Cognition & Reality

Saturday, 30 April 2011

The Dog Whisperer & Biological Determinism

Through his program, “The Dog Whisperer,” Cesar Millan has made himself into the most famous dog trainer in America, if not the world. His approach features his intuitions about dogs’ motivations. In explaining those motivations, he frequently refers to the descendence of domestic dogs from wolves, and only occasionally refers to the relationship between breed characteristics and a dog’s problem behavior. I have never heard him blame bad behavior on a dog’s genetics. In fact, he is a strong defender of pit bulls and other breeds that have been seen as dangerous because they are bred to be aggressive. Because he almost always sees the roots of a problem in confusion about dominance, he trains owners to reinforce positive, submissive behavior by becoming better “pack leaders.” When it comes to dogs, as the success of Millan’s program demonstrates, the public is willing to believe that behavioral pathology is mostly a product of learning.

It is therefore interesting that, in the popular imagination, human psychoemotional difficulties, not so different from the fearfulness and aggressiveness the Dog Whisperer often addresses, represent underlying physiological anomalies. Although people readily accept that dog psychopathology reflects bad “parenting,” they reject the idea that the same can be true of humans. To explain humans’ dysfunction, the public prefers explanations that seem to be at a remove from the direct experience of learning and developing, such as “chemical imbalance” or physical inheritance.

Cesar Millan’s treatments are invariably behavioral. Although I believe he doesn’t explicitly disapprove of using antidepressants with dogs, he never presents chemical or even dietary interventions on his show. Instead, through careful titration, he focuses on changing behavior, replacing dysfunctional behaviors with functional behaviors. He not only employs himself and other humans to do this, but also the dogs in his own pack, particularly his pit bull Daddy and a few other canine co-therapists.

Right now, I’m watching a touching installment of “The Dog Whisperer,” in which Cesar is rehabilitating a fearful Doberman mix named Baby Girl. When he discovers that Baby Girl refuses to eat, Cesar brings in a vet to examine the dog for physiological problems, but there is nothing physically wrong with her. Cesar concludes that Baby Girl’s eating disorder is “psychological.”

Admittedly, the psychological disorders of dogs do not track exactly the psychological disorders of humans. In addition, the cases that make it on to Cesar’s show, more often than not, involve violent dogs. Not only is an aggressive dog likely to drive owners to seek help, but a violent dog also makes better TV. On the other hand, Baby Girl was not violent. She had symptoms more similar to clinical depression or a personality disorder, and Cesar used a mixture of behavioral approaches to treat her. The point here is not so much that Cesar Millan believes in the efficacy of psychological treatment, but that the audience believes in the efficacy of psychological treatment, when the “patient” is a dog.

When the patient is a human, however, the public has been conditioned to accept the use of pharmaceuticals to treat psychoemotional problems, and they have accepted the notion that much psychopathology is “genetic.” Contrast this set of ideas with the way Cesar Millan operates. Although he does, under some circumstances, take into account a dog’s genetics, he almost always attributes behavioral problems to what we would call “upbringing” in the human context: The problem is really with the owners, an attribution most of the owners on the show readily accept.

One can see how much more difficult a similar conclusion about human parenting is to accept . Parents don’t want to believe that they contributed to the psychopathology of a child. In addition, physicians presently enjoy enormous power in treating psychopathology. It is therefore in their interest to promote a relationship between physiology and behavior that Cesar Millan implicitly rejects in the way he treats the psychological problems of canines.

Monday, 25 April 2011

The Survival Instinct

Filed under: Basic Goodness,Human Evolution — drtone @ 5:59 pm

Sometimes we do things that are hard to explain at the time, only to understand their significance later. It could be that this represents some kind of instinctive response that, because it arises from deep inside one’s being, does not respect time and space. I have had at least one experience of this phenomenon.

Anyone who knows me knows that, outside of the written page, I am “organizationally challenged.” I somehow managed to acquire a doctorate, although I can’t take notes to save my life (no matter how strong my survival instinct); the same problem with note-taking has arisen again in connection with my clinical practice. My “files” are a ridiculous, musty mess. Most of the time, every horizontal surface in my place is at least partially obscured with papers, magazines, and other crap. I am the opposite of “detail-oriented” and am the world’s worst clerk. Nevertheless, years ago, I accomplished a difficult clerical task, involving repeated attention to boring details, that promises to make it possible for me to live without having to flip burgers.

When I was working for Western Psychological Services, in LA, I found out that I could count my hours at my job toward the 3000 clinical hours required to obtain a psychology license. In order to accomplish this, I had to submit an application to the state Board of Psychology to be a “psychological assistant.” This involved asking my department head to be my “supervisor,” something I was loathe to do, because I never liked owing him anything. In addition, I had to send the Board a passport-sized photo and my fingerprints, which involved spending a few bucks at some Kinko’s-like place. If the business had not been farther than only a couple of blocks away, I might never had gone there. I also had to fill out a long form and have my transcripts sent from UCSD (and perhaps other places). Furthermore, I had to reapply each year to renew my status as a psych assistant, which I managed to do, as well. After I accumulated my hours, I also studied for and passed the national examination, the name of which escapes me, that is part of the California licensing process.

I did all of this stuff, although it was entirely out of character for me to do so, something I recognized at the time and mentioned to more than one person. Further, I filled out the applications, paid various fees, and maintained my status in spite of not needing a license for my work and without intending–ever!–to become a psychotherapist. At the time, nothing in my life was forcing me to act in ways I would normally not act unless forced. I even went to state orals exam, which I failed miserably (scoring 7-1/2%!), although it cost money and involved spending an absolutely horrible day at an airport hotel. I proved that I didn’t care whether I had a license by not finishing the process, because I knew I would have to study for real to have a chance of passing the orals.

Nearly a decade after abandoning my desultory quest for a license, I found myself in Silver City, New Mexico, facing both a divorce and the prospect of starting my life all over again. I knew that it was impractical for me to stay in Silver City, where there were no job prospects. Desperate for a sign to tell me where I should go next, I called up the California Board of Psychology, sure that they would tell me that my application was void and that, time having passed, my hours had expired. They told me no such thing. In fact, everything I had accomplished, the hours and passing the national test, remained in place. Miraculously, they told me that the state had abandoned the oral exam that had stood in my way previously, replacing it with a multiple choice test!

Having passed the national exam and aced many other multiple choice tests, I assumed that I would be able to pass the new exam easily. I was wrong: It took me over a year to prepare for the test. Once I passed it two years ago, however, I was a licensed psychologist in the State of California. It would never have been like that if I had not engaged in the bureaucratic dance years before. It was as if I had known, almost a decade in advance, that I would need and want to have a psychology license.

I’m not sure what this all means. At minimum, it warns that the feeling one has that one’s actions are transparent may be wrong. Sometimes, at least, our motives are hidden, and sometimes they’re downright mysterious.

Sunday, 24 April 2011

Disease, Disorder, Distraction

Responsible scientists who are familiar with the research but want to preserve the disease concept of alcoholism have had to redefine their terms. They define “disease” as whatever doctors choose to call a disease (Jellinek, 1960)! The point of using the word, they acknowledge, is “social” rather than medical. There is a lack of consistent self-control that leads to harmful consequences (Vaillant, 1990). Of course such sweeping uses of the term make almost every human and social problem into a “disease.”

In the above passage, from a book chapter published over 20 years ago, Herbert Fingarette prefigured the current obsession with attributing any troubling behavior to an underlying disease. The extension of medicine into areas where it does not belong, because its methods do not apply, is an insidious ongoing process. We have not only given doctors great power within the legal domain, but we have also permitted the ideology called “medical science” to dominate the cultural definition of many types of behavior.

Sadness and worry are now perceived as symptoms of an underlying disease, although they could result from a wide range of potential causes. To be in a down mood is the natural response to various circumstances, such as a bad marriage or financial difficulties; and events, such as the loss of a job or loved one. As the beginning of this piece from The Guardian suggests, however, the medical community and the pharmaceutical industry have succeeded in redefining a psychiatric condition called “depression” as a common disorder. Because it is presumed to have an underlying physiological cause, a critical feature of this newly redefined disorder is that it can be addressed with certain expensive medications.

Accordingly, the official numbers indicate that 9% of the US population count as “depressed,” with 3.4% meeting the criteria for Major Depressive Disorder, while doctors write millions of prescriptions for antidepressants yearly, at a rate that continues to accelerate. From one perspective, these figures raise questions about a society with a tenth of its members bummed out, some seriously bummed out, many of them dependent on daily doses of drugs having limited efficacy and unknown long-term effects. From another perspective, the same figures raise questions about what counts as a mental disease or disorder such that so many people suffer from such conditions.

Our society had become addicted to medicalizing social, moral and spiritual problems. As Fingarette predicted, many troubling behaviors have been reconceived as disease states. Doing so puts money in the pockets of pharmaceutical companies and physicians, while it reassures members of both the medical profession and the general public. Insurance companies and government agencies like it, too, because the treatment of medical disorders usually involves medication and other courses of treatment that are much less expensive than traditional psychotherapy, with its emphasis on developmental issues.

First of all, there are “food addiction,” and “sex addiction,” new names for otherwise normal activities that have reached an unacceptable level of excess. Although eating too much can be injurious to one’s health,and reckless promiscuity can wreak havoc, putting these problems into a category with dependence on intoxicants places them within the same disease-oriented framework. As discussed in a previous post, conceptualizing substance abuse as resulting from “disease” is misleading as a guide to treatment and unjustified by empirical evidence, and the same is true, of course, for destructive patterns of behavior to which the addiction metaphor has been extended. Nevertheless, there are many intensive, expensive treatment programs, modeled on programs for substance abuse, dedicated to treating overeating and promiscuity.

The emergence of Asperger syndrome as a diagnosis shows that the redefinition of human behavior as disease does not stop with sadness, overeating, and fucking too much (however much that is). Most people realize that this “syndrome” is nothing more or less than “nerdiness,” as it was called before it became a disease. A look at the diagnostic criteria for Asperger’s illuminates its shaky foundation. A child need only meet two diagnostic criteria by exhibiting “impaired social interaction,” and “repetitive and stereotyped patterns of behavior”; other criteria, such as having “inadequate relationships,” or “impaired nonverbal communication,”among others, belong in the “Maybe” category. Treatment for this “syndrome” is a joke, consisting mainly of medications insurance companies will pay for, and therapeutic modalities that, by their nature, are limited in duration: physical therapy, occupational therapy, cognitive behavioral therapy, social skills training, and parenting classes. It need hardly be said that none of these has yielded reliable improvement of the identified problems. Nerdy children may suffer some pain as a result of their behavior, although the very nature of the “syndrome” presupposes that they don’t notice the inadequacy of their relationships. For sure, children who fit the criteria for Asperger’s are annoying, and they can grow into adults with horrible manners, which may explain the amount of attention this “disorder” has received from physicians and psychologists.

Attention deficit hyperactivity disorder (ADHD) is another instance of the “diseasing” of behavior that is deemed to be troubling and disruptive. The controversy over ADHD is so old and so fraught with emotion that there is no point in revisiting it here. Suffice it to say that a recent study, conducted under the auspices of the National Institutes of Health, found that, despite initial improvement, children treated for ADHD through a variety of different recognized modalities, either singly or in combination, fare far worse than children who have not been diagnosed with ADHD. The children received the best treatment the medical establishment can offer, including advanced medications, for at least 14 months, and some were still receiving treatment years later, when they were assessed for their school performance and many other variables relevant to social  and psychological adjustment. Nevertheless, as the results summarized in this table show, they compared unfavorably with comparison subjects on almost every measure chosen by the investigators, who undoubtedly believed in the efficacy of treatment. If ADHD is a disorder with physiological substrates that reflect a genetic disposition, as has long been claimed, “medical science” has not succeeded in discovering how to treat it.

Much the same can be said about the medical approach to the other problems surveyed here. Recidivism by alcoholics and drug addicts who have gone through draconian rehabilitation regimes is notorious. Depression remains a significant problem, as one can tell from the number of commercials one sees for antidepressants. No one is suggesting that there is a reliable treatment for Asperger’s or ADHD. In spite of this abysmal record, physicians continue to operate under the questionable assumption that these conditions represent underlying, circumscribed causes, and continue to treat these conditions as if they know how to ameliorate their effects.

Saturday, 23 April 2011

Antidepressant Addiction

Filed under: Chemical Imbalance,Diagnosis,Medical Morality,Propaganda,Science — drtone @ 12:08 pm

I doubt that I’m the first one to bring attention to the purely American tolerance of addiction to drugs that don’t actually make you high, the antidepressant medications. The United States, responding to a cultural mandate inherited from some of the earliest European settlers, has fought relentlessly to control and eradicate the use of all intoxicants. Nevertheless, established medical practice, encouraged and promoted by the authorities, involves offering selective serotonin re-uptake inhibitors and the other newer antidepressants to those complaining of a wide variety of ills, not confined to clinical depression. Despite evidence mounting since the first flush of Prozac’s popularity that they are ineffective, antidepressants are still prescribed to millions of patients, many of whom are suffering from the loss of a loved one or a job, as well as from headaches and a variety of other ailments, rather than from clinical depression.

Years ago, I began telling people that. as the end of the patents on the new antidepressants approached, evidence would begin to come out that they are dangerous and ineffective. My prediction was based on the fate of Valium and other benzodiapenes, relatively benign medications that actually do what they’re supposed to do. I remember when those were the “wonder drugs.” Then they were prescribed to hundreds of millions of people around the world. It is no wonder, partly because they are efficacious, that problems appeared among those taking them. I would suggest that it’s not a coincidence that these negative consequences emerged into the public consciousness when the price of these drugs approached zero AND the major pharmaceutical companies were releasing a new generation of drugs intended to address many of the same ills for which benzos were prescribed. Benzodiazapines were also easy to attack because they actually can produce a high. The medico-legal establishment, including the drug companies, clearly recognized both the necessity and ease of targeting benzodiazapenes as yet another group of intoxicants the use of which was seriously out of control.

Instead of “epidemic” use of drugs that work, such as Valium and Xanax, we have the specter of hundreds of millions of people chronically taking medications, such as Prozac and Paxil,  that are relatively ineffective. Although discontinuing their use can produce serious negative side-effects, SSRIs and similar drugs don’t make you high. For that reason alone, they will remain on the market for a long time to come. This is a country in which doctors will cut the supply of opiates to a terminal patient for fear that he or she will become an addict, but refuses to describe as “addiction” the dependence of millions on expensive medications that may do nothing.

I know from personal experience that antidepressants produce a condition indistinguishable from addiction. In about 2002, I started taking Paxil, having been offered it for the nth time as a treatment for headaches I have had since age five. The headaches diminished, and it’s also possible that my mood evened out. My weight, already a minor problem, ballooned by 40 pounds, probably putting the added strain on my lower back that resulted in the bulging disk at L4-5 that still fucks up my life. I was taking Wellbutrin in an attempt to counteract the weight gain. I began taking double doses of both drugs in 2008, after my most recent marriage blew up.

A year or so after that, having read many warnings about the problems attendant on discontinuing Paxil in particular, and discussed those warnings with physicians, I began a months-long process of tapering off one dose of the drug; I followed that not long ago, with a similar procedure to take myself off the other dose. I had to do the same thing with the Wellbutrin, of course. Imagine, therefore, the negative incentive for a patient who takes these drugs to stop taking them. It took me a long time to take the plunge. There must be many people who stay on these drugs, with the collusion of their physicians, because of legitimate fears about the potentially severe effects of discontinuing their use. What could be better for corporate drug dealers?

The difference between dependence on antidepressants and opiate or cocaine addiction is that those drugs make you feel good, whereas antidepressants, at best, make you feel OK. Consequently, the latter don’t count as “drugs of abuse.” Nevertheless, the circumstances under which they are used seem to me to constitute abuse of the public by physicians and pharmaceutical manufacturers.

Wednesday, 20 April 2011

“Alcoholism”

As I read a history of the disease theory of alcoholism, there is much about how describing addiction to alcohol as a disease de-stigmatizes those deemed to drink too much. For example, Bill W. thought that portraying excessive drinking as a “disease” was a useful metaphor, rather than a medically accurate description of the syndrome, because it removed blame from users. The problem with such metaphors, as the history of the “computer metaphor” in cognitive psychology shows, is that they are inevitably taken too seriously, leading to massive confusion and misunderstanding. In the case of alcoholism, it is widely assumed that it is, indeed, a disease of the brain, subject to treatment by medical professionals, although the the evidence that it represents an actual disease entity is thin, at best.

There are many reasons why the disease concept of alcoholism persists, among them that the confusion caused by applying the disease metaphor to the excessive use of alcohol benefits the makers of alcoholic beverages. If those who ruin their lives with alcohol are suffering from a “disease,” that takes the onus off alcoholic beverages and those who make them. It’s a perfect out. Temperance advocates at the turn of the previous century did blame the makers of alcoholic beverages for the “scourge” of drunkenness, as well as the moral weakness of those who drink. For that reason, the sellers of beer, wine and spirits have to be extremely happy that the approach of the rehabilitation movement blames neither them nor the users of alcohol. Instead, the problem is caused by a disease entity.

By taking the blame away from the substance and from the the user, the treatment of alcoholism as a disease resembles the date rape drugs phantom.

Sunday, 17 April 2011

Jackie Robinson Day

Filed under: Race,Sports — drtone @ 3:05 pm

Friday night, 15 April, was the anniversary of the day Jackie Robinson became the first Black man to play in a major league baseball game. Before the game, the Dodgers aired a short piece, narrated by Vin Scully, celebrating Robinson’s accomplishments as a player and as a Civil Rights pioneer. It showed, among other things, Robinson stealing home and Robinson signing autographs for adoring fans. Reminding me of my feelings about the current view of Martin Luther King, it did not show, nor so much as mention, the constant abuse Robinson took during his first season, 1947, and subsequently, for having broken baseball’s color bar. The abuse came from fans, but also from his fellow players, many of them Whites from the South. Robinson’s stoic response to this outpouring of hatred made him a hero.

Something is happening to history, and it is not good. As a friend of mine said about leaving out the death threats, etc., that Jackie Robinson faced leaves the frosting and takes away the cake, portraying an empty heroism. To forget about the open bigotry unleashed by Robinson’s debut season, not only detracts from Robinson’s greatness as a man, but also does a disservice to our country, especially to young people, who deserve to know what we were then and how we have changed. In these daze when a person somehow becomes a “hero” for simply being a police officer or soldier, we can’t afford to forget what real heroism requires.

Thursday, 14 April 2011

Still At It With X

Filed under: Uncategorized — drtone @ 11:53 am

A week or so, completely by accident because the TNT basketball coverage spilled over, I discovered “Southland,” a police drama set in LA. I like it a lot for a number of reasons, one of them being the extent to which it features the city. I like it, but…

In one episode, the daughter of a somewhat crazed detective goes to a rave and takes Ecstasy. He and a couple of his cop friends go to the rave the find her. At first, she’s really happy and calls him on his cell to tell him how much she loves him. He responds by telling her to drink water. Drink water???!! They’re still on that, the absurd myth that MDMA, a substance Your Humble Servant took fairly recently and in the distant past, causes potentially fatal dehydration, although the supposed cases brought forward involved individuals who had been drinking and dancing for hours. Even the anti-drug people hedge their language when talking about this supposedly dangerous side-effect. Nevertheless, the myth lives on in TV show dialog. I should add that at the end of the episode, the daughter comes to the cop, and she is wiped out and weepy, clearly remorseful about her “dangerous” behavior.

Tuesday, 12 April 2011

Marijuana: The Point-Shaving Drug

Filed under: Cannabis,Date Rape Drugs,Sports — drtone @ 12:00 pm

They’re not just date rape drugs any more.

In an interview I’m watching about a point-shaving scandal involving players for the University of San Diego and UC, Riverside, once attended by yours truly, the NCAA’s point person for enforcement answered a question about how they investigate such allegations with a nod toward “our contacts with Vegas.” In other words, she does not have any problem consorting with gamblers. The real problem with point shaving is not that it changes who wins basketball games, which it need not. The real problem is that it fucks up the point spread, which hurts gamblers. Consequently, this scandal is not about “the integrity of the game,” as the NCAA rep calls it. It’s about damage to the NCAA’s Vegas contacts.

The scandal indicates the power of gambling and the so-called “gaming industry” in American life. That the fixing of a basketball game (not across state lines) should occasion a federal indictment demonstrates the control gambling interests exercise over our government. Think about it: The point spread is sufficiently sacred that to trespass against it in a game between teams from two obscure schools (sorry UCR!) is deemed a crime against the American people.

A discussion of the scandal on ESPN’s supposedly hard-hitting “Outside the Lines” omitted any serious discussion of the hypocritical partnership between the NCAA and the oddsmakers in Las Vegas, a partnership that appears to be a matter of pride to both parties. One question about the “irony” of talking about the integrity of sport and gambling in the same sentence was directed at the representative of the Las Vegas sports betting association, who of course did not answer it. Much more interest was directed at the question of whether players “need” for money motivates point shaving, and also at the involvement of those indicted with the use and distribution of marijuana. For the interested parties, it would be nice if the public blamed smoking pot for point shaving by college athletes.

Sunday, 10 April 2011

Selling Drunken Sex IV

Filed under: Date Rape,Date Rape Drugs,Propaganda,Sex & Love,Television — drtone @ 2:59 pm

I knew yesterday that there was more I wanted to say about the Bud Light commercials. So I beg your indulgence as I continue to pursue this topic.

As the persistence of the belief in a widespread threat of “date rape drugs” shows, the marketing of beer as a sexual intoxicant by Anheuser-Busch does not exist in isolation. Post-industrial society is struggling with the effects of having freed women from most of the traditional constraints on their behavior. The process of integrating men and women into a culture that recognizes their inherent equality is not finished, if “finishing” is a possibility for social change. In fact, change is continuous and almost always appears to be more predictable than it actually is. The hypocrisy regarding women and alcohol with which I have recently been obsessed represents an unanticipated consequence of what, for want of a better term, we call “women’s liberation.”

Saturday, 9 April 2011

Selling Drunken Sex III

Filed under: Date Rape,Television — drtone @ 2:01 pm

I’ve never had anything like the response to a post that I have had to my initial post about Bud Light TV commercials. As I said in the follow-up, I’m not sure to what to attribute the number of hits, a hot topic, a hot product, or something else. It surprises me that, as I Googled around, I did not find any commentary about the form of beer commercials, the portrayal of drunkenness as a strategy. Everyone is familiar with the pairing of beer and breasts, but you might think that both the drunken behavior of those in beer spots and the direct selling of beer as an aphrodisiac would have drawn more attention. I’m not talking about the our-beer-will-make-you-look-cool appeal of, for example, “The Most Interesting Man in the World” commercials for Dos Equis. I’m talking about showing how to use the beer bottle to “hook up” with a drunk female, or demonstrating that beer will render a woman numb and suggestible. These are the very factors implicated in warnings about date rape.

 

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