Cognition & Reality

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.

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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.

Monday, 21 March 2011

Figuring It Out

Filed under: Uncategorized — drtone @ 2:25 pm

Despite recognizing that my story of myself is an illusion, I have maintained a naive faith that I could position my mind in such a way as to answer every question at once. Although I recognize limits of my strategy, because I can only experience my “mind” as a rather complicated story, I nevertheless try to figure it all out. I am not alone in experiencing this conundrum. None of us can figure out the web of stories we tell ourselves. “Figuring it out” is, in fact, another story. There has to be a better way.

Thursday, 17 March 2011

Japan & Reality

Filed under: Uncategorized — drtone @ 9:41 am

The disaster in Japan has become another opportunity for me to act the curmudgeon. Maybe inside this tai-chi-and-yoga social democrat there lurks a despicable right-wing creep. I hope not. Anyway…

When I suspended my news blackout to read about the nuclear meltdown in Japan, one of my first thoughts was that a lot of people were going to become even more afraid of nukes than they already are. Although nukes can represent a serious danger, as we now have illustrated for us again, they are only one danger in a dangerous world. Meanwhile, the industrialized world must obtain energy from somewhere. People can moralize all they want about overpopulation and over-industrialization, but everyone wants electricity, motorized transportation and the other basics of modern civilization. There is no way to produce these without “breaking a few eggs,” by drilling for oil, building nuclear plants, etc. The alternative is…There is no alternative. (There are those who offer the solution of a “sustainable” world population at about a quarter what it is now. In other words, their alternative is that four or five billion people should die.)

There’s reality, and then there’s everything else. At my yoga class the other night, people were talking about empty shelves at the local health food store. Apparently, if you want some iodine, you can now forget it. Fukushima, Japan, the site of the nuclear plant where the meltdown might be happening is over 5000 miles from Southern California, where the radiation plume will arrive tomorrow, raising background levels by a “miniscule” amount. Stipulating that the authorities, particularly the owners of the nuclear plant, are downplaying the risk, surely there is a danger gradient in effect, such that people close to the meltdown are in far more peril than someone literally across the ocean.

Consider, as well, that Japan is the only country in the world where people remember widespread radiation sickness, thanks to the boys at Los Alamos. A meltdown is a different animal, to be sure, but bombs that blew up in the atmosphere, incinerating and poisoning hundreds of thousands of Japanese, did nothing to the rest of the world. The Japanese are the ones with the warrant to be scared. The rest of the world is on a fear jag.

Then there is the destruction from the earthquake and tsunami. The horror. As real as the disaster might be for someone in Northeast Japan, what could be more of an illusion than scenes of broken cars and buildings and people beamed into one’s house from thousands of miles away? Shit happens, as Gautama would have said were he alive now.

There are a lot of things in this world to be afraid of. I worry about my doggies all the time, for example, and there are one’s own health problems. Things blow up. There are car wrecks, windstorms, and lightning strikes. Life is fragile, and the trappings of civilization are fragile, as well. Maybe that’s why we meditate, not to escape our fears, but to gather the inner strength to live with them.

Friday, 18 February 2011

Trying Pinker

Filed under: Uncategorized — drtone @ 8:47 am

I decided to try to read Steven Pinker’s The Blank Slate: The Modern Denial of Human Nature. For the same reason that I don’t follow the news, I had been avoiding it for years. It’s going to be bitch. One of the book’s main premises, as the subtitle suggests, is that the importance of “nature” in the nature-nurture debate is typically underestimated in our society. One wonders on what planet Pinker lives. In the society I inhabit, one can hardly watch TV for ten minutes before someone ascribes some characteristic as “genetic.” In the academic world, the one Pinker inhabits, those who attribute human behavior and development to “innate” properties of the mind have been in the ascendant for decades. Pinker’s whiny introduction, in which he claims that most people are horrified by the idea that human behaviors have an innate basis, and compares “the denial of human nature” with Victorian attitudes toward sex, reminds me of the American notion that we are underdogs in the “War on Terrorism.”

Friday, 4 February 2011

Political Sociobiology?

Filed under: Uncategorized — drtone @ 1:42 pm

I have noted in the past that the tangling of political and scientific claims confuses any issue involved and degrades both domains. A cursory search regarding “sociobiology” turned up this nugget of political argument, which seems to be based on the assumption that individual scientists’ political views can be marshaled to address the content of their theories. As usual, Steve Pinker represents the confused view that critics of sociobiology and evolutionary psychology somehow reject those theoretical positions because of the distasteful politics they imply. Nothing could be further from the truth.

Friday, 28 January 2011

Psychology In America

Filed under: Uncategorized — drtone @ 9:48 am

As I have been reading The Metaphysical Club, I have been struck with the way the author, Louis Menand, who is an English professor, portrays academic psychology. For him, it is of far greater importance to American letters than I am accustomed to imagine. In the period about which Menand is writing, the late nineteenth century, not only did William James, John Dewey, and even Charles Sanders Pierce, as well as several others who perhaps later either became philosophers, consider themselves to be psychologists, but also academic psychology (the New Psychology, as Menand calls it) was catching a fair amount of the limelight in the public imagination. Because James hated the laboratory, I shy away from using the term “experimental psychology” to distinguish the related disciplines of social, developmental and what would come to be called “cognitive” psychology from clinical psychology. I remember being aware, when I was a grad student that psychology had lost some of the robustness it seemed to have in previous times. During my era, and I think that the same conditions prevail today, psychologists have prided themselves on having, in effect, separated themselves from the previous era, dominated by “behaviorism.” The problem is that behaviorism was, if nothing else, the bridge back to psychology as it was at the beginning of the twentieth century. Something has been lost.

Monday, 24 January 2011

Roethlisberger Revisited

Filed under: Uncategorized — drtone @ 2:18 pm

At the beginning of the NFL season, I posted regarding Commissioner Roger Goodell’s reduction of the suspension he had handed out to Ben Roethlisberger, the Pittsburgh Steelers’ quarterback, for having raped a woman in Georgia. I joined the chorus complaining that Roethlisberger, his wealth and fame  standing between him and the prison sentence that any other man would serve for the same crime, should receive a year’s suspension from play, if not outright banishment from the league. There seems to be little question that he did rape the woman, and that he has raped other women. The man fairly glows narcissistic contempt for the world at large, and it seems likely that, his present reformed demeanor notwithstanding, he will rape again. The NFL, in its constant effort to generate new and higher forms of hypocrisy, has typically overlooked the facts, and has let him play because of his rare talents. I should add that in the game the Steelers won last week they faced  the Baltimore Ravens, led by Ray Lewis, among the greatest linebackers ever, and a murderer.

As of yesterday’s games, the Steelers will face the Green Bay Packers in the Super Bowl, and Roethlisberger’s excellent play is certainly a major factor in his team’s success. Although he’s not considered to be quite as good as the Packers’ QB, Aaron Rodgers, Roethlisberger gives his team, which is built around running, what it needs: his ability to maneuver, despite his exceptional size, and his toughness, an object of great respect in football circles. Not long after his suspension ended, Roethlisberger fucked up one of his ankles, and has played ever since wearing a specially constructed boot. There is nothing–nothing!–football people (and other “athletic supporters”) like better than a guy who plays in obvious pain; if he is also extraordinarily talented, that’s merely icing on the cake. Therefore, and on account of his team’s having matriculated all the way to final game, Roethlisberger has gone from being something of a pariah when he returned from his suspension, to becoming once again one of the game’s most admired players. To me, he remains a rapist who should be locked up instead of being celebrated and paid truckloads of money.

I don’t pretend to be an expert and I’m not a gambling man, but if I did gamble, I’d put my money on the Steelers to win the Super Bowl, not least because of Roethlisberger’s ability to make the big play. Almost every season, I ask myself why I continue to watch this weird game, seemingly designed to produce horrible injuries and to promote bad behavior, both on and off the field. In spite of my disgust for the game’s extravagant hypocrisy, and in spite of my disdain for the awe-inspiring stupidity and waste of the Super Bowl, I remain a fan.

Wednesday, 19 January 2011

Attachment

Filed under: Uncategorized — drtone @ 12:37 pm

Attachment, on the other hand, involves identification with the products of the conscious mind, and concern for the later effect of actions done in the present moment. Instead of free play, attachment is therefore about constrained expectations of the future, hoping that the world will conform to my expectations about it, or wishing that it had already done so. Because it consists in wanting things to go my way, attachment is therefore a story about me, my past and my future. For that reason, attachment is little more than a dream, because neither the past nor the future exists.

Friday, 14 January 2011

Self-Torture: Car Stereo Edition

Filed under: Uncategorized — drtone @ 4:28 pm

When I got my new car, I reversed my previous habit of buying new cars with the “premium” sound system. This time, I got the basic system, with the plan of upgrading the audio myself, saving money in the long run and maybe getting more of what I want. I am no expert on home audio, but have put together a number of systems in my life, and I pretty much know what I’m looking for and how to hook everything up. Car audio is a completely different animal. The brands are, by and large, different. The equipment is different, too, although it all performs the same function.

Despite my deficit in expertise, I moved ahead. My plan was to build the car system in stages, first with a better set of speakers in the front doors and an amplifier for those speakers; later, perhaps much later, I would add a subwoofer, as well as more speakers on the rear deck and in the rear doors. As is usual for me, I shopped and shopped for the right speakers and the right amp, knowing that I did not have enough information. I tried talking with a couple of installers, to pick their brains, but of course they were uncooperative, not wanting to undercut themselves. Based on home audio, for which one obtains the biggest, baddest amp one can, I bought the most powerful 2-channel amp I could get within a pretty tight budget, but spending more than if I had bought a 4-channel amp. More is better, and I was only powering two speakers.

When the installer I found through Craigslist put everything in, he told me he had to turn the amp down because the speakers could not handle that much power. The first time I tried the system out, I discovered two things. The first was that, even at less than the highest volume setting and with the gain on the amp down, the speakers will shut off if the signal is too loud. The second was that the installer had failed to latch the hood of my BRAND NEW CAR, and that I was riding down the freeway in danger of having the hood of my BRAND NEW CAR fly up, block my vision, get destroyed, and forever twist the engine compartment opening of my BRAND NEW CAR. In the event, I was able to pull over before disaster hit and latch the hood; I also found that, as I expected, the speakers would reset if I shut the car off and restarted it. Nevertheless, the system does not work right and shuts down when scared by loud noises.

The installer, the same one who left my hood unlatched, says that my 2-channel amp can be configured to run a subwoofer through a third channel. That might distribute the power better, and solve the problem of the speakers cutting out when overdriven. It would also give me better sound. I’ve looked at the manual and am not sure if that is true, although I do see how it’s a possibility, if the settings and outputs are as I understand them to be. But I am, as I say, pretty ignorant about this type of equipment. At any rate, to do that, I’d have to spend more money, which was exactly what I was trying to avoid.

These are the questions my Inner Bully is asking. First of all, why didn’t you simply buy the cheaper 4-channel amp, which is designed to configure as two stereo channels, plus a third channel for the sub? Secondly, how dare you  think of spending yet more on a sub? You already shouldn’t have bought the car, and having bought the car, shouldn’t have tried to upgrade the stereo. Also, how did you manage to pick that sad-sack, monumentally obese, irresponsible car stereo installer? There were other options. Finally, why are you spending so much energy on this? No wonder your life isn’t the way you want it. You dissipate all your energy on the trivial, first going through all the rituals of buying and then twisting in the wind of buyer’s remorse.

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