Cognition & Reality

Sunday, 1 May 2011

Medical Science: An Ideology

In a previous post, I referred to “medical science” as an “ideology.” Modern medicine, since its beginnings in the 19th century, has had a number of amazing successes: Open heart surgery, and the use of insulin to treat diabetes have saved countless lives; orthopedic surgery has literally made it possible for cripples to walk again. Vaccination, pasteurization, and other health measures have virtually rid the industrialized world of a host of plagues. Advances in obstetrics are in a class by themselves because they have been such a huge factor in reducing human misery. These successes have led to the arrogant presupposition that every ill has a cause that will ultimately fall under the purview of the physician.

Although the amalgamation of medicine with biological science has been fruitful, it has led to the belief that the two together can provide the answer to every question. Germ theory has been important, both theoretically and practically, but it has led to the confused idea that every observed “pathology” has an identifiable physiological cause. Medicine has likewise embraced molecular genetics, leading to the similar confusion that every observed variation must represent an underlying genotype. These unsupported propositions have been applied to the understanding of human behavior.

Therefore, the idea that behavior results from physiological substrates has become an article of faith. Behavioral geneticists have more or less deliberately exaggerated the heritability of behavioral traits by using statistical techniques that magnify the apparent “genetic” component. Meanwhile, despite increasing evidence that antidepressants and other advanced pharmaceuticals don’t work or don’t work well, the medical community has continued pushing chemicals that are supposed to modify mood and behavior. In this, they are aided and abetted by the entertainment industry, which continues to make reference to genetic influences on behavior and to the role of “chemical imbalance” in psychoemotional distress.

They can continue to do this as long as the public buys the medical ideology, something that is supported by the news and entertainment media. Although medical community has conceded that “chemical imbalances” do not explain depression and other psychoemotional disturbances, the myth survives, in large part because it’s easy to believe and relieves all parties of responsibility.

As we have seen, the imperium of medicine extends beyond behavioral questions into other areas where medicine has repeatedly failed, but continues to exert an all-powerful influence. The “war on cancer” has gone on for decades without yielding the long-promised cures. Instead, doctors prescribe chemotherapy, which causes great discomfort, often prolonging life at the cost of a patient’s misery. The cure is worse than the disease, or no better, at any rate. For example, after successfully fighting brain cancer that spread to her brain, the wife of a former client has spent the past two years suffering from iatrogenic conditions that resulted from her initial treatment, and has had to have a shoulder and a hip replaced because the medications made her bones brittle. The last I heard, she was still not out of the woods with her cancer, either.

The success of medicine has come at a great price. In the first place, it is literally very expensive. Secondly, we have allowed the many successes to blind us to the many failures. We have forgiven the latter in part because of the ungrounded expectation that present-day failures will turn to success later on. Rarely does that happen. Most advances that have occurred, such as in heart and orthopedic surgery, have been incremental. New discoveries that change the entire life-and-death picture seldom occur. Because of the faith the public and the medical profession have put in genetics, for example, the Human Genome project was long expected, to yield answers about various forms of mental illness, but has not done so.

It is quite possible that the great discoveries that propelled medicine for a long time, vaccination, sterilization, etc., which mostly occurred in its early days, do not in any way predict the future of medicine. The discovery of DNA, over half a century ago, was possibly the most spectacular, but it might also be the last. Those early discoveries bequeathed to industrialized society a false model of medical progress, one that has not applied for some time. The great hope for medicine that remains is based largely on laurels accumulated long ago. It is time to see that our society has idolized and idealized medicine out of all proportion to what it can or will deliver.

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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.

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.

Saturday, 5 March 2011

Date Rape Drugs And Other Evil Spirits

This article from a couple of years ago sums up nicely the factors contributing to the urban mythology around so-called “date rape drugs.” It is interesting that, as the article mentions, the response in some quarters was to perceive the reports debunking the role of drugs other than alcohol in “date rape” as blaming the victim and as ignoring a danger that, however rare, remains real. No matter how many studies demonstrate that the only “date rape drug” of any consequence is alcohol, the false message about the threat posed by other substances remains strong. For example, the Rape, Abuse & Incest National Network (RAINN) blankly (and falsely) states, “Memory loss can result from the ingestion of GHB and other ‘rape drugs.'” As I have indicated elsewhere, a substantial threat of being “roofied” is often assumed on TV and in films. The argument is essentially over, and the side with the false, hysterical message has prevailed.

Fear of “date rape drugs” clearly serves purposes so important that, confronted with the evidence that they are a tiny problem compared with the “date rape” potential of alcohol, society as a whole persists in maintaining that they represent a severe hazard requiring stringent precautions. As I thought about what those purposes might be, I realized that they are the same ones served by the persistence of other myths I find troubling, those about “chemical imbalances” and behavioral genetics. All of these combinations of myth and metaphor have in common their dependence on alleviating guilt while elevating powerful institutions. Because belief in them is therefore identical with a deep faith in the powers at the center of our culture, to deny their truth is an attack on those same powers.

These quasi-scientific constructs involving chemicals and other elements of medical science are the modern version of identifying what is fearful with invisible demons that can only be quelled through rituals dictated or performed by an authoritative elect. They not only resemble religious beliefs in being dependent on little else but faith and repetition; they are religious beliefs, embedded in our culture because they derive from a widely shared system of doctrines, values and commitments. Just as humans have always done with regard to cherished practices sanctioned by the powerful and believed in by the many, our modern society marginalizes anyone who questions such articles of faith.

I did not realize it until I started Googling about this topic, but young women are now instructed, when at a bar or other public place, to carry any drink with them wherever they go, even into the ladies’ room, accept drinks only from a bartender, drink only from freshly opened bottles, and use available test kits for “date rape drugs.” Thus, they ward off evil spirits who might invade their otherwise harmless alcoholic spirits, transforming the latter into a supernaturally potent, honor-destroying sex potion. In addition to involving young women in established forms and beliefs, these restrictions serve alcohol manufacturers in two important ways: First, they assure that young women consume alcohol in its most expensive, “safe” form, straight from individual bottles and cans; second, they distract attention from the “date rape drug” of the ages, the alcohol they sell.

According to beliefs descended directly from alchemy and other pre-scientific systems, disequilibrium within the fluids of the body produces spiritual disorders that can be cured only by using mysterious concoctions dispensed by medicine men. As I have discussed perhaps more than many of my readers might like, belief in “chemical imbalances” as the cause of at least some forms of emotional disturbance persists as a social and literary trope despite having been abandoned by most of those who originally promulgated it. The reason for that may be that it addresses primitive fears while justifying forms of treatment that satisfy the imperial requirements of the medical profession, save insurance companies money and fatten the purses of pharmaceutical companies. To believe in “chemical imbalances” as the cause of “mental disorders” is therefore a way of paying obeisance to the powers that be.

It all seems rather silly until you confront the fierceness with which these notions are defended. To believe that a child is psychotic because of some physical substance inadvertently passed on through the “blood” is unpleasant, but it is infinitely preferable to believing that his or her condition is the result of bad parenting . Likewise, to believe that one’s daughter was raped by a man who slipped her a mickey is far more tolerable than to believe she made it easier on the rapist by choosing to get shitfaced on Jack Daniel’s at the local bar. One need hardly say that a drug that destroys memory is the perfect antidote to a night one would rather forget, and the perfect explanation for a police report long on histrionics and short on details. No wonder belief persists in some manifestly crude, naive, and false explanations of behavior that serve a host of social and cultural functions.

(BTW, this is in no way intended to let rapists off the hook. Far from it: I find it difficult to imagine circumstances in which it is OK to fuck a semi-conscious woman. In another post, I unpack this issue more fully.)

Friday, 4 March 2011

Drinking, Double Standards, And “Date Rape Drugs”

Filed under: Medical Morality,Propaganda,Psychomyths,Sex & Love,Urban Myths — drtone @ 11:39 am

Since time literally immemorial, men have being “having their way” with women by getting them drunk first. For most of human history, no respectable woman would obtain her own alcohol, nor would she, without male escort, enter an establishment where alcohol is served. That was in the the olden daze, not so long ago, when women were the property of their men.

In a world in which a woman is free to come and go as she pleases, however, she is in a position to get herself drunk with no male assistance and thereby assumes some of the responsibility for the consequences of doing so. If she leaves the bar and is broadsided by another driver who has run a red light, she is still guilty of drunk driving, regardless of whether she was technically at fault, and may bear some legal responsibility for the accident on account of her negligence in driving drunk. It is, moreover, reasonable to assume that she would have been more likely to arrive home safely had she not been as intoxicated as she was. In the same way, if she makes herself an easy target by getting drunk and dropping her guard, she is partly responsibly if she is raped.

This is not the same thing as saying that, because she was three sheets to the wind, it was morally or legally acceptable for Jack to rape Jenny. It is saying that women are responsible for the consequences of their own behavior in every sphere of action, just as men are. Otherwise, we would simply be reinventing a world of double standards in which women are protected because they have no minds of their own.

As I thought about this topic in connection with my interest in society’s fantasy about “date rape drugs,” I realized that it gets us pretty fast into some pretty murky territory. Because women are typically smaller and weaker than men, they are more vulnerable to attack. To own that fully, however, leads directly into regarding women as “the weaker sex,” a designation our society has attempted to leave behind. We are thus confronted with two opposing images of woman: the tough, smart free agent, in every way the equal of men, who must and will make her own way; and the dependent, vulnerable bearer of children, constantly in danger from a hostile society and the men in it. As much as we might want to endorse the former as the real truth about women, men and women both know that there is some truth to the latter, as well.

If we allow women the full freedom of men, which we are legally and morally bound to do, we allow them to enter situations that are potentially more dangerous for a woman than for a man. At a bar, people get drunk. Women are people. Therefore, they get drunk at bars. In that frame, a woman is the exact equal of a man, with the exact same right to get shitfaced and to act shitfaced, which could include interacting with the other patrons at the bar. A man does that, gets drunk and talks to the other bar patrons, and the chance that he is attacked, sexually or otherwise, is very low, unless he directly or indirectly provokes such an attack. That is where the “same situation” is actually a different situation for a woman. Whether it is a matter of social convention or biology, what counts as “provocative” for a woman is simply not the same as for a man. A woman who does not recognize that is being foolish. For a variety of reasons, the same rules do not apply to her as would apply to a man walking into the a bar alone. That is a matter of fact directly contradicting the completely understandable and also true claim that, as a bar patron, she is the moral and legal equal of a man. Wow! What a problem.

One way out of this conundrum would be to invent an evil genie that is not an accepted part of the a-woman-walks-into-a-bar scenario. The right evil genie would transform the situation into one in which it is permissible, within the framework of laws and beliefs specifying that men and women are equal, to see them as unequal nevertheless. One bottle of beer is the same as another, and men and women have an equal right to buy one. What if, however, one of the bottles, the one the woman buys, is surreptitiously spiked, after it is opened, with a chemical that will incapacitate her, rendering her an easy rape victim? In that way, it stays cool that men and women can come into bars and buy beers for themselves, but there’s an evil force emanating from outside that cool situation magically changing it into one in which women are under greater threat then are men.

That evil force would be the “date rape drug,” such as Rohypnol or GHB, recognized pharmaceutical preparations that are far less familiar to most people than is alcohol. That unfamiliarity makes the demonic powers ascribed to them seem plausible, at absurd variance from reality as they may be. It is an established fact, that such drugs are rarely, if ever, used in the context assigned to them as “date rape drugs.” Studies have confirmed that women who believe they were “roofied” and raped, with the tiniest number of exceptions, did not receive any other drug besides the alcohol they chose to drink (and occasionally other drugs they chose to consume). As we saw, however, that reality does not square with the nice picture of men and women as equals in the cozy atmosphere of the local tavern, safely drinking together. It hardly needs be said that it does not square with the nice picture that, say, Anheuser-Busch would want to promote, nor with the picture that women have of themselves as free agents in society, able to go anywhere and do anything. The hugely exaggerated fear of “date rape drugs” therefore acts as a kind of de-equalizer operating outside the prevailing social equality of the sexes, readjusting the focus and keeping everyone happy in their legal, friendly alcoholic haze.

One need only look at the rules one is supposed to apply in order to protect against the use of “date rape drugs” to understand the implicit assumption behind them is that alcohol by itself is safe, something every child knows to be false. These rules were formulated within the context of  a society in which alcohol consumption is a factor in at least half of all auto accidents and homicides–and in many rapes, of course. They are further evidence that the “date rape drug” is part of an urban mythology the function of which is to preserve the status quo.

Saturday, 15 January 2011

“Drugs, Inc.”: Reinventing The Sensitization Wheel

Filed under: Medical Morality,Propaganda,Psychomyths,Television — drtone @ 3:36 pm

I couldn’t help myself. I had to watch “Drugs, Inc.: Cocaine,” on the National Geographic Channel, once I inadvertently tuned into it. I knew it would annoy me. The few things I’ve  seen on National Geographic have all annoyed me, which is why I seldom watch it. This documentary tread the thin line between being open-minded and non-blaming enough to seem “scientific,” and at the same time sufficiently condemnatory and scary to satisfy the PTA at your local Christian high school. In that universe, powder cocaine is a lesser evil than crack, which of course has nothing to do with anything except the way US laws are currently written. The powder cocaine user they showed was a highly paid, sophisticated family man in the British TV industry, who happened to be Black (must have had to look high and low for him). The crack addict they showed was a snaggle-toothed, impoverished American degenerate with no family, who had to be Black (must have had to look high and low for him, too). It was both hilarious and sad, but not what I’m here to talk about.

Near the end, they included an extended segment featuring a Mexican-born American physician with a Russian name who studies cocaine addiction, because her uncle was an alcoholic (???!!!). In between all her moralizing, disguised as “science,” the documentary introduced her “revolutionary” discovery that “merely seeing video of someone lining out coke stimulates the dopamine centers in the brain,” which proves, of course, that cocaine is addictive (????!!!). This “revolutionary” finding is so old that it has great-great-grandchildren, so old that it has been rediscovered and renamed many times.

In essence, it is the most basic finding in Pavlovian conditioning: The “conditioned stimulus” (CS), in this case the lining out the cocaine, but in the classic experiments, the bell signaling the delivery of food powder, becomes associated with the “unconditioned stimulus,” in this case the cocaine, but in the classic case, the food powder, eliciting the “unconditioned response,” the cocaine high, or salivation in the classic case. The response thus established is called the “conditioned response” (CR). Junkies know about this relationship and will, desperate in the absence of drugs, prepare an empty fix, boiling up some distilled water in a bent spoon and injecting it, as if it had dope in it. In spite of knowing that it is a placebo, they get some relief from their “Jones.” The most recent rediscovery of this phenomenon–before this Mexican-American-Russian  rediscovered it again, this time having to use brain scans–is called “sensitization.”

Note: As I peer deep into my Google results, I notice that the name of the Mexican-American-Russian doctor, Volkow, may actually be associated with research showing the very opposite of the way it was portrayed in the National Geographic documentary. In my experience, this is par for the course with what passes for science on TV.

Thursday, 13 January 2011

Medicine & Law: The Psychiatric “Hold”

Filed under: Diagnosis,Medical Morality,Psychotherapy — drtone @ 1:54 pm

Many are familiar with the meaning of the term “5150,” It refers to a provision of California law, Section 5150 of the Welfare & Institutions Code, pertaining to the involuntary commitment of an individual designated as “a danger to self or others” or “gravely disabled.” The law is administered at the county level, usually involving county sheriffs as the main agents of commitment, although others, principally psychiatrists so designated by the county, can place a person in an involuntary “hold” at a psychiatric facility. Naturally, such a law is a constant matter of debate among civil libertarians, but let us stipulate, for the moment, that there are circumstances in which it is necessary to confine someone who is acting out in a potentially dangerous manner or is manifestly and severely suffering from self-neglect.

From my perspective, the interesting thing about this kind of “hold” is the legal power it places in the hands of physicians, not so much in admitting the individual in question, but in ending the hold and allowing him or her to leave the facility. According to a subsection of the law, WIC Section 5152, not only is it up to a psychiatrist to continue or end a hold, but the final decision to end a hold in disputed cases resides with the head of the medical facility where the person is being held, or if that doctor is not a psychiatrist, by a psychiatrist appointed by him or her. Think about that: A segment of the medical profession, psychiatrists, have legally defined powers over a person’s freedom. This is surely not the only instance where doctors are written into the law. We take it for granted, however, that members of a given profession who are usually not public officials deserve a level of trust far in excess that accorded other citizens. I’m not suggesting it’s wrong that we do this, but only that we consider what it means.

Tuesday, 11 January 2011

Fantasy Drug

Filed under: Chemical Imbalance,Medical Morality,Propaganda,Psychomyths — drtone @ 3:04 pm

For someone like me who believes that there is a great confusion around the meaning and effectiveness of psychiatric medications, it can get pretty discouraging. What I mean is that the idea that psychiatrists and pharmacologists can develop medical cures for what ails us is so embedded in our culture that it will be decades before people will be able to get a genuine perspective on the causes of and cures for psychoemotional distress. Sometimes, it’s hard to tell whether a given cultural product was deliberately created as a piece of psychiatric propaganda or the creators simply take for granted that eventually there will be a medicine for every form of disturbance.

The latest case in point is an episode from the first season of “The Closer,” starring Kyra Sedgwick (Mrs. Kevin Bacon). The plot revolves the development of an “antidepressant” that can “cure” teenage drug addiction while also treating teenagers’ anxieties. Problems arise in the development of the drug, but not because, strictly speaking, it doesn’t work. It does seem to “cure” all the worst ills of adolescence (from many parents’ point of view), but it also has potentially fatal side effects. Early in the episode, moreover, mention is made of the various drugs of abuse the new medication sort of works against. The implication is that merely trying these drugs (Ecstasy, speed, etc.) is highly likely to do permanent damage. So the faith in drugs works both ways: Drugs are so strong, for good or ill, that we are helpless before them, as if the world is a giant 12-step meeting.

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