornell medical school, says he first tried a very low carbohydrate diet in 1963 after reading about one in the Journal of the American Medical Association. He lost weight effortlessly, had his epiphany and turned a fledgling Manhattan cardiology practice into a thriving obesity clinic. He then alienated the entire medical community by telling his readers to eat as much fat and protein as they wanted, as long as they ate little to no carbohydrates. They would lose weight, he said, because they would keep their insulin down; they wouldn't be hungry; and they would have less resistance to burning their own fat. Atkins also noted that starches and sugar were harmful in any event because they raised triglyceride levels and that this was a greater risk factor for heart disease than cholesterol.
Atkins's diet is both the ultimate manifestation of the alternative hypothesis as well as the battleground on which the fat-versus-carbohydrates controversy is likely to be fought scientifically over the next few years. After insisting Atkins was a quack for three decades, obesity experts are now finding it difficult to ignore the copious anecdotal evidence that his diet does just what he has claimed. Take Albert Stunkard, for instance. Stunkard has been trying to treat obesity for half a century, but he told me he had his epiphany about Atkins and maybe about obesity as well just recently when he discovered that the chief of radiology in his hospital had lost 60 pounds on Atkins's diet. ''Well, apparently all the young guys in the hospital are doing it,'' he said. ''So we decided to do a study.'' When I asked Stunkard if he or any of his colleagues considered testing Atkins's diet 30 years ago, he said they hadn't because they thought Atkins was ''a jerk'' who was just out to make money: this ''turned people off, and so nobody took him seriously enough to do what we're finally doing.''
In fact, when the American Medical Association released its scathing critique of Atkins's diet in March 1973, it acknowledged that the diet probably worked, but expressed little interest in why. Through the 60's, this had been a subject of considerable research, with the conclusion that Atkins-like diets were low-calorie diets in disguise; that when you cut out pasta, bread and potatoes, you'll have a hard time eating enough meat, vegetables and cheese to replace the calories.
That, however, raised the question of why such a low-calorie regimen would also suppress hunger, which Atkins insisted was the signature characteristic of the diet. One possibility was Endocrinology 101: that fat and protein make you sated and, lacking carbohydrates and the ensuing swings of blood sugar and insulin, you stay sated. The other possibility arose from the fact that Atkins's diet is ''ketogenic.'' This means that insulin falls so low that you enter a state called ketosis, which is what happens during fasting and starvation. Your muscles and tissues burn body fat for energy, as does your brain in the form of fat molecules produced by the liver called ketones. Atkins saw ketosis as the obvious way to kick-start weight loss. He also liked to say that ketosis was so energizing that it was better than sex, which set him up for some ridicule. An inevitable criticism of Atkins's diet has been that ketosis is dangerous and to be avoided at all costs.
When I interviewed ketosis experts, however, they universally sided with Atkins, and suggested that maybe the medical community and the media confuse ketosis with ketoacidosis, a variant of ketosis that occurs in untreated diabetics and can be fatal. ''Doctors are scared of ketosis,'' says Richard Veech, an N.I.H. researcher who studied medicine at Harvard and then got his doctorate at Oxford University with the Nobel Laureate Hans Krebs. ''They're always worried about diabetic ketoacidosis. But ketosis is a normal physiologic state. I would argue it is the normal state of man. It's not normal to have McDonald's and a delicatessen around every corner. It's normal to starve.''
Simply put, ketosis is evolution's answer to the thrifty gene. We may have evolved to efficiently store fat for times of famine, says Veech, but we also evolved ketosis to efficiently live off that fat when necessary. Rather than being poison, which is how the press often refers to ketones, they make the body run more efficiently and provide a backup fuel source for the brain. Veech calls ketones ''magic'' and has shown that both the heart and brain run 25 percent more efficiently on ketones than on blood sugar.
The bottom line is that for the better part of 30 years Atkins insisted his diet worked and was safe, Americans apparently tried it by the tens of millions, while nutritionists, physicians, public- health authorities and anyone concerned with heart disease insisted it could kill them, and expressed little or no desire to find out who was right. During that period, only two groups of U.S. researchers tested the diet, or at least published their results. In the early 70's, J.P. Flatt and Harvard's George Blackburn pioneered the ''protein-sparing modified fast'' to treat postsurgical patients, and they tested it on obese volunteers. Blackburn, who later became president of the American Society of Clinical Nutrition, describes his regime as ''an Atkins diet without excess fat'' and says he had to give it a fancy name or nobody would take him seriously. The diet was ''lean meat, fish and fowl'' supplemented by vitamins and minerals. ''People loved it,'' Blackburn recalls. ''Great weight loss. We couldn't run them off with a baseball bat.'' Blackburn successfully treated hundreds of obese patients over the next decade and published a series of papers that were ignored. When obese New Englanders turned to appetite-control drugs in the mid-80's, he says, he let it drop. He then applied to the N.I.H. for a grant to do a clinical trial of popular diets but was rejected.
The second trial, published in September 1980, was done at the George Washington University Medical Center. Two dozen obese volunteers agreed to follow Atkins's diet for eight weeks and lost an average of 17 pounds each, with no apparent ill effects, although their L.D.L. cholesterol did go up. The researchers, led by John LaRosa, now president of the State University of New York Downstate Medical Center in Brooklyn, concluded that the 17-pound weight loss in eight weeks would likely have happened with any diet under ''the novelty of trying something under experimental conditions'' and never pursued it further.
Now researchers have finally decided that Atkins's diet and other low-carb diets have to be tested, and are doing so against traditional low-calorie-low-fat diets as recommended by the American Heart Association. To explain their motivation, they inevitably tell one of two stories: some, like Stunkard, told me that someone they knew -- a patient, a friend, a fellow physician -- lost considerable weight on Atkins's diet and, despite all their preconceptions to the contrary, kept it off. Others say they were frustrated with their inability to help their obese patients, looked into the low-carb diets and decided that Endocrinology 101 was compelling. ''As a trained physician, I was trained to mock anything like the Atkins diet,'' says Linda Stern, an internist at the Philadelphia Veterans Administration Hospital, ''but I put myself on the diet. I did great. And I thought maybe this is something I can offer my patients.''
None of these studies have been financed by the N.I.H., and none have yet been published. But the results have been reported at conferences -- by researchers at Schneider Children's Hospital on Long Island, Duke University and the University of Cincinnati, and by Stern's group at the Philadelphia V.A. Hospital. And then there's the study Stunkard had mentioned, led by Gary Foster at the University of Pennsylvania, Sam Klein, director of the Center for Human Nutrition at Washington University in St. Louis, and Jim Hill, who runs the University of Colorado Center for Human Nutrition in Denver. The results of all five of these studies are remarkably consistent. Subjects on some form of the Atkins diet -- whether overweight adolescents on the diet for 12 weeks as at Schneider, or obese adults averaging 295 pounds on the diet for six months, as at the Philadelphia V.A. -- lost twice the weight as the subjects on the low-fat, low-calorie diets.
In all five studies, cholesterol levels improved similarly with both diets, but triglyceride levels were considerably lower with the Atkins diet. Though researchers are hesitant to agree with this, it does suggest that heart-disease risk could actually be reduced when fat is added back into the diet and starches and refined carbohydrates are removed. ''I think when this stuff gets to be recognized,'' Stunkard says, ''it's going to really shake up a lot of thinking about obesity and metabolism.''
All of this could be settled sooner rather than later, and with it, perhaps, we might have some long-awaited answers as to why we grow fat and whether it is indeed preordained by societal forces or by our choice of foods. For the first time, the N.I.H. is now actually financing comparative studies of popular diets. Foster, Klein and Hill, for instance, have now received more than $2.5 million from N.I.H. to do a five-year trial of the Atkins diet with 360 obese individuals. At Harvard, Willett, Blackburn and Penelope Greene have money, albeit from Atkins's nonprofit foundation, to do a comparative trial as well.
Should these clinical trials also find for Atkins and his high-fat, low-carbohydrate diet, then the public-health authorities may indeed have a problem on their hands. Once they took their leap of faith and settled on the low-fat dietary dogma 25 years ago, they left little room for contradictory evidence or a change of opinion, should such a change be necessary to keep up with the science. In this light Sam Klein's experience is noteworthy. Klein is president-elect of the North American Association for the Study of Obesity, which suggests that he is a highly respected member of his community. And yet, he described his recent experience discussing the Atkins diet at medical conferences as a learning experience. ''I have been impressed,'' he said, ''with the anger of academicians in the audience. Their response is 'How dare you even present data on the Atkins diet!' ''
This hostility stems primarily from their anxiety that Americans, given a glimmer of hope about their weight, will rush off en masse to try a diet that simply seems intuitively dangerous and on which there is still no long-term data on whether it works and whether it is safe. It's a justifiable fear. In the course of my research, I have spent my mornings at my local diner, staring down at a plate of scrambled eggs and sausage, convinced that somehow, some way, they must be working to clog my arteries and do me in.
After 20 years steeped in a low-fat paradigm, I find it hard to see the nutritional world any other way. I have learned that low-fat diets fail in clinical trials and in real life, and they certainly have failed in my life. I have read the papers suggesting that 20 years of low-fat recommendations have not managed to lower the incidence of heart disease in this country, and may have led instead to the steep increase in obesity and Type 2 diabetes. I have interviewed researchers whose computer models have calculated that cutting back on the saturated fats in my diet to the levels recommended by the American Heart Association would not add more than a few months to my life, if that. I have even lost considerable weight with relative ease by giving up carbohydrates on my test diet, and yet I can look down at my eggs and sausage and still imagine the imminent onset of heart disease and obesity, the latter assuredly to be caused by some bizarre rebound phenomena the likes of which science has not yet begun to describe. The fact that Atkins himself has had heart trouble recently does not ease my anxiety, despite his assurance that it is not diet-related.
This is the state of mind I imagine that mainstream nutritionists, researchers and physicians must inevitably take to the fat-versus-carbohydrate controversy. They may come around, but the evidence will have to be exceptionally compelling. Although this kind of conversion may be happening at the moment to John Farquhar, who is a professor of health research and policy at Stanford University and has worked in this field for more than 40 years. When I interviewed Farquhar in April, he explained why low-fat diets might lead to weight gain and low-carbohydrate diets might lead to weight loss, but he made me promise not to say he believed they did. He attributed the cause of the obesity epidemic to the ''force-feeding of a nation.'' Three weeks later, after reading an article on Endocrinology 101 by David Ludwig in the Journal of the American Medical Association, he sent me an e-mail message asking the not-entirely-rhetorical question, ''Can we get the low-fat proponents to apologize?''
Gary Taubes is a correspondent for the journal Science and author of ''Bad Science: The Short Life and Weird Times of Cold Fusion.''
from Salon.com, 2000-Aug-2, by Lesli Mitchell:
Secrets and lies
Is the astonishing rise in autism a medical mystery or a pharmaceutical shame?
As an Internet project manager in telecommunications, I am familiar with the symbiotic business relationship of industry and government. I understand the dynamics of profit, getting new products to market as quickly as possible, negotiating "value-added" partnerships, and above all the potential for ethics to be sublimated to the bottom line.
As a mother, I didn't want to believe that the same business practices applied in medicine, because that would have meant accepting the possibility that my child was perceived first and foremost as a target market. A new mother is particularly vulnerable, and most of us harbor a trust bordering on reverence for the medical community, believing its members to be omniscient and above reproach.
When I held my baby in my arms for the first time and understood the magnitude of my responsibility, my faith in medicine translated into an implicit contract with my doctor: My job is to love him; your job is to keep him well.
And my baby was well, at least until 1998, when, at 2 years old, he was diagnosed with autism. When I read statistics from the Department of Education that said autism in school-age children had increased 556 percent in five years, skyrocketing past any other disability, I was shocked and horrified. But I trusted what my doctors told me: that the increase was due to better diagnostic skills, not to any real increase in autism.
It took two years for that trust to erode, chipped away by increasing evidence that business motives had mandated my child's health. I learned that congressional investigations were underway into key members of the Food and Drug Administration and the Centers for Disease Control who vote on U.S. immunization policy despite a web of conflicts of interest: panel members who owned stock in vaccine makers, received research grants from those companies or even owned vaccine patents themselves.
I found out that vaccines given to my child had unsafe amounts of mercury, contained in the preservative thimerosal: a fact that led to the introduction this year of new "thimerosal-free" vaccines. I learned that last year a rotavirus vaccine was rushed to market too soon, without enough research, and had to be suspended by federal health officials because children were experiencing life-threatening bowel obstructions.
But it was during a conference this June that I crossed over to the other side, from conventional mom to vaccine-reform advocate, and began sounding more and more like Mulder in "The X-Files," saying to anyone who would listen, "The truth is out there."
At an autism conference in Irvine, Calif., I heard the first theory that made sense to me intuitively, not just about autism but about other children who were sick, children I could see around me every day, children of my friends, the "typical" children who shared my son's classroom. Respected doctors and researchers presented evidence that the rise in autism over the past decade was related to immune system impairment, part of a spectrum of other childhood illnesses on the rise such as allergies, asthma, ADHD, learning disabilities and seizure disorders.
What was causing the immune system to turn against itself? The research was pointing to bombardment by multiple vaccines that overwhelmed the immature immune systems of infants and toddlers.
My son Connor was a perfect baby, the kind you see in commercials: engaging, happy, angelic. I had a normal delivery after a pitocin-and-epidural labor, and Connor scored a 9 on his Apgar, nursed vigorously, never had colic, smiled early and even laughed in his sleep at six weeks old. We figured we were doing everything right. When he got sick with his first ear infection at three months -- the first of many to come -- we did what most parents do: We relied completely on his doctor for treatment.
The American Academy of Pediatrics cautions against vaccinating children who are sick. I didn't know this policy at the time, and apparently neither did anyone in the doctor's office, because I was never told about it. What I did know was that he was supposed to get 33 vaccines before he started school, many of them simultaneously. My refrigerator magnet "freebie" of the vaccination schedule, included along with my complimentary diaper bag and free formula from the hospital, showed that he would be receiving as many as eight vaccines at the same time: combined measles, mumps, rubella (MMR), combined diptheria, tetanus, pertussis (DPT), polio and haemophilus influenzae type B. It seemed like a lot at one time, but I was simply grateful that the combination vaccines meant he would have fewer overall injections.
The ear infection and vaccination pattern continued unabated during Connor's infancy and into his toddler months. His reactions to vaccines ranged from nothing to crankiness to occasional fevers. All of these reactions were considered normal, and all of them passed within a day. The ear infections became harder to treat over time, as if Connor's system was building up an immunity to the frequent antibiotics.
One day in June of 1998 I noticed that his left ear was pushed out from his head. I had no idea what it meant but I took him to the doctor. Despite being on antibiotics, his latest ear infection had progressed into mastoiditis and he was rushed to the emergency room to get tubes in his ears that same day. The ear infections ceased. But an illness remained with him that was far worse than we had ever anticipated.
Much of his first year had been a period of triumphs. I marked his skills in my dog-eared copy of "What To Expect Your First Year," noting with satisfaction that he was hitting all of his milestones early. I could see that he was a sharp kid, alert to the world around him, and I was proud of his precocious awareness. This ability to focus extended to people as well -- he was compassionate and gentle in his temperament, possessing an unusual insight into the moods of the people around him. I honestly believed he showed early gifts of self-awareness and sensitivity to others.
Around his first birthday everything began to change. Connor regressed in his social behavior and speech and seemed to lose ground on all of his milestones. We had trouble getting his attention. We would call his name over and over again and finally had to look him in the face to get a response. At his birthday party, he was more interested in his balloons, ribbons and boxes than his new toys or the people celebrating around him. He would play with his toys repetitively and in unusual ways, like flipping over his bubble lawn mower to spin the wheels or rolling objects down a ramp for 30 minutes straight. Family members commented jovially that he might be a physics or engineering prodigy, already testing objects to see how they performed.
But when his language started to deteriorate, we lost any hope for his Nobel Prize and wanted desperately for him just to act normal. At 22 months he was mute; instead of pointing or naming things, he would lead one of us by the hand and place it on the thing he wanted. He preferred to watch the same video of "Thomas the Tank Engine" all day long rather than play with us. When people came over to our house he was shy, more than shy -- he would run away and hide -- and if we forced him out he would throw his body to the ground and scream.
I could see that the core of his real personality was still there, but I could only bring it out in him when he was totally at ease, which meant without distractions or interruptions in his routine. Even his diet changed for the worse. He would only eat about five foods -- crackers, Cheerios, McDonald's French fries, chips and cookies.
Time to take Connor back to the doctor, I thought. He'll know. He'll confirm my mom's intuition that something is very wrong. But he didn't.
"He used to talk and now he's quit talking."
"Well, he's been sick from the ear infections. Have you considered having his hearing tested?"
"Yes, we thought of that. His hearing is normal. I'm also worried that he's only eating a few foods, and he's not getting any vegetables and fruits anymore."
The doctor laughed. "My kids are extremely picky, too. As long as his weight is OK -- looks like he's in the 80th percentile -- I wouldn't worry about it. Toddlers are very finicky. As long as he's getting a multivitamin he's getting everything he needs."
Meanwhile Connor is flapping his arms and spinning in circles. I watched for a while. "So he's OK?"
My doctor's forte was reassuring worried moms. "Of course. He's fine. Let's see him again in a month and make sure his weight is on target."
As it turned out we didn't see the doctor again for a few months. By that time Connor's day care staff had evaluated his development and determined that he was autistic.
Months earlier, when we hadn't suspected any problems, I had enrolled Connor part-time in a day care program that mixed typical kids and special needs kids. My mother was physically disabled, and I wanted Connor to grow up in an environment that didn't exclude the handicapped. As it turned out the decision was a blessing -- the staff therapists had seen plenty of autistic kids, unlike my doctor, who had never seen even one (and who admitted humbly, later, that he only got three days of education on autism in med school). But the day care staff was able to diagnose him earlier than many kids with the same condition, which was probably the key to Connor's eventual progress.
I remember very clearly my first reaction to the label of autism: "But my kid's not Rain Man." And he wasn't. When I started reading I found out the real statistics on autism, and they were scary. There was a new crop of kids who had what many called "acquired autism." Unlike Dustin Hoffman's character, the kids progressed normally until their second year and during that period lost any accumulated skills and socially retreated from people.
The late-onset kids made the current genetic theory suspect -- if the cause was inborn, the kids would never have gained ground in the first place. Plus, the rate of these kids was staggering: In 10 years the incidence of autism had increased from one child in 10,000 to one child in 500. No one was sure why.
So I continued to go to doctors -- immunologists to help me understand why Connor's mosquito bites took six weeks to heal; neurologists to explain why his IQ was so low it couldn't be measured; allergists to tell me why his cheeks and ears got red when he ate certain foods; gastroenterologists to relieve his constipation. Over and over again I was told that the outlook for autistic kids was grim, there was no treatment available for his symptoms, that perhaps I should consider putting him (and myself) on Prozac to help with his behavior.
Frustrated by the lack of sympathy and knowledge in the medical community, I networked with parents on the Internet and read as much as I could on my own. I decided to focus on cures instead of causes. Some parents had actually been able to "recover" their children with behavioral therapy, or ABA. This therapy used a one-on-one approach to teach autistic kids how to interact in the world, to talk, to socialize, to learn academic concepts, to regain the skills they had lost or never developed. We started within weeks of Connor's diagnosis. In my heart and in my prayers I asked for one thing: Please, please let him say "mama" to me again.
And, amazingly, he did progress. One of Connor's doctors, who had seen the results of the therapy with her own eyes, agreed to write a prescription for this treatment, and I sent it along with my claims to the medical insurer. The claim was denied because the therapy was considered "educational." We continued to spend around $2,000 every month on behavioral treatment anyway. It was the only thing that was working.
Within a year Connor began talking again, regaining his old words first: mama (Yes!), daddy, cookie, no. Then he had a cognitive leap when language finally seemed to "click," and he was off and running. He sought out adults and other children to talk to and play games with, caught up to age level in comprehension, bypassed his classmates in academics, and even developed a sense of humor (he renamed "Carnotaurs from Disney's "Dinosaur" movie to "Connor-taurs").
In March of this year he finally lost his autism label, after a year and a half (at 25 hours per week) of intensive ABA. His speech was still a year behind, but it was appropriate, and his therapists predicted that by the time he started first grade he would have the same basic skills as his peers. I breathed my first tentative sigh of relief -- he had a chance of living a normal life.
It was only then that I began to focus attention back to the cause of Connor's condition, and listened with interest to the congressional hearings on autism in April, spurred by Rep. Dan Burton (R-Ind.), chairman of the Committee on Government Reform. Burton had almost lost his granddaughter to anaphylactic shock after her DPT vaccination, and lost his grandson to autism within a week of the child's receiving 11 vaccines administered in a single office visit.
I read the media coverage, too, most of it from medical professionals who pitied Burton's situation, but tended to dismiss him with red herrings, "out-sensationalizing" Burton with claims that not vaccinating children would lead to outbreaks of life-threatening diseases. (A recent Newsweek story does this too, ending on the note: "Autism aside, the measles virus can kill.")
But Burton wasn't interested in eradicating the vaccine program, just in getting some answers about the rise in autism. He asked CDC representatives about their investigations of the Brick, N.J., township where the autism rate was dramatically higher even than the rising national average. He wondered aloud about California Department of Developmental Services statistics, now replicated in many states, that reported a 273 percent increase in autistic kids in the school districts.
Autism was an epidemic, Burton insisted to the CDC. What are you doing about it?
The vaccination issue had come up many times in online chats about autism, but I didn't think it applied to me. Unlike many autistic kids, Connor was not whisked away to the emergency room after his MMR (mumps, measles and rubella) vaccination for seizures; he didn't "turn" autistic within hours of his DPT. He had a few mild reactions, nothing more.
But I didn't discount the parents' claims: I knew these parents personally and respected their judgment. Many were doctors or research professionals themselves. The only thing that connected a lot of us was a common history of chronic infections, mainly ear infections, and consistent doses of antibiotics.
I decided to attend a conference on autism and learn more about the biological research.
Before I left I went through Connor's photo album. I did this soon after he was diagnosed, but perhaps I was too close to him and too ignorant of autism to recognize dramatic changes. This time, I saw it: Connor at 11 months, smiling for the camera, looking into his daddy's eyes, touching his mommy's hair. Connor on his first birthday, after his morning visit to the doctor's office and MMR vaccination, no longer looking at anyone, no longer smiling. And perhaps the most revealing picture: Connor walking on his toes, one of the most common behaviors in autism. Within a day he had changed.
The conference speakers presented the theory that autism was part of a spectrum of related immune disorders on the rise in children. The immune dysfunction in the body was triggered by reactions to multiple vaccines, either an ingredient in the vaccines themselves or the accumulated damage of multiple vaccines to the immune system. The body reacted by attacking its own cells, an "auto-immune" response, with reactions in the body ranging from mild allergies and behavioral changes to severe neurological damage such as autism and seizure disorders.
This evidence made a lot of sense to me because I was seeing these kids with my own eyes everyday -- friends of mine whose kids were prone to severe allergies, asthma, attention and learning problems, all with no family history. When I was growing up, there was always one kid in the classroom who was allergic to eggs, who had circles under his eyes and pale skin. I never saw an autistic kid at all. Now I look around and see sick kids everywhere.
Dr. Andy Wakefield's presentation was particularly compelling. A respected gastroenterologist at the Royal Free Hospital in London, he had been minding his own business studying inflammatory bowel disease and Crohn's disease when he encountered something very curious that he hadn't seen before. When he tested the growing number of autistic children who had come in with bowel problems, he noticed that their GI systems were damaged as if they'd been diseased for years.
Wakefield listened to parents about the late onset of symptoms, the similar stories of regression and the parents' belief that vaccine damage may have caused the problem. When he ran more tests on the children he found measles virus in their GI tracts, where it wasn't supposed to be. He published preliminary findings in a respected British medical journal, the Lancet, and immediately came under fire from colleagues in the U.S. and UK.
As I listened to the evidence Wakefield had gathered, I looked around at the other parents. There was no commonality among us -- we were of all races and ethnic backgrounds and geographically spread out. A few of us had a genetic history of autism or allergies but most of us didn't.
If you controlled for all of these factors, what common link was there? Controlling for genetics, allergy histories in families and environmental toxins from varied geography, there was only one candidate left that applied to all of us -- a mandated vaccine program. Industrialized countries like the U.S., the UK and Canada were experiencing this tremendous rise in autism and other neurological disorders. And these were the same countries where modern medicine flourished.
Interestingly, Japan didn't figure among the other countries' high increase, and had withdrawn the MMR in 1993 because of concerns about adverse reactions. I started to become uneasy.
"I'm going to ask everyone a question," said the conference host after Wakefield's talk. "How many of you here believe your children have been damaged by vaccines?"
Seventy-five percent of the attendees stood up and raised their hands. One woman a few rows behind me was crying, and I knew intuitively that her faith in the medical establishment had finally crumbled. Her suffering was genuine; she sobbed quietly. When I looked back, she was embarrassed, covering her face with her hand.
But I was moved by her anguish, her private suffering, and I relived for a moment my own struggles since Connor's diagnosis. The long nights of guilt I felt as a mother, constantly wondering what I had done wrong to give him autism; the long days of research to find a cure -- the doctors told me to put him in an institution, but I wasn't going to leave him; the countless doctor visits and tests Connor bravely endured without understanding why he was hurting or receiving little relief.
And finally -- unsurprisingly -- I was overwhelmed with rage. I felt it building within me and it was like nothing I'd experienced before. I knew very clearly at that moment that I had crossed over to the other side, that I was convinced my son was a cash cow for an industry that tested its products in production rather than the lab, motivated by $2 billion per year in profits, no different in its potential for corruption than any other industry.
There were no higher standards in medicine than in any other business -- the rule of caveat emptor applied to vaccines as surely as it applied to any other consumer product. I could not trust the FDA and the CDC to protect me from pharmaceutical companies that wanted to get their products to market with as little testing as possible and to promote the repeated use of their products in order to maintain their monopoly under the guise of the public good.
I don't have a medical degree, but I have learned how to be a thoughtful medical consumer. Connor's up for his mandated boosters next year. I know now that he can have a simple blood test of his antibody titers, which measures his antibodies and confirms that he has the protection he needs against disease. I had the blood test done and he's protected.
There's no medical exemption from these boosters in my state for "sufficient protection based on antibody titers," so I'll have to use a religious exemption instead. I've accepted that there is no binding contract between me and the agencies and companies that purport to protect my child. But my bond with Connor remains, my responsibility as his mother expanding to include advocacy -- even activism -- along with love.
About the writer
Lesli Mitchell is a writer and editor who specializes in education and technology. Her children's book about autism, "Party Train!," will be published in September by DRL Press.
from Salon.com, 2000-Apr-13, by Arthur Allen:
Inoculated into oblivion
When families hit the Capitol last week, they demanded answers about the source of their children's autism.
You couldn't pick a better day for a rally on the Mall. The Capitol gleams white as a Clorox bottle against a sapphire sky. New elm leaves sway in the breeze. Everything is clear and cool and clean, so different from the lives of the families who have come asking the government to find out what happened to their children.
Bob Howley, 43, is watching his daughter Kathleen, a brunet 8-year-old dressed in blue tights and a flowered shirt. Kathleen is intent on something, but it isn't clear what. She is proceeding in a tight circle, slowly pumping her legs like a Lipizzaner on parade. Someone on the soundstage is blaming the Centers for Disease Control for poisoning our children. Kathleen is far away, in the land of strong horses.
Her dad watches, but does not understand. "It's very odd," he brings himself to say. Kathleen seemed normal before she got pneumonia at age 2. When she came home from the hospital, something had changed. At age 3 she was diagnosed as autistic. Since then she's been in a world of her own.
Locked away on psychiatric wards, thought to be unreachable and unteachable, autistic people like Kathleen didn't pose much of a dilemma for society until recently. That has changed in the past several years, as children newly diagnosed as autistic have swamped special education programs around the country.
The number of kids and teenagers labeled autistic rose from 23,000 in 1994 to 54,000 last year, an astonishing leap that suggests something in American life is driving a lot of children crazy. Whether or not those numbers reflect an epidemic or better accounting, they have helped generate a pointed debate about public health in general and the risks of vaccination in particular.
Autism is a range of disorders that share in common an inability to relate to other people. Many autistic people never talk. Others manage to learn rote phrases. Many have odd behaviors, lining up their toys in a precise unfathomable order, compulsively wriggling their fingers. Some feel no pain when they smash their heads into the sidewalk. Some wander into traffic.
For the most part, the origins of autism remain a mystery. The most that can be said is what is said about all chronic ailments -- that it's a mixture of genes and environment. Most parents are baffled by the disorder, which sometimes is evident practically at birth, and other times kicks in in the second year or later.
"It's an enigma," says Howley, an actuary in Maplewood, N.J. "They think there's a genetic basis of it, then other things. It could have been viruses. Or antibiotics. There are so many theories."
It's equally hard to be sure how much autism is really growing. Changing diagnostic criteria, the latest in 1994, have expanded the diagnosis to include kids with milder problems. The 1990 Americans with Disability Act mandated education for these children, ensuring that they are counted and monitored. The Internet brings parents together, raising their convictions and clout.
Many parents at last Saturday's rally, backed by a powerful right-wing congressman and a smattering of research, believe they have found the culprit for as many as half of the autism cases. The guilty party, they believe, is the vaccine.
At a hearing he called to coincide with the Mall rally, Rep. Dan Burton, R-Indiana, invited three panels of witnesses to speak before his Government Reform Committee. The panels were stacked with parents and researchers who believe that vaccines cause autism. Strangely absent were mainstream autism researchers and vaccine experts.
By some odd and tragic coincidence, both Burton and Helen Chenoweth, another fire-breathing, anti-government Republican on the committee, are both grandparents of autistic boys who appeared to be developing normally until they received measles-mumps-rubella and other combination vaccines when they were 15 months old.
The annals of autism research make it clear that a subset of autistic children suddenly regressed at this age long before the measles vaccine became available. But tell that to a parent whose kid goes from bubbly chatmeister to howling mute.
"I and my daughter truly believe this," Burton said at Thursday's hearing. "I just can't believe it wasn't related to the vaccine. When people tell me it's a genetic problem, I'll tell you -- that's just nuts."
"This hearing was called to establish the point of view of the chairman who believes there's a connection between autism and vaccination," countered Henry Waxman of California, the lead Democrat on the committee. "But why should we scare people about immunization until we know the facts?"
Burton's first witnesses were Andrew Wakefield of Scotland and John O'Leary of Ireland, who believe they have shown that autistic children suffering from gastrointestinal problems have measles viruses colonizing immune cells in their guts.
Wakefield, a gastroenterologist, said this suggests that a subset of autistic people may suffer brain inflammation resulting from infections that began in their intestines after they were inoculated with the measles-mumps-rubella (MMR) vaccine.
The vaccine community bitterly contests Wakefield's measles claims. Brent Taylor, who, like Wakefield, serves at the Royal Free Hospital in London, completed a study this year that showed no epidemiological evidence for a measles vaccine-autism link.
Wakefield's studies of the measles vaccine, which appeared in the Lancet, have received enormous press attention in the United Kingdom. Frightened Britons have kept their kids away from the measles "jab," and rates of vaccination against the highly contagious disease fell to about 85 percent last year.
Epidemiologists have been predicting a measles epidemic to result and this week got some confirmation: Ireland reported an outbreak of 300 measles cases, compared to only 30 in all of 1999. Two of the new cases were infants who had to be hospitalized with pneumonia complications.
"My fear," says Benjamin Schwartz of the CDC's immunization program, "is that we could get the same thing here."
Wakefield acknowledges that his is a hypothesis. But he and other researchers believe the public health bureaucracy is circling the wagons around the vaccination program -- a priority of the Clinton administration -- and should put some research money into the question.
Government scientists are skeptical. Wakefield has refused to share his tissue samples with the CDC and "we don't see a credible hypothesis to test," says Schwartz. Noting that most of the data presented by Wakefield and O'Leary is unpublished, he added, "There's a danger in reporting scientific findings at a congressional hearing."
For Schwartz and many others, the fact that a significant portion of autistic kids regress into silence shortly after their MMR shots is just a sad coincidence. "That's not a very easy explanation for a parent devastated by this disease, and I think it points out the importance of us finding a scientific reason why children are autistic," he says.
A small group of scientists hypothesize that low-grade infections caused by live viruses in MMR and other vaccines may overwhelm the immune systems of a small percentage of toddlers. Proving this requires complex experiments in an arcane field called neuroimmunology.
Neurologist Candace Pert and her virologist husband Michael Ruff, co-directors of Georgetown University's Institute For New Medicine, are members of this cutting edge, or fringe, as the case may be. They step lively where most scientists fear to tread.
The idea that vaccines, arguably the top public health achievement of the past half century, are damaging children "is such a horrible possibility, or in my eyes a high probability, that no one wants to be associated with it," Pert says. "And that's tragic because it's all been done in the name of good. But it has to be pinned down. It's too important to be just a philosophical debate."
Walter Freeman was one of the greatest monsters the human race has ever produced. His crimes do not differ substantively from those committed by the worst of the Nazi and Japanese doctors of WWII - if anything, his are worse, perfectly evil. History may draw parallels between Freeman and Jack Kevorkian - both zealous mavericks, both operating for a time with the consent of the establishment. However, I believe, and I believe the hindsight of history will show, that Kevorkian is in fact a good man unwittingly serving the egregious agenda of the establishment.
Freeman is an example of a man (and his ideas) that the establishment included within its boundaries for a time, then excluded, as more politically and strategically effective means to the same end (neutering of nonconformists) became available.
It is well to observe early that Psychiatric Genetics, the specialty of the Rockefeller-Rudin apparatus (which was incorporated as a section of the Nazi state, as the "Racial Hygiene Society"), involved the extermination and forced sterilization of individuals adjudicated to be mentally ill.
From "Brief History of the Lobotomy," from http://public.carleton.edu/~vestc/pages/brief.html:
[...]
That year Walter Freeman performed his most famous trans-orbital lobotomy when he hammered his ice pick into the head of the movie star and radical political activist Frances Farmer. She had rebelled all her life against every form of authority, and despite her success in Hollywood and Broadway, found herself incarcerated in the Western State Hospital in Fort Stellacoombe, Washington, aged only 34. The hospital, notorious for its dreadful conditions, had in desperation performed an increasing number of lobotomies on its inmates. Frances Farmer was a particularly sore point, because no treatment yet devised seemed to work on her; she would not be tamed. But her communist sympathies and her aggression towards officialdom had offended too many people for them to give up without "curing" her.
Hither rode Walter Freeman, knight to the rescue, ice pick in one hand, hammer in the other. On an October morning, in front of an eager audience of staff, curious visiting psychiatrists, and photographers, female patients in wheelchairs were ranged before the great showman of psychosurgery. After giving a brief lecture to the assembled crowd on the wonders of the ice-pick lobotomy -- no more complex then a shot of penicillin, no scar, and amazing potential for controlling society's misfits, schizophrenics, homosexuals, communists -- he went to work. Freeman was always quick to seize on new selling points for his art.
Patient number one was wheeled before him. He put the electrodes on her temples and shocked her into a faint, lifted her left eyelid, and plunged the ice pick into her head. He pulled it out. Another woman was brought before him. Again he shocked, and stabbed. And another, and then again another, and so on, and on, remorselessly, in a production line of controlled, casual violence until even the director of the hospital, near to passing out with nausea, left the room.
Afterwards, in a dark and silent ward, the patients lay supine on beds, or cried quietly; their faces were disfigured with a questioning blankness. The personality that was Frances Farmer had been effectively terminated earlier in the day, in a remote room to avoid publicity. She was reduced to a state of turgid, generalized mediocrity by the surgery. Society had won its battle with her; she would never again be a threat. She was released and, grown fat and slow, she drifted off into oblivion. She ended her life as a clerk in a hotel, dying of cancer in 1970. Freeman had a photograph of himself performing the lobotomy on her, and, before lobotomy fell into disgrace, he used to show it proudly to friends. In the end, he didn't mention the operation in his memoirs.
[...]
From "The History of Lobotomy," from http://www.epub.org.br/cm/n02/historia/lobotomy.htm:
[...]
Lobotomy took America and some other countries by storm. They were performed in a wide scale in the 40s, because the mental asylums were brimming over with cases after the Second World War. Between 1939 and 1951, more than 18,000 lobotomies were performed in the United States, and tens of thousands more in other countries. It was widely abused as a method to control undesirable behavior, instead of being a last-resort therapeutic procedure for desperate cases. In Japan, the majority of the operated cases were children, many of whom had only problematic behavior or a bad performance at the school. Inmates in prisons for the insane were widely operated. Families trying to get rid of difficult relatives would submit them to lobotomy. Rebels and political opponents were treated as mentally deranged by authorities and operated. Amateur surgeons would often perform hundreds of lobotomies without even doing a systematic psychiatric evaluation.
In 1949, Dr. Antônio Egas Moniz was awarded the Nobel Prize for Medicine and Physiology, in recognition of his creation of the prefrontal leucotomy, This had the effect of making lobotomy a respectable procedure, and as a result, in the ensuing three years, more lobotomies were performed than in all previous years.
[...]
excerpt from "Psychosurgery redux: The 1990s version uses radiation and brain imaging" by Wray Herbert, U.S. News, from http://www.usnews.com/usnews/issue/971103/3surg.htm:
Knowledge of brain function has also been revolutionized over the past five decades. In the early days, psychosurgeons were operating on a pseudoscientific notion that illness resulted from abnormally "fixed" neuronal patterns in the brain's frontal lobes. Destroying brain tissue was supposed to remove what Freeman termed the "emotional nucleus of the psychosis." On the basis of this flimsy theory, they cut indiscriminately: Personality problems, mood disorders, psychosis, aggression--all were potential targets of the surgeon's knife. Today the links between specific brain areas and mental disorders--though far from proven--are better understood. The four procedures most commonly performed all target the bundle of nerve fibers that connect the frontal cortex, the so-called thinking brain, with deeper limbic structures thought to be involved in the interpretation of stimuli, memories, and emotions. (A cingulotomy, for example, severs the cingulate gyrus, part of this pathway.) Both depression and obsessive-compulsive disorder (OCD)--the prime candidates for psychosurgery--involve distortions in thinking and emotion, and brain imaging studies have revealed abnormalities in the regulation of chemical messengers through these pathways in both illnesses. And though they don't know exactly why, scientists know from individual cases that severing this misfiring circuitry can reduce or eliminate symptoms.
from the New York Times, 2001-Mar-9, by Timothy Egan:
School Shooting Underlines Illusion of Safety
SANTEE, Calif., March 8 - Here again are the echoes of Littleton and Springfield and Conyers, the chorus of whys from the mostly white, mostly middle-class families, directed this time at Santana High School, at the corner of Carefree and Magnolia.
The geography of wide streets that lead to dead ends at the edge of construction sites, and roomy houses so new the mud has yet to dry on the sheetrock, is largely the same. And so is the week's refrain - this is a safe haven, these are the best schools, the best people, the best neighborhoods scratched from farmland at the far urban frontier.
"The adults think there are no really mean people at this school, so they hardly ever search a backpack or ask you about stuff that kids are doing after school, and we don't have metal detectors - my God," said Jennifer Chandler, a freshman at Santana and a classmate of Charles Andrew Williams, the 15-year-old charged with killing 2 classmates and wounding 13 other people at the school on Monday morning.
In Santee, as in Littleton, Colo., people point to the low crime rate, the ubiquity of schoolchildren, the dearth of visible poverty or gangs, as if these were all immunizing factors.
Santee was not even officially on the map of California cities until 1980 and still likes to think of itself as a Midwestern farm town, set against the salmon-colored rocks 20 miles northeast of San Diego.
Until Monday, a persistent "It can't happen here" mentality prevailed, residents say, five years into a string of school shootings that showed this is indeed the kind of place where it does happen.
"I searched and searched all over the country for a place where my kids would be safe and I chose Santee," said Jennifer Zimmerlink, who has two children in the schools here. "I mean, we have Los Angeles and Crenshaw just up the road and nobody is going into their schools and shooting people. I'm just baffled why it would happen here."
Child psychiatrists, educators and other researchers have been asking similar questions since teenagers began shooting other teenagers at suburban high schools in the last five years.
Their explanations point to the easy availability of guns, but they also wonder whether the violent student outbursts are a byproduct of communities like this one, where children come and go as they please, and where the ups and downs of student life and cliques are magnified by a school's position as the center of the local universe.
The boy known as Andy Williams, who appeared in court in an orange jail jumpsuit on Wednesday, facing 2 charges of murder and 13 of attempted murder, lived with his divorced father in a beige and stucco apartment in a city that has been trying, in its way, to freeze time.
People here still speak of Santee as if it were a farm town, and residents recently voted down a plan by developers to add 25,000 homes to a place that has grown steadily from cow pastures to a city of nearly 60,000.
Santee is not the New West suburb of tri-level trophy homes and three- car garages. The average household income is $60,000 and most people own their own homes, which tend to new, red-tiled houses inside stucco- walled communities. But there are also gated communities, like the one just down the street from Santana High, named New Frontier.
The town is 85 percent white, has the second-lowest crime rate of any jurisdiction in San Diego County and one of the highest densities of school- age children. The school district is Santee's biggest employer, followed by a geriatric hospital.
It is a town, as Mayor Randy Voepel said while choking back tears, "of Little League and doctors - it is America."
Over all, violence at schools is down, despite the spate of shootings that capture the media spotlight and often produce copycat incidents.
But the biggest drop has been in urban schools, where administrators in the mid-1990's adopted safety measures like metal detectors and the hiring of security guards. The suburban schools that have been hit by sudden violence were generally reluctant to take actions that would give an airy campus the appearance of a correctional institution.
"We do all these research projects on inner-city youth and poverty," said Dr. Stuart Twemlow, a clinical psychiatrist and adviser to the White House commission on school violence. But only since the 1999 shooting at Columbine High School just outside Littleton, Colo., he said, have experts "decided to add the affluent middle class because they are the ones having the most bizarre problems of violence."
Indeed, Columbine was itself just one of a series of recent suburban school shootings, with Thurmond High School in Springfield, Ore., and Heritage High School in the Atlanta suburb of Conyers, Ga., two others.
Friends of Andy Williams say that he joined a regular group of students who smoked marijuana and drank stolen tequila near a rock wall just across the street from school - within view of parents picking up their children in oversized S.U.V.'s and new, high-riding pickups.
"In the last couple months, he was drunk a lot, and smoked a ton of pot, but I think that's because everybody was always jagging on him," said David Toombs, a classmate and sometimes friend of Andy Williams. He was chomping on his regular afternoon snack, a burrito from Del Taco, one of three fast-food outlets in the mall across from the high school.
At schools like Santana or Columbine, it seems that nearly every student has a cell phone or beeper, that the strip mall is the main hangout and that social pressures are immense in a way children at big city schools cannot imagine.
Guns are also a benign part of the culture, because people assume they are to be used only for target practice or hunting birds in the fall.
Like many who have studied the school shootings of the last five years, Paul Mones, a legal expert on youth violence, says children in suburban schools are less likely to report friends who boast of plans to shoot up their school, as was the case here.
Today, school officials here said that the students who refused to tell on their friend Andy would likely be kept out of the school for the rest of the year, and have been asked to attend another school.
"People don't want to rock the boat in these communities, in part because they don't really believe it," said Mr. Mones, author of "Kids Who Kill" (Simon & Schuster).
A study released by the National Center for Health Statistics on school crime found that whites, and students who attend suburban and rural schools, are far less likely to fear violence at the schools. Nearly twice as many blacks and Latinos said they were afraid of being hurt at school as were whites. This may account, in part, for why urban schools are more likely to have security measures and procedures in place, experts said.
"There has simply never been a need for metal detectors here," said Jim Bartell, a Santee City Council member, father of three, and 23-year resident of this town. "We don't even have a gang problem."
Graffiti is hard to find here, but so is the town center. There is no main street, no central gathering spot. The malls, with identical chain stores, repeat themselves at geographic intervals determined in advance by commercial demographers.
Some social critics, like the author James Howard Kunstler, have called these new urban settings "the geography of nowhere," and say they encourage detachment, boredom and a false sense of security.
Residents of Santee wince at such descriptions. "The community did not produce this kind of child - he is the product of two parents, and I say with some hesitation that he did not have very strong family," said Dianne Jacob, a former teacher who now represents the area on the San Diego County Board of Supervisors.
Andy Williams had access to his father's guns, was in a broken family, had recently moved, and complained of being picked on - warning signs that fit a recent profile done by the Secret Service Agency and the Justice Department on student shooters. The federal agencies warned that such profiles are imperfect, and there are many exceptions.
But one thing researchers have pinpointed is how children who are bullied can quickly turn from passive victim to explosive shooter, particularly at suburban schools.
In these schools, being the brunt of a public slight or excluded by the dominant social groups take on added importance because the schools are so central to the children's lives, according to experts.
"The basic issue in these middle class schools is competition - who has the biggest car, who is the best athlete, who is in the right group - and students are under intense pressure, unlike the urban school where often the basic issue is just survival," Dr. Twemlow said.
Just a few weeks ago, the City of Santee opened a teen center next to a Food 4 Less store in a strip mall at the edge of town; it was an alternative to the skateboard park where Andy Williams smoked pot and drank, sometimes to the point of blacking out, his friends said.
The teen center had been largely empty until the shooting. Now it is packed with students, many of them asking the same questions as their parents and their teachers.
"I can tell you what the kids are telling me," said Marisa McFedries, who runs the center. "Something's missing in these kids' lives. They're on their own.
"Their parents work all the time. Their peers have become family. As corny as it sounds, in the end, they just want to feel loved."
After school today, several students reported a change in how their parents were treating them.
"It's pretty cool, because two kids who are my friends say they haven't been hugged for so long and last night, they got hugged," said Chris Brzeczek, a freshman at Santana.
And Ms. Zimmerlink, the woman who had searched the United States to find the perfect setting for her two children, also reported a change from school. "Two football players who had been bullying this one small kid all year turned to the boy and said, `We're so sorry.' "
from The New Statesman, 2001-Apr-2, by Julian Evans:
Julian Evans declares that eating people is not wrong, after reading a feeble study of cannibalism
Buy this book now! New Statesman Bookshop
Cannibal: the history of the people-eaters
Daniel Korn, Mark Radice and Charlie Hawes Channel 4 Books, 208pp, £14.99
The closest I have come to cannibalism was on a short walk I took through the West Papuan highlands in the mid-1980s. Three days out of Wamena, the main settlement, I descended from spectacular rainforest to find myself in a lush, damp village clinging to the mountain wall of the Baliem river gorge. The village, Tangma, belonged to the Papuan Dani people, but it had a missionary airstrip, and, remarkably, a lone white female missionary lived there. Before turning back, I stayed with her for two days at the mission house, a place furnished in unlovely, oaken 1950s simplicity. Why did I not go on? Partly because the forest on the other side was less penetrable and the way less certain; and partly because fewer than 20 years earlier, in 1968, the people on the far side of the gorge had killed and eaten two Protestant missionaries, Stan Dale and Phil Masters. In 1974, these people, the Kim Yal, had also attacked a preacher from another tribe and a dozen of his helpers; all 13 were eaten. Though I possessed not a shred of missionary zeal, I didn't feel like risking any misunderstanding about my intentions.
There had been an interesting detail to the 1974 case. Some had put the massacre down to missionary interference; others had attributed it to the Kim Yal being hit by influenza and blaming it on outsiders. But I discovered later that the preacher and a number of his helpers had been suspected of fooling around with the local women. As a result, they had been sexually mutilated and had their genitals hung on posts beside the airstrip, a traditional practice in cases of adultery.
One of the greatest problems in discussing any incident of cannibalism is that its anecdotal power easily overwhelms its cultural significance. Another, less substantial problem (though only slightly so) is that, having given the listener's horror a narrative framework, to evoke such horror is often assumed to be all that is necessary when speaking of instances of cannibalism.
Eating People Is Wrong was the admirable title of one of the late Malcolm Bradbury's campus novels - a phrase that generally encapsulates our moral attitude to the issue, but ignores the great cultural mosaic that begins just the other side of our parish boundary. So let me say, here and now, that I do not believe eating people is wrong.
Cannibal: the history of the people-eaters deals with, broadly, three types of people-eating (as did the Channel 4 TV series that the book accompanies). It discusses cannibalism as: first, a cultural ritual; second, something to be done because one wishes to avoid starvation; and third, something to be done because one gets a serious kick from it as an accessory to (usually sexual) murder. Some variants on the act, such as the behaviour of the Red Guards during the Cultural Revolution, when students killed their teachers and cooked their livers on campus, straddle the categories. Drawing these disconnected motives together, Cannibal then seeks, via a smattering of Holocaust references and talk of the various ways in which human beings may be dehumanised, to make conclusions about how "thin and perhaps inauthentic the veneer of modern liberal civilisation really is". Such conclusions are twaddle - but that's contemporary television for you (which, for reasons obscure to me, has long been obsessed by the contents of people's fridges).
An attempt at a serious approach is made. There is a nod in the direction of the history of the literature of cannibalism, and the archaeological record is examined in the light of new finds - for example, of 800,000-year-old hominid bones bearing cut marks in northern Spain and, last year, of a cache of smashed Iron Age bones in a lake at Eton College. But the problem - leaving aside the television prose, the pseudo-serious documentary tone and a text studded with "incredibles" and "sort ofs" - is that, having briskly disposed of the historical and cultural record, the authors spend the remaining two-thirds of their book treating the reader to a scrapbook of cannibal episodes, ranging from Sir John Franklin's doomed 1845 expedition to find the Northwest Passage, through the Ukrainian famine of the 1930s, the siege of Leningrad and the 1972 Andes plane crash, to the murderous sexual antics of celebrity cannibal killers such as Jeffrey Dahmer and the Russian Andrei Chikatilo. These episodes have absolutely nothing in common except what is on the menu.
The danger is that, by association, such shiver-mongering entertainment has repercussions on the other kind of cannibalism, the culturally related kind, encouraging readers to look only for the anecdotal details of "savage" and "primitive" behaviour. Concepts of the raw and the cooked, and the ritual exchange between them, are shorn of metaphorical significance and symbolic dignity: it's all just meat.
So how are we to see culturally related cannibalism? From an amateur interest in the anthropology of Melanesia, I am aware of a structural panoply of ritual and practice. Two factors, however, are common to almost every group and clan: first, unlike Europeans' cultural concept of the body, clinging to ancient Greek models of flawless beauty (or the Vogue version thereof), nobody in Melanesia goes through life unmarked by initiation, emotion or spiritual belief (the lopping of fingers in mourning being just one example); second, in the pre-colonial era, headhunting - exo- cannibalism - was endemic. The body and its image are the single strongest cultural signifier; and exo-cannibalism in Melanesia - by which an enemy body was utterly dominated - was once vital to the drama of growing to adulthood.
By eating one's victims, one was regenerated: socially by the consumption of "noble meat"; biologically by the dismemberment of the enemy; spiritually by good (reproduction, strength, integrity of the community) vanquishing evil (threats to reproduction and the community). And violence was ritually devoured. It is worth recalling, perhaps, that the most important thing about ritual - a subject largely ignored in this book - is its restorative, equilibrating power.
It might be outside the scope of a book review to argue the contention that, in developed societies, we are beginning to witness a correlation between media-imposed models of beauty and the erosion of a healthy sense of self, leading to feelings of alienation. We would possibly consider Melanesian practices of, say, scarification, finger-lopping, and endo-cannibalism (eating one's dead, drinking their cadaveric fluid) to be ugly and repellent, but they play important roles in engendering senses of community and continuity - I believe a young Kiwai warrior mystified by Vogue would readily understand the modern-day symptoms of eating disorders, schizophrenia and depression as forms of self-cannibalism.
Nor should we forget that our Christian world does possess one such remaining ritual: "People have not the custom of eating human flesh and drinking human blood," wrote St Thomas Aquinas; "indeed, the thought revolts them . . . the flesh and blood of Christ are given to us to be taken under the appearances of things in common human use, namely bread and wine . . . in taking the body and blood of our Lord in their invisible presence we increase the merit of faith." Eat and drink, bread and wine - the body and blood of Christ who was given to us - and perhaps we are saved from consuming ourselves.
To talk, then, of cannibalism largely as a narrative phenomenon - a pot full of the grisly stories of Andrei Chikatilo and his 53 victims, Jeffrey Dahmer and his 17, of Arthur Shawcross and the 11 prostitutes whose sexual organs he is supposed to have consumed - without making it clear that there is no connection whatever between these essentially banal crimes and the cannibalism that stabilised pre-colonial, pre-Christian societies, is to violate the historical record. Chikatilo, Dahmer et al do not interest me as cannibals. They seem hugely boring psychopaths whose motivations may lie in pre-frontal cortex dysfunction or unhealthy relationships with their mothers, but whose cases reveal very little about oral aggression that we don't already know, and have nothing to do with the history of spiritual and ritual practice.
What is most disturbing about this book and its accompanying television series is that, by dismembering a subject that is of intrinsic cultural interest to a minority, by seeking to expand its audience by reducing it to its goriest body parts and throwing in all manner of false associations - particularly those to do with serial murder - they become an appalling incitement of scorn and hatred against the beliefs and persons of the remaining indigenous peoples of the earth.
Julian Evans is a literary critic and author of Transit of Venus: travels in the Pacific
from The New American, 2000-Feb-14, by William Norman Grigg:
Off His Rocker?
"PC Police" are demonizing Braves pitcher John Rocker so that certain "intolerant" beliefs can be equated with mental illness.
Paging Igor Smirnov: Major League Baseball may have need of your skills. Smirnov, a psychologist with the Moscow Institute of Psycho-Correction, offered his services to the FBI during the Bureau's 51-day siege against the Branch Davidians at Mt. Carmel. With his expert advice, the FBI mounted a psywar campaign intended to break the Davidians' will. Smirnov's expertise might be in demand again, now that Major League Baseball has adopted Soviet-style "psycho-correction" strictures in its treatment of renegade Atlanta Braves pitcher John Rocker.
Rocker is a 25-year-old reliever with the mouth of Howard Stern and the self-restraint of - well, of the typical New York Mets fan. During last fall's National League Championship Series against the Mets, Rocker made disparaging remarks about the Mets and their home city during several press interviews. The rebuttal offered by Mets fans displayed the sophistication for which our cultural capital has become famous: Rocker was pelted with batteries and beer bottles; his girlfriend was showered with beer; and Shea Stadium resounded with profane insults about Rocker's mother.
Since the New York Yankees subsequently disposed of the Braves with little difficulty in the World Series, it seemed that the Rocker episode would be only a footnote to an otherwise unremarkable baseball season. However, Sports Illustrated's editorial brain trust sniffed out a potentially profitable opportunity to capitalize upon Rocker's adolescent resentments. SI sent a reporter to bait Rocker into producing appropriately caustic quotes. The reporter chummed the waters by repeatedly asking Rocker about his experiences with Mets fans and by reciting some particularly bilious offerings posted on an anti-Rocker website. Predictably enough, Rocker responded with sound bites worthy of a barracuda.
New York City is "the most hectic, nerve-racking city," Rocker complained. "Imagine having to take the [Number] 7 train to the ballpark, looking like you're [riding through] Beirut next to some kid with purple hair next to some queer with AIDS right next to some dude who just got out of jail for the fourth time right next to some 20-year-old mom with four kids. It's depressing." Rocker also complained about the preponderance of "foreigners" in New York, and the fact that a visitor "can walk an entire block in Times Square" without hearing the English language being spoken. Of course, prominent mention was made of the fact that Rocker was an enthusiastic hunter from rural Georgia. Clearly, Rocker was the victim of an exercise in journalistic entrapment, but "hate criminals" such as he can expect no extenuation from the custodians of "tolerance."
Even President Clinton took a swipe at Rocker, pontificating that "these bigoted remarks were outrageous and unacceptable and send a terrible message to our kids," and that Rocker "should be appropriately sanctioned." This from a man who bombs "foreigners" - in Haiti, Bosnia, Serbia, and elsewhere - for political expediency.
As the controversy grew, Major League Baseball Commissioner Bud Selig ordered Rocker to undergo psychological testing, the purpose of which, reported the New York Times, was to give him a "chance to prove that, despite the inflammatory remarks he made to Sports Illustrated, he is a rational person." Rocker was given a Soviet-style choice in the matter: He could consent to the tests prior to being sanctioned by the league, or waive the tests and face immediate discipline. Not surprisingly, Rocker chose to undergo testing.
As sports commentator Bob Klapisch points out, Selig's edict sets "a dangerous precedent by linking Rocker's comments to a behavioral disorder that can be treated by medical science." But Selig is by no means alone in making such linkage. Surgeon General David Satcher recently published a report claiming that 22 percent of all Americans suffer from a "diagnosable mental disorder" at any given time, and that "up to half the population will suffer from mental illness ... at some time in their lives." Cathy Young of the Women's Freedom Network points out that Satcher's "findings" offer nearly unlimited "potential for coercive therapeutic intervention in private lives" in the name of "mental health."
The ease with which public outrage over Rocker's comments morphed into a "consensus" that the young man was mentally ill suggests that the episode was intended to teach the public a lesson - namely, that "intolerant" people are too sick to be entrusted with certain rights, such as freedom of speech. But not all forms of intolerance betoken such infirmity.
When actor Alec Baldwin told a television audience that Representative Henry Hyde (R-IL) and former Special Prosecutor Kenneth Starr should be beaten to death by mobs, nobody suggested that the left-wing actor was in need of psychological counseling. Neither the mass media nor Major League Baseball questioned the sanity of Rocker's boss, Braves owner Ted Turner, after he made anti-Catholic remarks (including a Polish joke at the Pope's expense) in February 1999. Rocker - a white, middle-class, gun-owning, politically illiberal native of rural America - was obviously a much more suitable stereotype of the type of people supposedly in need of the forcible ministrations of the "tolerance" police.
``So what is the first thing he would do to decrease violent behavior? Quick answer. `We've got to dismantle the NRA.' And what to do with Charlton Heston? `Shoot him - with a .44-caliber bulldog," he says with a laugh.''
-Howard Feinstein, New York Post writer, reporting the views of (racist, rich, peddler of psychopath training films, black, and establishment Liberal) Spike Lee, in "Spike Takes On 'Sam' & The NRA" (New York Post, 1999-May-22 - Feinstein interviewed Lee at the Cannes Film Festival in France; the type of handgun Lee identifies was used in the Son of Sam slayings)
from the New York Times, 2001-Sep-16, by Erica Goode:
Some Therapists Caution That Trauma Services Could Backfire
For many mental health professionals the disaster was a summons. Therapists of all varieties and degrees of expertise set up impromptu grief counseling centers, offered their wisdom on television and radio and sped to the site of the devastation to provide crisis support for rescue and emergency workers.
But in an open letter to their colleagues distributed this weekend, a group of psychologists questioned whether the ministrations of a therapist are what all people want or need now, at a time when stress, fear, anger, uncertainty and grief are entirely normal, and when the full impact of what has happened has not yet sunk in. And they cautioned that thrusting help on people instead of letting them seek it themselves might in some case do more harm than good.
"As psychologists, our instinct is to help, and indeed there is much we can do," said the letter, signed by 19 psychologists, some of whom study the psychological effects of traumatic events and others of whom have themselves been involved in crisis work. "But in times like this it is imperative that we refrain from the urge to intervene in ways that - however well intentioned - have the potential to make matters worse."
The psychologists include several prominent experts on the psychological effect of trauma. They cited several studies that had found that certain crisis intervention techniques might be ineffective or might even slow recovery. In particular, they said, are one-time "debriefing" sessions immediately after a trauma that tell people what symptoms they might develop and encourage them to vent their emotions but offer no specific coping strategies.
They said therapists could be most helpful by empathizing with the suffering of victims and their families, by offering "appropriate psychological services" to people who in a few weeks are still having problems and by "supporting the community structures that people naturally call upon in times of grief and suffering."
The letter writers emphasized that they did not want to discourage therapists from making help available or people from seeking help if they felt they could not cope on their own. But Dr. Gerald Rosen, a clinical psychologist in private practice in Seattle and one of the letter's authors, said, "The public should be very concerned about medicalizing what are human reactions to things."
The symptoms that some experts are publicly calling post-traumatic stress disorder - like startle reactions, intrusive images like the tower collapsing, fear of tall buildings, sleeping problems, irritability and intense sadness - are in fact normal responses to extreme fear and stress that will fade with time, for most people. A diagnosis of post-traumatic stress disorder, a serious, abnormal reaction to trauma, is made only when symptoms have lasted for at least a month.
The letter was posted on several Internet bulletin boards for mental health experts and sent to the Monitor on Psychology, the magazine of the American Psychological Association. The signers included Dr. Edna Foa of the University of Pennsylvania, an expert on post-traumatic stress disorders, and Dr. Richard McNally of Harvard, another expert on the effects of trauma.
But the psychologists' statements drew immediate criticism from other specialists in crisis intervention, who said the letter could discourage rescue workers and other people from accepting vital services that might help protect them from more serious psychological trouble later.
"To hear these criticisms when people are in the midst of the operation is just ludicrous," said Dr. Jeffrey Mitchell, the president of the International Critical Incident Stress Foundation, a nonprofit organization that provides crisis intervention, training and support for emergency services, corporations and law enforcement internationally.
A former firefighter and paramedic, Dr. Mitchell agreed that some therapists who go to disaster scenes are badly trained and inappropriately intrusive. He also concurred with many signers of the letter that the majority of people exposed to traumatic circumstances recover and that no one should be forced to talk about feelings, especially immediately after a disaster.
But he said the letter writers misrepresented the nature of organized programs offering mental health crisis services to trauma victims. And he noted that other studies demonstrated the protective benefits of such early intervention. "Early intervention is an extremely important part of the process," he said.
Dr. Richard M. Gist, a signer of the letter who is an assistant to the director of the Fire Department in Kansas City, Mo., said he became concerned about debriefing techniques after using them in 1981, when an explosion in Kansas City killed six firefighters.
"The impact of the first attempt at intervention was clearly not successful in addressing or relieving symptoms," Dr. Gist said. When the same methods were used with rescue workers after a plane crash killed 112 people in Sioux City, Iowa, he added, the workers complained that the help had been both ineffective and intrusive.
Dr. Grist also said 11 studies of debriefing techniques, analyzed in a report this year in The Cochrane Library, a publication devoted to evidence-based medicine, found that some types of debriefing techniques were either ineffective in preventing the more serious symptoms or actually appeared to increase the risk. The studies focused on single-session treatment that involved some form of emotional venting by encouraging the recollection of the event.
It is not clear why such techniques might make things worse, Dr. Gist and other psychologists said, but it may be that asking people to be aware of symptoms and having them recall their experiences "opens up the wound," without providing people with specific techniques - like desensitization or cognitive therapy - for coping with the stress.
"If we tell people there is a severe danger that they will fall from a precipice, we should not be surprised that some of those people end up on the rocks," Dr. Gist said.
Epidemiological studies have found that in the majority of people, even those exposed to even the most severe traumas, acute symptoms of stress subside within three months. About 25 percent go on to develop stress disorders.
Traumatic experiences can also stir up memories of stressful events, aggravated symptoms of acute stress, but these also usually diminish over time.
Dr. Mitchell, however, said the studies considered by the review's authors were not representative of the way his foundation, or any other reputable group, went about providing mental health help to people under extreme stress.
Rescue and emergency workers are not pushed to talk or to vent feelings while they are still in the middle of the crisis, as they are now.
"Rescue personnel right now are in operations mode," Dr. Mitchell said. "They must suppress their emotions in order to do the job. They're seeing if they can recover any other lives from this building."
from the New York Times, 2001-Jun-24, by Margaret Talbot:
The Shyness Syndrome: Bashfulness Is the Latest Trait to Become a Pathology
In the social evolution of a new psychological syndrome, there may be no moment more important than the appearance of its first celebrity victims. A star or maybe a fading star "discloses" a "troubling diagnosis" that he or she has "struggled with" in "silence." The star receives warm studio-audience applause and big Hollywood hugs for "bravery," for "just wanting to help others in the same situation." (In the case of rockers and drugs, the evidence of a "struggle" is often kind of thin; more often it looks as if they partied really hard and then slacked off a bit when they turned 50 or 60 or the drummer died.) Meanwhile, as the celeb makes the rounds of the talk shows or "sits down" with People magazine, the syndrome itself moves up in the world, acquiring a new high profile, maybe a catchy acronym and a presumption that it is "far more widespread" than we ever realized.
This is the stage we have now reached with "social anxiety disorder," also called "social phobia" and colloquially known as shyness. The condition had been identified in the D.S.M., the bible of psychiatric diagnosis, as far back as 1980. But until recently, it was thought to be a rare disorder, characterized not only by a distracting nervousness at parties or before giving a speech, say, but also by a powerful desire to avoid such situations altogether. Then in 1999, buoyed by the success of the new psychotropic drugs, the pharmaceutical company SmithKline Beecham began marketing its antidepressant Paxil as a treatment for social phobia. Public awareness campaigns equated the syndrome with an allergy to people. Experts cited alarming new statistics -- around 13 percent of us were socially phobic, for example -- and magazines dished up the requisite alarmist trend stories. A set of traits and behaviors, at least some of which were once regarded as neutral or even desirable, re-emerged as a pathology -- a function of brain chemistry, amenable to and indeed demanding pharmacological manipulation.
Enter the socially anxious celebrities. Donny Osmond was one of the first to come forward with a full-scale confessional. Recently, for some reason, it has been athletes. The English soccer star David Beckham, who is married to a Spice Girl, published a memoir last fall in which he admitted to being painfully shy. And last month, the New Orleans Saints running back Ricky Williams told reporters that his social anxiety disorder had been officially diagnosed and that he is now medicated for it. The syndrome, he said, accounted for his unusual behavior: keeping his helmet on during rookie-year interviews, curling up inside his locker. It was touching, actually, to hear Williams's teammates rally around him. "We're all family," a defensive tackle said. "If one of us hurts, all of us hurt." But it was also a reminder that it is much easier to turn on the spigots of empathy and attention these days when you can cite a diagnosed imbalance in brain chemistry rather than an eccentricity, a character flaw or an economic disadvantage.
In two years, then, social anxiety disorder has picked up all it needs -- a psychotropic drug of choice, an army of advocates, a handful of celebrity sufferers -- to sustain itself as a widely recognized syndrome. And for some people, people truly incapacitated by their fears of others' disapproval, that is a blessing. It will make it easier for them to seek help and perhaps obtain relief.
And yet, there are always costs to medicalizing what is not, essentially, a medical condition. If extremely shy people require a pill, maybe mildly shy people could be improved by one, too. How about a few more outgoing types in the office -- fewer Eeyores, more Tiggers? Advocates of the new diagnosis are forever saying that social phobia is worse than mere shyness, but in practice the line between them is fluid, depending as it does on highly subjective judgments about whether a person's social reticence causes significant "distress." As an article on the subject in a recent issue of American Family Physician acknowledges, social phobia can be tricky to diagnose because "the types of fears and avoidance commonly associated with" it "are, to some degree, experienced by most people." I took the social phobia inventory, a self-administered test offered on the Facts for Health Web site among other places, including Paxil's site, and on one afternoon got the verdict that I was not socially phobic and on the next that I might be and should consult my clinician.
The truth is that shyness is not exactly an objectively measurable condition -- or trait or whatever it is. A generation ago, personality assessments folded it into the general category of introversion and characterized neither introversion nor extroversion as pathological. In surveys taken in the 1970's and again in the 1990's, the percentage of Americans claiming to be shy jumped from 40 to nearly 50 percent, which suggests not some mysterious epidemic of shyness, however you define it, but more likely a shift in social values. Maybe more people feel shy in a culture in which the omnipresent media is so full of the aggressively unshy. Maybe in another generation or so, we'll find ourselves sorely missing the meek and the mild, the stoic and the taciturn among us. Is somebody out there inventing the drug to treat excessive perkiness?
Margaret Talbot is a fellow at the New America Foundation and a contributing writer for the magazine.
from Space Science at NASA, from http://spacescience.com/headlines/y2001/ast23feb_2.htm :
The Great Moon Hoax
Moon rocks and common sense prove Apollo astronauts really did visit the Moon.February 23, 2001 -- Last week my phone rang. It was my mother ... and she was upset.
"Tony!" she exclaimed, "I just came from the coffee shop and there's an [adjective omitted] man down there who says NASA never landed on the Moon. Everyone was talking about it ... I just didn't know what to say!"
That last bit was hard to swallow, I thought. Mom's never at a loss for words.
But even more incredible was the controversy that swirled through her small-town diner and places like it across the country. After a long absence, the "Moon Hoax" was back.
All the buzz about the Moon began on February 15th when Fox television aired a program called Conspiracy Theory: Did We Land on the Moon? Guests on the show argued that NASA technology in the 1960's wasn't up to the task of a real Moon landing. Instead, anxious to win the Space Race any way it could, NASA acted out the Apollo program in movie studios. Neil Armstrong's historic first steps on another world, the rollicking Moon Buggy rides, even Al Shepard's arcing golf shot over Fra Mauro-- it was all a fake!
Fortunately the Soviets didn't think of the gag first. They could have filmed their own fake Moon landings and really embarrassed the free world.
Shows like Conspiracy Theory ought to be as tongue-in-cheek as they sound. Unfortunately, there was an earnest feel to the Fox broadcast, enough to make you wonder if the program's makers might have fallen under their own spell.
According to the show NASA was a blundering movie producer thirty years ago. For example, Conspiracy Theory pundits pointed out a seeming discrepancy in Apollo imagery: Pictures of astronauts transmitted from the Moon don't include stars in the dark lunar sky -- an obvious production error! What happened? Did NASA film-makers forget to turn on the constellations?
Most photographers already know the answer: It's difficult to capture something very bright and something else very dim on the same piece of film -- typical emulsions don't have enough "dynamic range." Astronauts striding across the bright lunar soil in their sunlit spacesuits were literally dazzling. Setting a camera with the proper exposure for a glaring spacesuit would naturally render background stars too faint to see.
Here's another one: Pictures of Apollo astronauts erecting a US flag on the Moon show the flag bending and rippling. How can that be? After all, there's no breeze on the Moon....
Not every waving flag needs a breeze -- at least not in space. When astronauts were planting the flagpole they rotated it back and forth to better penetrate the lunar soil (anyone who's set a blunt tent-post will know how this works). So of course the flag waved! Unfurling a piece of rolled-up cloth with stored angular momentum will naturally result in waves and ripples -- no breeze required!
The Fox documentary went on with plenty more specious points. You can find detailed rebuttals to each of them at BadAstronomy.com and the Moon Hoax web page. (These are independent sites, not sponsored by NASA.)
The best rebuttal to allegations of a "Moon Hoax," however, is common sense. Evidence that the Apollo program really happened is compelling: A dozen astronauts (laden with cameras) walked on the Moon between 1969 and 1973. Nine of them are still alive and can testify to their experience. They didn't return from the Moon empty-handed, either. Just as Columbus carried a few hundred natives back to Spain as evidence of his trip to the New World, Apollo astronauts brought 841 pounds of Moon rock home to Earth.
"Moon rocks are absolutely unique," says Dr. David McKay, Chief Scientist for Planetary Science and Exploration at NASA's Johnson Space Center (JSC). McKay is a member of the group that oversees the Lunar Sample Laboratory Facility at JSC where most of the Moon rocks are stored. "They differ from Earth rocks in many respects," he added.
"For example," explains Dr. Marc Norman, a lunar geologist at the University of Tasmania, "lunar samples have almost no water trapped in their crystal structure, and common substances such as clay minerals that are ubiquitous on Earth are totally absent in Moon rocks."
"We've found particles of fresh glass in Moon rocks that were produced by explosive volcanic activity and by meteorite impacts over 3 billion years ago," added Norman. "The presence of water on Earth rapidly breaks down such volcanic glass in only a few million years. These rocks must have come from the Moon!"
Right: A glass spherule (about 0.6 mm in diameter) produced by a meteorite impact into lunar soil. Features on the surface are glass splashes, welded mineral fragments, and microcraters produced by space weathering processes at the surface of the moon. SEM image by D. S. McKay (NASA Photo S71-48109).
Fortunately not all of the evidence needs a degree in chemistry or geology to appreciate. An average person holding a Moon rock in his or her hand can plainly see that the specimen came from another world.
"Apollo moon rocks are peppered with tiny craters from meteoroid impacts," explains McKay. This could only happen to rocks from a planet with little or no atmosphere... like the Moon.
Meteoroids are nearly-microscopic specks of comet dust that fly through space at speeds often exceeding 50,000 mph -- ten times faster than a speeding bullet. They pack a considerable punch, but they're also extremely fragile. Meteoroids that strike Earth's atmosphere disintegrate in the rarefied air above our stratosphere. (Every now and then on a dark night you can see one -- they're called meteors.) But the Moon doesn't have an atmosphere to protect it. The tiny space bullets can plow directly into Moon rocks, forming miniature and unmistakable craters.
"There are plenty of museums, including the Smithsonian and others, where members of the public can touch and examine rocks from the Moon," says McKay. "You can see the little meteoroid craters for yourself."
Right: Nick-named "Big Muley," this 11.7 kg Moon rock was the largest returned to Earth by Apollo astronauts. One side of Big Muley was peppered with meteoroid "zap pits." Below right: A close-up view of 1 mm diameter zap pits shows tiny craters lined with black glass surrounded by a white halo of shocked rock. [more]
Just as meteoroids constantly bombard the Moon so do cosmic rays, and they leave their fingerprints on Moon rocks, too. "There are isotopes in Moon rocks, isotopes we don't normally find on Earth, that were created by nuclear reactions with the highest-energy cosmic rays," says McKay. Earth is spared from such radiation by our protective atmosphere and magnetosphere.
Even if scientists wanted to make something like a Moon rock by, say, bombarding an Earth rock with high energy atomic nuclei, they couldn't. Earth's most powerful particle accelerators can't energize particles to match the most potent cosmic rays, which are themselves accelerated in supernova blastwaves and in the violent cores of galaxies.
Indeed, says McKay, faking a Moon rock well enough to hoodwink an international army of scientists might be more difficult than the Manhattan Project. "It would be easier to just go to the Moon and get one," he quipped.
And therein lies an original idea: Did NASA go to the Moon to collect props for a staged Moon landing? It's an interesting twist on the conspiracy theory that TV producers might consider for their next episode of the Moon Hoax.
"I have here in my office a 10-foot high stack of scientific books full of papers about the Apollo Moon rocks," added McKay. "Researchers in thousands of labs have examined Apollo Moon samples -- not a single paper challenges their origin! And these aren't all NASA employees, either. We've loaned samples to scientists in dozens of countries [who have no reason to cooperate in any hoax]."
Even Dr. Robert Park, Director of the Washington office of the American Physical Society and a noted critic of NASA's human space flight program, agrees with the space agency on this issue. "The body of physical evidence that humans did walk on the Moon is simply overwhelming."
"Fox should stick to making cartoons," agreed Marc Norman. "I'm a big fan of The Simpsons!"
from The New Statesman, 2000-Dec-25, by Edward Skidelsky:
Freud: darkness in the midst of vision
Louis Breger John Wiley, 472pp, £19.99
ISBN 0471316288
The Secret Artist: a close reading of Sigmund Freud
Lesley Chamberlain Quartet Books, 339pp, £12.50
Psychoanalysis is often thought of today as a softening influence on the personality, as a device for making people more tolerant, more open, more "in touch" with their feelings. It is seen - for good or for ill - as part of the trend towards the "feminisation" of the modern psyche. So it comes as a surprise that the founder of psychoanalysis, Sigmund Freud, was the most severe of Victorian patriarchs. With his autocratic demeanour and phallocratic cigar, Freud has become something of an embarrassment to his modern disciples. One of these embarrassed disciples - Louis Breger, an American analyst - has now become his latest biographer.
Breger turns the weapons of Freudian analysis against Freud himself; this is biography as psychoanalysis. But in order to make room for his own analysis of Freud, Breger must first discredit Freud's self-analysis. At the age of 41, during a period of intense introspection, Freud stumbled on what was to become the centrepiece of his psychological theory, the Oedipus complex. "I have found, in my own case, too, the phenomena of being in love with my mother and jealous of my father, and I now consider it a universal event in early childhood." Breger demurs. Freud, he argues, did not so much discover as invent the Oedipus complex. He invented it in order to conceal from himself the real cause of his childhood suffering, which lay in the more mundane experience of poverty, bereavement and maternal neglect. The example of Oedipus allowed Freud to picture himself as a powerful warrior, rather than the helpless and unhappy infant he must, in fact, have been. It was a machismo emblem with which to ward off memories of childhood trauma. Breger thus succeeds in discrediting Freud's most "patriarchal" doctrine, while remaining within the general framework of Freudian analysis.
This story has an initial plausibility, but only because it corresponds so closely to the nostrums of modern-day psychology. Freud is presented as a passive victim, rather than as an active protagonist. The "damaged" psyche of contemporary therapy has replaced the libidinal psyche of classical psychoanalysis. Yet here, Breger displays his parochialism. The "traumas" of Freud's infancy consist in experiences that any poor Jewish boy in mid-19th-century Vienna might have faced. Freud was no more "damaged" than any person of his background. In fact, he seems to have been relatively privileged. As soon as his intelligence was recognised, Freud became the darling of his family. It was their support, rather than any childhood trauma, that spurred his ambition.
"A man who has been the indisputable favourite of his mother goes through life with the feeling of a conqueror," wrote Freud, surely with himself in mind. Breger's certainty that Freud must have had a traumatic infancy rests on the tendentious doctrine, derived ultimately from Alfred Adler, that all ambition originates in feelings of helplessness and inferiority.
The Oedipus conflict was far more than a compensatory fiction for Freud; it was the central reality of his psychic life. In the battle between father and son, Freud was always on the side of the father. His own father was a weak and ineffectual man, and so, from an early age, Freud assumed the role of paterfamilias. He cast around for more inspiring figures on which to model himself; his imagination lighted on Hannibal, Alexander, Napoleon and Moses. Later on, his medical mentors, Ernst Brucke and Jean-Martin Charcot, played the same role. Freud's relationship with all these father figures was one of emulation rather than rebellion. He sought to appropriate their authority, to absorb, as he might have put it, their phallic potency. When at last he became a father himself (and "father" to the psychoanalytic movement), he jealously guarded his patriarchal status. Any deviation on the part of his psychoanalytic children was interpreted - in line with the thesis of Totem and Taboo - as an attempt to murder him. Freud's friendships with men were thus marked by a peculiar intensity. His relations with women, on the other hand, were anodyne and conventional. One gets the impression that he wasn't very interested in them. This is reflected in the passive and subordinate role they play in his theory.
One has to be careful drawing connections between Freud's life and his work, because this was, notoriously, a technique he himself used to discredit the work of rivals. Freud liberally employed diagnosis as a weapon of abuse, dismissing all rebellions against psychoanalytic orthodoxy as "neurotic" and "pathological". Adler's motives, Freud wrote to Jung, "are all of neurotic source . . . his influence on others depending on his strong terrorism and sadism". Later on, Jung was subjected to the same treatment: "One who, while behaving abnormally, keeps shouting that he is normal gives ground for suspicion that he lacks insight into his illness." And Freud took a similarly reductive view of other disciplines. James Strachey, Freud's English translator, once showed Freud a copy of Wittgenstein's Tractatus. Freud perused it and handed it back, saying: "Well, it's quite straightforward; the man's clearly an anal-obsessive." This, to my knowledge, is Freud's only recorded comment on his great compatriot.
The use of diagnosis as a tool of polemic was not a peculiarity of Freud alone; it characterised the movement as a whole. Meetings of the Vienna Psychoanalytic Society were often marred by vitriolic personal attacks. Rudolf Reitler described a paper of Wilhelm Stekel's as "a neurotic symptom - a wave of asexuality has surged up in the author". Stekel, discussing a paper by Fritz Wittels, remarked that "the speaker has projected the unpleasant self-knowledge of his own insignificant hysteria on to a quite harmless class of people".
Something in the nature of psychoanalysis, it seems, lends itself to this form of abuse. An analogy can been drawn with Marxism. Both movements renounce the possibility of disinterested argument; both view reason as irredeemably tainted by unconscious motivation. Thus debate within Marxism and psychoanalysis inevitably carries a personal dimension: any disagreement over doctrine is simultaneously a clash of economic or psychological motives. And as no objective standard exists for resolving these disputes, victory normally falls to the person who can most successfully impugn the opponent's intentions. The bad manners of Marxists and psychoanalysts is no accidental trait; it is central methodological principle.
The history of the Vienna Psychoanalytic Society - replete with disputations, splits and denunciations - bears an uncanny similarity to that of the Russian Communist Party. Freud acted as a miniature despot, surrounding himself, Stalin-like, with a posse of sycophants. These unpleasant creatures were zealous in their defence of orthodoxy, knowing full well that their status within the movement depended on the grace of "the Professor". Heretics were punished with expulsion from the society, accompanied by vicious personal attacks. They were readmitted only after making a full public confession and recantation. "From a state which I now recognise as neurotic," wrote the dissident member to the committee, "I have suddenly returned to myself . . . I can only hope, dear Abraham, that my painfully won insight into this whole matter and my sincere regret will make it possible for you to forgive and forget the wrong which came to you from my state of mind."
As Freud's biographer Ronald Clark points out, the wording of this letter closely follows the formula of a Stalinist confession. Breger provides detailed accounts of this and similar episodes, but fails to recognise that their source lies in the nature of psychoanalysis as a discipline, not merely in the despotic tendencies of its founder.
Yet it is too simple to dismiss psychoanalysis as pseudo-science. In his rejection of the Enlightenment doctrine of pure reason, Freud was returning to the central tradition of Christian theology. What the German philosopher Ernst Cassirer writes about St Augustine could equally well be applied to Freud. "Reason for Augustine does not have a simple and unique but rather a double and divided nature . . . From the time of the fall its original power has been obscured. Reason alone can never show us the way back. It cannot reconstruct itself; it cannot, by its own efforts, return to its former pure essence."
For Freud, too, reason is "fallen", captive to the dark forces of the unconscious. The path to truth lies not through rational argument, but through sudden revelation; only revelation can break the power of the unconscious mind and restore reason to its prelapsarian glory. Recognition of the fallibility of reason is both the glory and the curse of the Augustinian tradition. It is the source of its profound truths, but also of its vicious odium theologicum. It is like a scalpel that can be used both to heal and to murder. Insight into the irrational sources of our own thoughts and actions can be experienced as a tremendous liberation. Yet the same insight, directed against another person, can be used to malign and destroy. This is what makes Freud and Augustine such ambiguous figures. What is great in them is inextricably bound up with that which is repulsive.
The comparison with Augustine points towards the true status of Freud. He is not a scientist, nor is he - as Lesley Chamberlain suggests in her intriguing new book - a "secret artist". He is the last of the great theologians. If Marx provided the 20th century with a secular millennialism, Freud provided it with a secular Gnosticism. These secular myths give us something that the special sciences cannot, by their very nature, give us - a symbolic system in which we "live, and move, and have our being". [The foregoing sentence is wretched bilge. Marx and Freud did not give mankind a system in which to live and be, but rather, a system in which to kill and die and be destroyed. -AMPP Ed.] This is why we cannot do without them. [Thus is the dreadful stance of the author revealed. -AMPP Ed.] Despite the refutation of almost all of Freud's scientific claims, our understanding of the mind is still more Freudian than it is pre-Freudian. [Maybe his is. Mine (on mind and gender) is not. -AMPP Ed.] And we will continue to live under his shadow until a new theologian displaces him. [No we will not. I and those aligned with me have already condemned religion without reservation or exception. -AMPP Ed.]
Edward Skidelsky writes regularly for the books pages
from the British Medical Journal, 2000-Dec-23, by David Greaves, senior lecturer in medical humanities, School of Health Science, Centre for Philosophy and Health Care, University of Wales, Swansea SA2 8PP:
The obsessive pursuit of health and happiness
Manic depression is part of my life, and as I have suffered both the agony of manic episodes and the despair of depressive ones, the thought of obtaining lasting happiness has a recurring appeal. Yet deep down I know this appeal to be false.
Richard Bentall once proposed that happiness be classified as a mental disorder,1 but only as a device to parody psychiatric orthodoxy, and so did not intend it to be taken literally. He may have stumbled unwittingly, however, on a modern truth -- that the obsessive pursuit of happiness is a sort of madness to which our society is particularly prone.
Our beliefs about health also parallel this. The famous definition of health by the World Health Organization as a "state of complete physical, mental, and social wellbeing" is similarly attractive. On reflection, though, it bypasses the unalterable reality of most people's lives, so the quest for such a perfect ideal of health is an equivalent form of madness.
Health and happiness are then held out as a promotional package to which all good citizens are expected to aspire, but the paradox is that it can lead to an addictive disorder that acts like a distorting mirror, affecting every aspect of our lives.
Thus the definition of health proposed by the French historian and philosopher Georges Canguilhem seems more appropriate; Kenneth Boyd paraphrased Canguilhem's rather lengthy definition as "not a matter of getting back from illness, but getting over and perhaps beyond it."2 With this approach, health and happiness lose their tempting allure, but we would be less in thrall to the utilitarian imperative of "the greatest happiness (and health) of the greatest number," and so be correspondingly less troubled by "shortages" of healthcare resources and the spectre of ageing and death.
My own experience of manic depression is that it is not something that can be eradicated through the avoidance of life's troubles or through deadening these troubles with either drugs or psychological distractions -- although these strategies may have their place. Rather, depression must be grappled with, lived through, and reinterpreted just as far as is possible. The risk of chronic distress, mental destruction, or even suicide is never far away, but nor is the possibility of joy, warmth, and insight. Hence pain and suffering can never be banished, but with fortitude and a degree of luck they may be tempered by more positive experiences, and bent to a constructive purpose.
References
Bentall RP. A proposal to classify happiness as a psychiatric disorder. J Med Ethics 1992; 18: 94-98
[Medline] .Boyd KM. Disease, illness, sickness, health, healing and wholeness: exploring some elusive concepts. Medical Humanities 2000; 26: 14
.
from the Washington Times, 2001-Jan-19:
Speeding as a disease
Speeding may soon get you more than a simple traffic ticket. How about a warm and fuzzy stint at an "anger management" clinic?
In Arlington County, traffic offenders identified as "aggressive drivers" are being sent to the couch instead of traffic school (which was bad enough). This has been an option for traffic court judges since December, when the program first went into effect.
In essence, you're clearly not well in the head if you ignore or disobey the traffic edicts laid down by politicians. Arlington is famous for its radar traps and relentless enforcement of HOV lane restrictions. You need soothing voices. Perhaps a quiet talk about your childhood. Please, tell us about your mother. . .
Supposedly, of course, the anger management claptrap is intended only for "aggressive" drivers. The implication, of course, is that we're dealing only with dangerous, even homicidal motorists who are on the verge of "going Postal" behind the wheel. But no one has ever defined "aggressive driving" in anything other than absurdly vague generalities. The term is highly fluid and has been used by self-appointed "safety" advocates to encompass everything from simple speeding to vehicular jousting matches. It is often a judgment call on the part of the police officer, or, later, a judge.
The concept of "aggressive driving" is very clever - and potentially quite ominous. For now, the term is taken to mean only those motorists who have come unhinged, who are deliberately reckless, looking to create mayhem. But given the absence of a clear definition, it's no great leap to imagine that the term "aggressive driving" will shift to encompass merely technical violations.
And instead of simply fining you and assessing points, a judge may send you to the shrink to deal with your "anger." People who run afoul of the safety lobby's edicts are not merely scofflaws -they are considered in need of "treatment."
It's a brave new world, indeed.
from the Wall Street Journal's Opinion Journal, 2001-Jan-23, "Best of the Web":
Angry Young Man
On Friday we noted a Washington Times editorial about a new program in Arlington, Va., that will send some traffic offenders to "anger management" clinics rather than traffic school. Also on the cutting edge of this trend is the University of Colorado. Abetted by the Colorado courts, the university has ordered one of its students to complete an anger-management course after the student was accused of "driving his vehicle in a reckless manner on campus while avoiding accepting a parking ticket."
The student, Carlos Martinez, has set up a Web site detailing his case, http://www.worstcaseever.com/. The Foundation for Individual Rights in Education, which intervened on behalf of Martinez, called the episode "yet another case of a free society confronted with the appalling reality of campus kangaroo courts."
When the campus disciplinary measure was finally reviewed in a state court, Judge Daniel Hale struck down the university's decision to expel Martinez. He wrote:
A disciplinary system must have the appearance of impartiality and fairness, neither of which were apparent in this case. There is simply no competent evidence in the record to support the University's decision. The decision was so devoid of evidentiary support that it can only be explained as an arbitrary and capricious exercise of authority.
While overturning the expulsion, the judge did rule that "Martinez is to enroll in and complete an anger management course and submit a letter of apology before the end of the next full semester for which he is enrolled in the University." We think Martinez has every right to be mad.
Surge in mental disorders predicted
The number of people with deprssion is set to rise Mental health disorders ranging from depression to epilepsy, will be the second most common cause of death and disability by 2020, say experts.
The World Health Organzation estimates the numbers affected by mental and neurological disorders will surge over the next 20 years.
They currently affect 400 million people across the world.
The WHO currently ranks depression in fifth place.
The United Nations health agency said the rise was probably due to people living more stressful lives, and suffering more poverty and violence.
Alzheimer's disease, which predominantly affects the elderly, is expected to increase as people live longer.
'Reduce stigma'
The World Health Organization was launching its campaign for this year called: "Stop exclusion - Dare to care", which aims to remove the stigma from mental illness.
Dr Derek Yach, from the WHO said: "This (campaign) is overdue, given that mental health is a major cause of disability, family and community distress and loss of production."
Dr. Benedetto Saraceno, director of WHO's department of mental health and substance dependence, said: "There is a common myth that mental health problems are those of rich, industrialised countries, a luxury.
"But mental and neurological problems are equally important in rich and poor countries."
Ischemic heart disease, now the sixth leading cause of death, is predicted to cause the largest number of deaths.
Acute lower respiratory infections currently cause the largest number of deaths around the world, but the WHO predicts infectious disease numbers are expected to fall.
Depression rates
Depression, which is often genetic, hits roughly twice as many women as men.
The WHO estimates United States and Japan have the highest numbers with depression.
The lowest rates are in Africa.
Dr Yach said: "Surveys in Brazil, Zimbabwe, India and Chile show the more impoverishment - measured by hunger, level of debt and education - the higher the prevalence of common mental disorders."
There are around one million suicides worldwide every year, out of 10m attempts.
All the top ten countries for numbers of suicides are former Soviet Union countries.
Mental and neurological disorders represent 11% of the "global burden of disease", which is expected to rise to14% in 2020.
Dr Saraceno said 70% of those suffering from major depression can fully recover if properly treated.
"We can expect a decrease in suicides if we are properly treating depressed people."
Schizophrenia affects 45 million people worldwide.
Post-traumatic stress 'misdiagnosed'
Employees claim post-traumatic stress for doing jobs A 'trauma industry' of lawyers, experts and claimants are pushing compensation claims higher than they should be, say experts.
They say a diagnosis of post-traumatic stress disorder is only applicable to extreme cases of psychological distress.
But the condition is commonly being misdiagnosed to add weight to compensation claims.
A paper by Dr Derek Summerfield, honorary senior lecturer at the Department of Psychiatry, St George's Hospital Medical School, London, says lawyers, psychiatrists and claimants have been banding together in an attempt to get higher pay-outs.
Cash pay-out higher
He said a diagnosis of post-traumatic stress disorder (PTSD) can push the pay-out awards for psychological damages up 'several times' higher.
He said: "There is a veritable trauma industry comprising experts, lawyers, claimants, and other interested parties.
"An encounter between a sympathetic psychiatrist and a claimant is primed to produce a report of post-traumatic stress disorder if that is what the lawyer says the rules require and what has, in effect, been commissioned."
In his paper, published in the British Medical Journal, Dr Summerfield says 'relatively commonplace' events such as accidents; muggings, a difficult labour with a healthy baby and verbal sexual harrassment can now be associated with post-traumatic stress disorder.
Dr Summerfield says British workers are increasingly turning to PTSD claims for carrying out their jobs and says there will be a price to be paid by both society and the NHS.
Workers claim stress
He said: "Increasingly, the workplace in Britain is being portrayed as traumatogenic even for those who are just doing their jobs: paramedics attending road accidents; police constables on duty at disasters and even employees caught up in what would have been described as a straightforward dispute for management.
"There are real implications for society and indeed for the NHS in these trends."
Dr Elizabeth Campbell, Senior Lecturer in Clinical Psychology at Gart Navel Royal Hospital, Glasgow, agrees there are a number of misdiagnosed cases.
She said: "Most commonly, we see people who have had car accidents where another expert or their GP say they have PTSD, but when we ask them they don't have it.
"They just have one or two of the symptoms and are distressed, but the wrong term is being used."
"People in car accidents sometimes want to get that label because unless you have that you do not get the cash."
from Oikos 1999-Jan-27, from http://www.oikos.org/mosher.htm:
Famous psychiatrist L.R. Mosher resigns from the American Psychiatric Association in disgust
This is a copy of a letter by Dr. Mosher resigning from the American Psychiatric Association. Note that Dr. Mosher was a pioneer in establishing programs of psychosocial community care in the field of psychiatry (e.g., Sartoria); his publications in that regard have been very influential (e.g.: Mosher, L., & Burti, L. (1989). "Community mental health: Principles and practice". New York: Norton.).
______________________________________________
Loren R. Mosher M. D.
2616 Angell Ave
San Diego, CA 92122
Ph: 619 550-0312
Fx: 619 558 0854December 4 1998
Rodrigo Munoz, M.D., President
American Psychiatric Association
1400 94 Street N. W.
Washington, D.C. 20005Dear Rod;
After nearly three decades as a member it is with a mixture of pleasure and disappointment that I submit this letter of resignation from the American Psychiatric Association. The major reason for this action is my belief that I am actually resigning from the American Psychopharmacological Association. Luckily, the organization's true identity requires no change in the acronym.
Unfortunately, APA reflects, and reinforces, in word and deed, our drug dependent society. Yet, it helps wage war on drugs. Dual Diagnosis clients are a major problem for the field but not because of the good drugs we prescribe. Bad ones are those that are obtained mostly without a prescription. A Marxist would observe that being a good capitalist organization, APA likes only those drugs from which it can derive a profit - directly or indirectly.
This is not a group for me. At this point in history, in my view, psychiatry has been almost completely bought out by the drug companies. The APA could not continue without the pharmaceutical company support of meetings, symposia, workshops, journal advertising, grand rounds luncheons, unrestricted educational grants etc. etc. Psychiatrists have become the minions of drug company promotions. APA, of course, maintains that its independence and autonomy are not compromised in this enmeshed situation.
Anyone with the least bit of common sense attending the annual meeting would observe how the drug company exhibits and industry sponsored symposia draw crowds with their various enticements while the serious scientific sessions are barely attended. Psychiatric training reflects their influence as well; i.e., the most important part of a resident curriculum is the art and quasi-science of dealing drugs, i.e., prescription writing.
These psychopharmacological limitations on our abilities to be complete physicians also limit our intellectual horizons. No longer do we seek to understand whole persons in their social contexts rather we are there to realign our patients' neurotransmitters. The problem is that it is very difficult to have a relationship with a neurotransmitter whatever its configuration.
So, our guild organization provides a rationale, by its neurobiological tunnel vision, for keeping our distance from the molecule conglomerates we have come to define as patients. We condone and promote the widespread overuse and misuse of toxic chemicals that we know have serious long term effects: tardive dyskinesia, tardive dementia and serious withdrawal syndromes. So, do I want to be a drug company patsy who treats molecules with their formulary? No, thank you very much. It saddens me that after 35 years as a psychiatrist I look forward to being dissociated from such an organization. In no way does it represent my interests. It is not within my capacities to buy into the current biomedical-reductionistic model heralded by the psychiatric leadership as once again marrying us to somatic medicine. This is a matter of fashion, politics and, like the pharmaceutical house connection, money.
In addition, APA has entered into an unholy alliance with NAMI (I don't remember the members being asked if they supported such an organization) such that the two organizations have adopted similar public belief systems about the nature of madness. While professing itself the champion of their clients the APA is supporting non-clients, the parents, in their wishes to be in control, via legally enforced dependency, of their mad/bad offspring. NAMI, with tacit APA approval, has set out a pro-neuroleptic drug and easy commitment-institutionalization agenda that violates the civil rights of their offspring. For the most part we stand by and allow this fascistic agenda to move forward. Their psychiatric god, Dr. E. Fuller Torrey, is allowed to diagnose and recommend treatment to those in the NAMI organization with whom he disagrees. Clearly, a violation of medical ethics. Does APA protest? Of course not, because he is speaking what APA agrees with but can't explicitly espouse. He is allowed to be a foil; after all he is no longer a member of APA. (Slick work APA!)
The shortsightedness of this marriage of convenience between APA, NAMI and the drug companies (who gleefully support both groups because of their shared pro-drug stance) is an abomination. I want no part of a psychiatry of oppression and social control.
Biologically based brain diseases are convenient for families and practitioners alike. It is no fault insurance against personal responsibility. We are just helplessly caught up in a swirl of brain pathology for which no one, except DNA, is responsible. Now, to begin with, anything that has an anatomically defined specific brain pathology becomes the province of neurology (syphilis is an excellent example). So, to be consistent with this "brain disease" view all the major psychiatric disorders would become the territory of our neurologic colleagues. Without having surveyed them
I believe they would eschew responsibility for these problematic individuals. However, consistency would demand our giving over "biologic brain diseases" to them. The fact that there is no evidence confirming the brain disease attribution is, at this point, irrelevant. What we are dealing with here is fashion, politics and money. This level of intellectual/scientific dishonesty is just too egregious for me to continue to support by my membership.
I view with no surprise that psychiatric training is being systemically disavowed by American medical school graduates. This must give us cause for concern about the state of today's psychiatry. It must mean, at least in part, that they view psychiatry as being very limited and unchallenging. To me it seems clear that we are headed toward a situation in which, except for academics, most psychiatric practitioners will have no real relationships, so vital to the healing process, with the disturbed and disturbing persons they treat. Their sole role will be that of prescription writers, ciphers in the guise of being "helpers".
Finally, why must the APA pretend to know more than it does? DSM IV is the fabrication upon which psychiatry seeks acceptance by medicine in general. Insiders know it is more a political than scientific document. To its credit it says so, although its brief apologia is rarely noted. DSM IV has become a bible and a money making best seller - its major failings notwithstanding. It confines and defines practice, some take it seriously, others more realistically. It is the way to get paid. Diagnostic reliability is easy to attain for research projects. The issue is what do the categories tell us? Do they in fact accurately represent the person with a problem? They don't, and can't, because there are no external validating criteria for psychiatric diagnoses. There is neither a blood test nor specific anatomic lesions for any major psychiatric disorder. So, where are we? APA as an organization has implicitly (sometimes explicitly as well) bought into a theoretical hoax. Is psychiatry a hoax, as practiced today?
What do I recommend to the organization upon leaving after experiencing three decades of its history?
1.. To begin with, let us be ourselves. Stop taking on unholy alliances without the members' permission.
2.. Get real about science, politics and money. Label each for what it is - that is, be honest.
3.. Get out of bed with NAMI and the drug companies. APA should align itself, if one believes its rhetoric, with the true consumer groups, i. e., the ex-patients, psychiatric survivors etc.
4.. Talk to the membership; I can't be alone in my views.
We seem to have forgotten a basic principle: the need to be patient/client/consumer satisfaction oriented. I always remember Manfred Bleuler's wisdom: "Loren, you must never forget that you are your patient's employee." In the end they will determine whether or not psychiatry survives in the service marketplace.
Sincerely,
Loren R. Mosher M. D.
from Nature Medicine 7(6):643 (2001-Jun), by Karen Birmingham:
Dark clouds over Toronto psychiatry research
[New York] The University of Toronto (UT) and its affiliated hospitals have become embroiled in another controversy regarding their attitude to corporate donors versus their behavior towards employees.
British psychiatrist David Healy accepted a senior position at the Centre for Addiction and Mental Health (CAMH) and the Department of Psychiatry at UT only to have the offer withdrawn months later on the basis of a speech he made at the University. The speech was highly critical of the pharmaceutical industry.
Healy, the Director of the North Wales Department of Psychological Medicine at the University of Wales in the UK, is a prolific author and his views on neurological medicines are widely known. He has acted as a medical expert in several legal cases involving antidepressant drugs.
He says he was courted by CAMH faculty over a period of 18 months to join the group as Clinical Director of the Mood and Anxiety Disorders Program and as a Full Professor in the Department of Psychiatry at UT. He formally accepted the offer on 13 September, 2000 and proceeded to apply for an immigration visa for himself and his family.
On 30 November last year, Healy took part in a symposium at UT and presented a lecture that he subsequently repeated at Cornell University, New York, and at the Centre for National Research in Health in Paris. The talk also forms the synopsis of a forthcoming Harvard University Press book.
Despite an evaluation form showing that Healy's talk was rated highest for 'content that met the audience's needs and objectives'-above that of speakers such as Steven Hyman, director of the US National Institute of Mental Health-Healy's future bosses took offense to the speech. On 8 December, David Goldbloom, Physician-in-Chief at CAMH emailed Healy canceling his faculty appointment. Goldbloom wrote, "...we believe that it is not a good fit between you and the role as leader of an academic program...This view was solidified by your recent appearance at the Centre in the context of an academic lecture...."
The lecture was an historical account of psychiatric medicine and was highly focused on the role of the pharmaceutical industry. For example, Healy said the reason for the development of new antipsychotic drugs was to create medicines without the tardive dyskinesia side-effects of older drugs and not because these were better for the disease symptoms of schizophrenia. Regarding institutionalization, he said patients in Britain "are being detained at 3 times greater rate than 50 years ago."
He repeated his views on antidepressant drugs: "I happen to believe that Prozac and other SSRIs can lead to suicide. These drugs may have been responsible for 1 death for every day that Prozac has been on the market in North America." And he went on to question why no research has been carried out to determine whether the drug does or does not cause suicide.
Towards the end of the lecture, Healy said that the information from the human genome will give rise to products belonging "almost exclusively to pharmaceutical corporations. If they are advised in the way that they are at present, this knowledge, which is so democratically important, will operate against the interests of democracy."
The manufacturer of Prozac, Eli Lilly, is acknowledged on CAMH's website to be its largest sponsor, having donated over CAN$1 million (US$645,000). While no-one is suggesting that Lilly played any part in the decision to sack Healy, some are questioning whether CAMH faculty were sufficiently worried about offending donors that they sacrificed the recruitment.
CAMH denies that the issue rests on Healy's statements about Prozac. Paul Garfinkel, chair of Psychiatry at UT, told Nature Medicine, "Our search committee knew of his views on Prozac, but that alone doesn't do it. It was the variety of extreme views [in his talk] based on extraordinary extrapolations and incompatibility with scientific evidence. ...his views...shocked a large number of future colleagues to the point where they felt he did not have the respect and support of the staff."
Specifically, Garfinkel cites Healy's comments about the rise in psychiatric hospitalization and his claim that "a significant proportion of the scientific literature is now ghost written [by people in the pharmaceutical industry]." Garfinkel says, "We have no idea where this comes from. Dr Healy has made sweeping statements that do not meet the standards of science."
The case has caught the attention of the Canadian Association of University Teachers (CAUT), an organization that represents 30,000 faculty across Canada. CAUT does not buy CAMH's explanation for canceling Healy's appointment-or see why such a lengthy and detailed hiring process can be reversed on one lecture-and is calling for an independent inquiry into the issue. "We are quite appalled at what appears to be a flagrant violation of academic freedom. Here's an institution-both CAMH and UT-that is uncomfortable having an outspoken critic of the pharmaceutical industry," says CAUT Executive Director, Jim Turk. "We will launch our own investigation if necessary, as we have had to do in the Olivieri case. That report is due out next month." (see overleaf).
Turk told Nature Medicine, "We think there's a very dark cloud over the University of Toronto and its affiliated teaching hospitals. We're sending out a message that this top notch university isn't prepared to tolerate dissent and diversity of viewpoints and amongst medical researchers."
The Faculty Association at UT has also filed a notice of Breech of Academic Freedom and will proceed to a formal grievance procedure if the University does not respond in 3 weeks. Meanwhile, Healy is considering whether to file a legal suit against CAMH for breech of contract.
from Nature Medicine 7(6):644 (2001-Jun), by Laura Bonetta:
Olivieri to testify against Apotex in Europe
[Bethesda] Almost five years after it began, Nancy Olivieri's dispute with the Canadian drug manufacturer Apotex over the effects of its drug for thalassemia (deferiprone), and with the University of Toronto (UT) for its role in the affair, shows no signs of abating.
Olivieri, Brenda Gallie, John Dick, Peter Durie and Hellen Chan are filing grievances against the University for harassment and infringement on their academic freedom. In addition, Olivieri has filed suit against Apotex president Barry Sherman for saying she was "nuts" in an interview aired last year in the television show 60 Minutes. Apotex has countered the suit by saying that Olivieri has defamed their drug product through the academic and lay press. Brenda Gallie recently left HSC to accept a post at another Toronto hospital. Olivieri's lab was closed down in 1998 and the administration has not provided her with new space.
The UT grievance process has been complicated by the fact that the Hospital for Sick Children (HSC), where the Olivieri-Apotex saga unfolded, has refused to allow the grievance panel to access relevant documents. Olivieri et al. call this a "stalling tactic" by the hospital. However, HSC spokesperson Cyndy DeGiusti says that the hospital is within its constitutional rights and has gone to the Court of Ontario to prove it. "We have asked the court whether the grievance panel has any jurisdiction to ask for the documents," says DeGiusti.
The issue dates back to 1996, when Olivieri published findings that deferiprone, which she was testing in collaboration with Apotex, might be ineffective and even toxic to some patients (Nature Med. 4, 1095; 1998). The situation worsened when HSC faculty member Gideon Koren sent Duries anonymous hateful mail because of his allegiance to Olivieri (Nature Med. 6, 609; 2000). Part of the grievance against UT is that the administration failed to deal with Koren's misconduct appropriately.
The University of Toronto Faculty Association (UTFA) has joined the researchers in filing grievances against the administration for UT's failure to uphold the academic freedom of faculty members. In an open letter, UTFA president Rhonda Love wrote, "UTFA alleges that the University failed utterly in its duty to act to protect Dr. Olivieri, her academic freedom, the academic freedom of all of us and the fundamental rights of the public which we in the University have the duty to uphold." UTFA has raised the more serious allegation that UT did not support Olivieri because of ongoing efforts to raise funds from the drug company.
Deferiprone was approved for limited use in Europe, a decision that has been challenged by Olivieri. The European Court of Justice has agreed that she has a right as principal investigator to be heard in the case and to defend the public health interest. According to Olivieri this is a legal first for a scientist.
Meanwhile, Olivieri was selected last month as a recipient of the 2001 award by the Civil Justice Foundation (CJF) in Washington. Olivieri was commended in writing by CJF president, Theodore Schwartz: "The legal assaults that you have endured in your battle against the drug company, and in your battle against the medical establishment appear to have been fought with the type of uncommon bravery that is rarely seen. It is for this reason that our trustees have unanimously chosen to recognize you for this most prestigious award."
from Psychiatric News, a publication of the American Psychiatric Association, 2000-Aug-4, by Sarah Klein:
Book's Claims About SSRIs Unleashes Angry Backlash
Prozac makes the news yet again as the subject of a controversial book. This time, Prozac and other SSRIs are criticized for causing "silent brain damage" and other harmful side effects.
You can tell a book has hit a nerve when its critics question not only the motivations of its author, but the judgment of the reviewers who appear on the book jacket.
That's the level of contempt many psychiatrists show the new book by Joseph Glenmullen, M.D., Prozac Backlash: Overcoming the Dangers of Prozac, Zoloft, Paxil, and Other Antidepressants With Safe, Effective Alternatives.
Released in April, the book by Glenmullen, a clinical instructor of psychiatry at Harvard Medical School, has touched off a wave of protest for its controversial proposition that selective serotonin reuptake inhibitors, or SSRIs, are causing silent brain damage and effecting chemical lobotomies by destroying the nerve endings they target.
As the title suggests, Glenmullen is urging patients to reconsider their use of the drugs, warning that they cause long-term side effects including disfiguring facial and whole-body tics; that they can cause debilitating withdrawal symptoms; and that they are capable of precipitating suicidal and homicidal behavior.
In Glenmullen's view, such risks are unnecessary. "In my experience, as many as 75 percent of patients are needlessly on these drugs for mild, even trivial conditions," Glenmullen writes. He contends that those patients would be better treated with exercise, psychotherapy, and/or the herbal antidepressant St. John's wort. Instead, Glenmullen contends, primary care physicians are prescribing SSRIs without proper diagnosis or follow-up.
Glenmullen is not completely opposed to the use of SSRIs. He believes that patients whose acute psychiatric conditions present greater risks than the medication itself may benefit from the drugs, but he argues that even those patients should limit their exposure by using the medications for discrete periods of time.
Almost as soon as the book hit the stands, psychiatrists around the country assailed it as a sensationalistic threat to the well-being of their patients.
The book "is pure speculation," said Harvey L. Ruben, M.D., a clinical professor of psychiatry at Yale School of Medicine and a corresponding member of APA's Joint Commission on Public Affairs. "He makes it sound like the worst-case scenario happens to everybody and that terrible things are going to happen to you in future. It scares the life out of our patients."
Much of the criticism revolves around Glenmullen's dramatic, and many times anecdotal, presentation of adverse reactions to SSRIs, including sexual dysfunction, parkinsonism, agitation, spasms, and tics - among others. His critics say that Glenmullen exaggerates SSRIs' potential for all such side effects, with perhaps the most important one being compensatory declines in patients' dopamine levels.
Glenmullen speculated that such drops are responsible for SSRI side effects ranging from sexual dysfunction to tardive dyskinesia, similar to major tranquilizers. With their use, "the brain damage that can result is slowly progressive and often silent, and only manifests itself once it is severe," he warned.
But that doesn't sit well with some psychiatrists. The warnings are "out of proportion to at least what most of us see as the risks," said Rex Cowdry, M.D., medical director of the National Alliance for the Mentally Ill. "Dr. Glenmullen enters into a set of unusual reviews of the literature, making connections and warnings about toxic effects of the drugs that I describe as not in fact terribly well grounded in science and intended to be sensational."
Glenmullen's analysis is largely based on a comparison of SSRIs with major tranquilizers. Critics say his discussions of the drugs are so intertwined that paragraphs beginning with SSRIs switch to major tranquilizers without noting the drugs work by different mechanisms. The result, they fear, is that unsophisticated readers will believe they are at greater risk of developing potentially irreversible tardive dyskinesia than they may actually be.
"This portrayal is quite misleading," said Frederick M. Jacobsen, M.D., a clinical professor of psychiatry at George Washington University School of Medicine. "There are very few data to suggest that the SSRIs have the dramatic dopamine-blocking effects of major tranquilizers."
Jacobsen said less than 5 percent of patients taking SSRIs suffer motoric side effects, while 5 percent to 10 percent end up in amotivational states. "The best treatment for those side effects is not to stop the drug and go on to nothing, if you have an otherwise good response to the drug," he said. The solution, in his view, is to add a second drug to rebalance the system.
Glenmullen, however, said he is issuing an important warning about the drugs to patients and physicians. "I am really conveying to the public what is in psychiatric journals," he commented. "I quote people directly who say that patients should be told about [the existence of extrapyramidal side effects]."
It is a message that Glenmullen said is further supported by research published after his book. "The concerns raised by Prozac Backlash are heightened by a new study in Brain Research suggesting that fluoxetine and sertraline may swell and truncate axons of the serotonin nerves they target," he said.
Glenmullen believes much of the criticism has been driven by pharmaceutical companies and drug proponents, who are displeased by the negative publicity the book has generated. In the month after its publication, several major newspapers and magazines highlighted the portions of the book that allege the drug companies have downplayed and distorted the risk of suicide and have co-opted physicians with research dollars.
That message comes through clearly and without distortion, he said. "I am very careful to say where we have good numbers on systematic studies versus estimates based on small-scale studies and where we lack numbers. I am calling for that research." The result is that readers do "not come away with a mistaken impression. They come away with a sense of everything that we know to date about why one might be concerned, and the limitations of what we know and the research that we need."
To prove it, Glenmullen said his answering machine and Web site were inundated with expressions of gratitude from patients and physicians who said they would not otherwise have known symptoms such as severe fatigue were the result of taking SSRIs.
And many psychiatrists agree. Alan Stone, M.D., a professor of psychiatry and law at Harvard University, praised the book for warning readers that "no one really knows the long-term consequences of these chemicals on the brain."
Stone, a former APA president who has been roped into the controversy for endorsing the book on its jacket, defends Glenmullen to critics.
"Dr. Glenmullen is not a research scientist. He is not a biostatistician. He is just a clinician who is thinking through what he is doing. Every psychiatrist in America has a responsibility to think through these drugs that they are prescribing to their patients and not just accept the advertising or the professors from on high," he said.
Joshua Sparrow, M.D., a child psychiatrist at Children's Hospital in Boston, agreed that the book raises the important, but disquieting, concern that the long-term effects of these drugs are uncertain. "I don't think anyone is facing how little we know," he said.
Nor are they paying much attention to the influence of drug companies in determining what research is conducted. "The crisis [that Glenmullen] puts his finger on is that we don't have a structure which allows us to get the information that we need to serve our patients because there is an imbalance of where these resources are for doing the research," Sparrow observed.
At the very least, the book has sparked a heated debate and gotten people thinking.
from the Pittsburgh Post-Gazette, 2000-Aug-17, by Anjali Sachdeva, staff writer:
Schools misdiagnose students with minor problems
In schools across the country, some children are being intentionally misdiagnosed as learning disabled or even brain damaged.
At times it's the only way for teachers to help troubled students, according to Howard Adelman, a professor of psychology and co-director of the School Mental Health Project at UCLA.
Adelman said that there is a small group of children who suffer from learning disabilities. But he estimates that 85 percent of the students in learning disabled programs are misdiagnosed, sometimes because the children are ineligible for aid programs unless they receive that designation.
"The only way you can help them is to let them fall to the bottom and give them a label," explains Adelman.
Adelman yesterday presented the keynote speech at a seminar for school administrators and mental health professionals from Allegheny and surrounding counties titled "Comprehensive Planning for Safe and Caring Schools."
The conference, held at the Edgewood Country Club, was sponsored by the Safe Schools Program, a branch of the Allegheny Intermediate Unit.
Adelman says that instead of forcing teachers and social service workers to use extreme measures to get children into aid programs, schools should develop comprehensive systems to deal with what he described as "garden variety" learning, emotional and mental health problems among children.
Through these programs, Adelman believes, problems can be controlled before they result in academic failure or, in the case of emotional problems, school violence.
Mark Greenberg, director of the Prevention Research Center for the Promotion of Human Development at Penn State, says that he once had to have a mentally ill fourth-grader arrested before the child was eligible for social services.
Greenberg, who also spoke at the conference, says that in most schools' social service budgets, between 70 percent and 80 percent of funds are directed to children who have been removed from their homes and put into foster care or juvenile detention.
"As long as we continue to spend 70 to 80 percent on those extreme cases, all we'll have is waves of more kids having problems," says Greenberg.
Adelman says that the highly publicized school violence of the past few years has led to increased funding for social intervention programs, but that constricting funds to anti-violence programs ignores the emotional and behavioral problems that are the precursors of school violence.
"When [school] crisis teams are really working, they start talking about prevention because they see that a lot of these problems are preventable and they don't want to have to keep mopping up the blood."
Autism misdiagnosis 'ruined a life'
Sean Honeysett has been in and out of institutions Sean Honeysett is paying the price for nearly two decades of being wrongly diagnosed as mentally ill.
His entire adult life has been blighted by frequent spells in and out of psychiatric units and prison.
He has been prescribed anti-psychotic drugs and anti-depressants, and has made several suicide attempts.
However, doctors have now discovered that Sean is not mentally ill, but instead suffers from a poorly understood form of autism known as Asperger's syndrome.
The number of people identified as having Asperger's has soared in recent years as GPs and psychiatrists get better at spotting the condition in childhood.
Some 300,000 people in the UK have now been identified as sufferers.
But it is feared that many people, like Sean, have slipped through the net, and are not receiving the psychological support they so badly need.
High hopes
Sean was a bright and friendly child, who learned to read before he went to school. His parents had high hopes for his future.
However, 30 years later he now finds it difficult to communicate - even with his parents.
In fact, Sean demonstrated classic signs of Asperger's from an early age. He was often naughty and his inability to relate to other children led one educational psychologist to label him as "emotionally disturbed".
Things came to a head at the age of 15. Instead of going back to school in September to study for "O" levels, he shut himself in his bedroom, and said he wanted to die.
Sean never went to school again. He was referred to a psychiatrist who wrongly diagnosed him as being mentally ill.
Sean's problems went from bad to worse, he became depressed and aggressive.
The variety of anti-psychotic drugs he was on did nothing to improve his condition.
At 24 he was sentenced to six months for assaulting a police officer while drunk.
He was released on appeal after 10 days in Brixton prison.
BBC programme
Finally, in 1995 Sean's mother Sally saw a BBC television programme on Apserger's.
She read up on Asperger's, and became increasingly convinced her son was suffering from the condition. The family pushed for a psychological assessment from an expert in autism.
Sally said: "The psychologist said to us, 'He has Asperger's, why has this never been picked up?'
"She was absolutely horrified."
Mrs Honeysett's first reaction was one of relief: "I thought my son's not a nutter. He has been treated by the psychiatric world since he was 14, but he has not got a psychiatric problem."
However, four years after his diagnosis Sean is still heavily dependant on psychiatric services.
At present, he is being cared for at a unit in Hillingdon, west London.
His psychiatrist, who has treated him since December, trained in the Netherlands where Asperger's syndrome has greater recognition as a possible reason for patients' apparent psychiatric problems.
He believes Sean's condition should have been picked up in childhood.
"He is of normal intelligence, but he feels very, very guilty because of a lot of nasty things that have happened to him.
"If his condition had been detected a lot earlier then he would not be that ill or that dependent on services as he is now."
Sean is now gradually being weaned off the cocktail of psychiatric drugs he had been taking.
Asperger's syndrome was identified by Hans Asperger - an Austrian psychiatrist in 1944.
But it wasn't until 1981 - when Sean was 16 - that his paper, written in German, came to the attention of a British psychiatrist.
Autistic children have no desire to interact. Children with Asperger's syndrome do want to mix, but do not have the social skills to do so effectively.
A recent study of patients in three high security special hospitals - Broadmoor, Rampton and Ashworth - found that up to 5.3% of the inmates had an autism-like disorder.
That is more than three times higher than the incidence in the general population.
The other great unknown is how many people in prison may have undiagnosed Asperger's syndrome.
The National Autism Society runs an information line on 0870 600 8585.
from The Times of London, 2000-Aug-8, by Lucy Elkins:
The illness that shrinks your soul
Lucy Elkins was happy, successful and engaged to be married. So why was her life nearly destroyed by anorexia?
I was crunching on the debris of my own crumbling teeth, wondering how to phrase a request to the waitress for a rubber ring to relieve the agony of sitting on my raw and wasted behind. As I sat there I felt panic rising up my throat.
I often think of anorexia as a form of slow and silent suicide. For more than three years the illness stopped me screaming for help and it was a scream I managed to let out only as I stared death in the face. Aged 29, almost five feet three, I tipped the scales at little more than five-and-a-half stone. My stepbrother had not seen me for a few months and must have been shaken at the skeletal vision before him. At least, I imagine he was shaken - at the time I didn't notice.
He was taking me out for dinner. Our food came, but my steamed vegetables might as well have been a bowl of writhing snakes. The chunks of broccoli and carrot looked insurmountable. I started to cry.
That night, as I struggled to mount the stairs to my top-floor flat, my heart started to skip beats and my kidneys ached. By the next morning I didn't have the strength to walk. I knew that I needed help, and fast.
I tried calling the NHS clinic I had been referred to months previously, but it was so overrun I could not get an appointment for more than a fortnight. I called my GP, who sympathised but said there was nothing he could do. In the end it was my mother's credit card that saved me.
How had I got myself into such a state? At the time I had a great job as a producer on Breakfast With Frost. I had a wonderful group of friends and I was blessed with a sunny disposition. I had a supportive family, had never been sexually abused and certainly did not hanker to look like Kate Moss.
Until anorexia hit, I was a normal nine stone-ish woman, with the usual hang-ups about my body, a series of failed diets behind me and a more or less healthy appetite for life. But something changed.
To this day I can't really put my finger on what that something was. My illness started as my career took off. I had worked my way up the career ladder very quickly and I sometimes wonder whether my anorexia was a silent way of saying "please stop giving me all this responsibility, putting me in this position, expecting so much of me".
The pressure on educated middle-class women, such as myself, to progress is immense (I think that the images of the "superwoman" Nicola Horlick are far more detrimental to our mental well-being than a snap of an emaciated supermodel), and to have said that I was not enjoying my success would not have been done. I suppose my personal life was complicated, but then, whose isn't?
Whatever the pressure was, the weight slowly began to drop off. At first my changing vital statistics drew admiration. But not for long. Because it is not just the body that withers; the personality shrinks too. Anorexics starve themselves of everything; happiness, comfort, rest, fulfilment and reliable friendships - even the touch of another person. It is like being on a mission to find pain.
Paradoxically, at the same time you are obsessed by the very things you have forbidden yourself: you are taunted by images of happy environments, contentment, peace and, yes, food.
During the worst periods of my illness, I pored endlessly over menus and sat glued to TV cookery shows. I walked around supermarkets in awe at the profusion of goodies, maybe stopping to buy a lemon or a bottle of water. I baked cakes, but not a crumb passed my lips.
About two years before the crisis, which happened in September 1998, I became aware that something was wrong. It wasn't the absence of chocolate eclairs in my diet that drew my attention to the fact that I had a problem. It was the way I pursued any course of action that was making me unhappy. Not allowing myself to relax, ever, caused me more pain than did the hunger.
I would not sit down until my legs were literally shaking with exhaustion. My brain told me that I was such a worthless, fat, horrible person that I didn't deserve to. Each day, after ten or 12 hours at the office, I would force my skinny frame through a fitness video or two before sitting in front of the television for 20 minutes. The sadistic side of anorexia stopped me from watching any programme I actually wanted to watch.
I spent nearly a year quietly trying to suggest to my GP that my lethargy could be due to the fact that "I didn't eat an awful lot and did do quite a lot of exercise", not because of the nameless virus he diagnosed repeatedly. When I finally brought up the "A" word, he blushed and mumbled. I was finally referred to an NHS specialist clinic as an outpatient. I waited almost a year for a place, by which time my weight had crashed to about six and a half stone. The illness was taking hold and I shrank beneath it.
When I finally went for the appointment, I had big hopes. They would show me what to do and my misery would b