Saturday, July 15

Triumph of the authoritarians 

"The practitioners' bludgeoning style of politics, their self-serving manipulation of the political processes, and their policies that focus narrowly on perceived self-interest -- none of this struck me as based on anything related to traditional conservatism. Rather, truth be told, today's so-called conservatives are quite radical. For more than 40 years I have considered myself a ``Goldwater conservative,' and am thoroughly familiar with the movement's canon. But I can find nothing conservative about the Bush/Cheney White House, which has created a Nixon ``imperial presidency' on steroids, while acting as if being tutored by the best and brightest of the Cosa Nostra." (Boston Globe op-ed) John Dean's eloquent crucifixion of the Bush regime, one conservative to another.

7/15/2006 10:46:00 PM   •  

Folk Songs of the Far Right Wing 

Too good not to click on [thanks, paula]

7/15/2006 10:36:00 AM   •  

Will Machines Become Conscious, and When? 

Why We Can Be Confident of Turing Test Capability Within a Quarter Century: "The advent of strong AI (exceeding human intelligence) is the most important transformation this century will see, and it will happen within 25 years, says Ray Kurzweil, who will present this paper at The Dartmouth Artificial Intelligence Conference: The next 50 years (AI@50) on July 14, 2006."

7/15/2006 09:17:00 AM   •  

Thursday, July 13

Wide Flaws Found in Boston Tunnel After Death 

"Massachusetts officials on Wednesday ordered every road and tunnel in the city highway system examined after inspectors found at least 60 more trouble spots in the Big Dig tunnel where a woman was crushed to death on Monday by three-ton ceiling tiles." (New York Times ) Perhaps it is because this is my city and I have driven through the new tunnels countless numbers of times, but I think everyone should be distressed by the fact that this is how it goes in one of the largest public works projects in American history. And the numerous faulty bolts (at least sixty more trouble spots as of last report) holding three-ton concrete ceiling slabs in place are probably the tip of the iceberg of the substandard and cost-cutting job done at the expense of innocent commuters' lives. Should we have expected differently? Do we have a right to? If there is more than one way to do a job and one of them will end in disaster, someone said, than somebody will do it that way. But I suspect the fault does not lie in the engineering or technological realm as much as that of human malfeasance and sloppiness.

7/13/2006 12:32:00 PM   •  

Paralyzed Man Uses Thoughts to Move a Cursor 

"A paralyzed man with a small sensor implanted in his brain was able to control a computer, a television set and a robot using only his thoughts, scientists reported yesterday.

Those results offer hope that in the future, people with spinal cord injuries, Lou Gehrig’s disease or other conditions that impair movement may be able to communicate or better control their world." (New York Times )

7/13/2006 12:24:00 PM   •  

The Taming of the Slur 

"“Slut’’ is tossed around so often and so casually that many teenagers use it affectionately and in jest among their friends, even incorporating it into their instant messenger screen names.

Like “queer” and “pimp” before it, the word slut seems to be moving away from its meaning as a slur. Or is it?" (New York Times )

7/13/2006 07:26:00 AM   •  

Wednesday, July 12

Best Obituary Ever? 

From the Richmond Times Dispatch

7/12/2006 11:13:00 PM   •  

What Kind of Genius Are You? 

"A new theory suggests that creativity comes in two distinct types – quick and dramatic, or careful and quiet." Wired is all over this supposedly ingenious theory of Chicago economist David Galenson, "nothing less than a unified field theory of creativity." Only it is not a new theory at all. Writers on creativity have long distinguished the brash immature version, often a flash-in-the-pan, from the more measured mature creativity which emerges later in life and seems to build more on a lifetime's groundwork. There also seems to be a relationship between the respective style of creativity and either iconoclasm or reverence, not surprisingly. It strikes me that it is sometimes more difficult to recognize mature creativity, and a fortiori to proclaim it genius, since it is a matter of opinion whether it is anything more than mere synthesis of, or even borrowing from, the prior creative work in whose tradition it is embedded and on which it draws. There may be an inverse correlation between the frequency with which someone is proclaimed a mature genius and the critic's familiarity with what has already been done in the field. Perhaps that is why the Wired writer is so enamored of Galenson's work.

7/12/2006 07:53:00 PM   •  

In Big Shift, U.S. to Follow Geneva Treaty for Detainees 

"The Bush administration called today for Congress to fix, rather than scrap, the system of military tribunals that was struck down by the Supreme Court last month, while the Pentagon pledged to treat detainees in accordance with the Geneva Conventions as the court required." (New York Times )

Before the court ruling, the administration repeatedly stated that the detainees were not subject to the protections of the Geneva Conventions; now they are, but mealymouthed administration spokesmen feel the most important point to make about this announcement is that it is not a change of policy. Let us hope there is a fight brewing in Congress about an imperious administration now needing to crawl hat in hand to them to rubberstamp its abuses of power.

7/12/2006 07:52:00 AM   •  

U.S. Terror Targets: Petting Zoo and Flea Market? 

"It reads like a tally of terrorist targets that a child might have written: Old MacDonald’s Petting Zoo, the Amish Country Popcorn factory, the Mule Day Parade, the Sweetwater Flea Market and an unspecified “Beach at End of a Street.”

But the inspector general of the Department of Homeland Security, in a report released Tuesday, found that the list was not child’s play: all these “unusual or out-of-place” sites “whose criticality is not readily apparent” are inexplicably included in the federal antiterrorism database.

The National Asset Database, as it is known, is so flawed, the inspector general found, that as of January, Indiana, with 8,591 potential terrorist targets, had 50 percent more listed sites than New York (5,687) and more than twice as many as California (3,212), ranking the state the most target-rich place in the nation." (New York Times )

7/12/2006 07:44:00 AM   •  

Another Mission ‘Accomplished’ 

"This is proof, if anyone still needs it, that this administration is desperate for something to boast about. On Mr. Bush’s watch, triple-digit budget surpluses have turned into annual triple-digit budget deficits. There’s no information in the midsession report to alter that utterly dispiriting fact. Yes, the report is expected to project that this year’s deficit will be somewhat less gargantuan than last year’s — probably somewhere between $280 billion and $300 billion, versus a $318 billion shortfall in 2005. That’s not much to crow about.

But Mr. Bush is likely to gloat, anyway. Earlier this year, the administration conveniently projected a highly inflated deficit of $423 billion. With that as a starting point, the actual results can be spun to look as if they’re worth cheering." (New York Times editorial)

7/12/2006 07:43:00 AM   •  

Tuesday, July 11

When the Personality Disorder Wears Camouflage 

"When a war crime doesn't look quite like a war crime — when it seems cold and deliberate like a serial murder, rather than an impulsive act of vengeance — it can be especially disturbing, as United States Army officials have learned over the past week." (New York Times Week in Review)

Given that the Army has said it has discharged the accused ringleader of the massacre for having a "personality disorder", the reporter wonders why this evidence of a serious mental disorder was not recognized sooner and the soldier quickly discharged before he could do any damage.

"In this environment, people who have one diagnosis in particular — antisocial personality disorder — can often masquerade as bold, effective soldiers, psychiatrists argue. Antisocial behavior is characterized by reckless irresponsibility, habitual lying and an indifference to the suffering of others. In some reports Army officials have listed such a diagnosis as the reason for Mr. Green's discharge."

Psychopaths, the reporter explains (using a term which has been an imprecise synonym for antisocial personality disorder), feel no tension over the moral implications of their actions. He concludes that the atrocities in Iraq are few and that "just a few soldiers cause big trouble." First of all, where did this writer get the notion that a 'normal' war crime is done in the heat of vengeance? This is a convenient explanation but is mostly in the service of his thesis that a few cold calculating sociopaths can turn a good war bad. Moreover, what one calls a war crime or atrocity is at issue here. Arguably, the entire invasion and occupation of Iraq is one enormous atrocity which has massacred and maimed tens if not hundreds of thousands of innocent Iraqis.

The author fails to draw on a distinction we make in clinical psychiatry between personality 'traits' and 'disorders'. 'Personality disorders' are unlike the major mental illnesses the reporter hopes would be screened out of the military because of the stress intolerance and distress that they cause their sufferers. A personality disorder is merely an accentuation of a personality style, or set of traits (a person's typical coping strategies, defense mechanisms and interactional style), which rigidly dominates the person's personality and is relied upon inflexibly to a dysfunctional extent. In some cases this causes suffering to the affected individual (think, for example, of a person with disabling compulsiveness or shyness). In other cases, the personality disorder is — one might say — a successful adaptation insofar as it prevents the individual from feeling distress, instead inflicting it on those around him or her. This is true of many of the more notorious personality disorders we face in clinical psychiatry — borderline, narcissistic, paranoid and, as discussed in this article, antisocial states. A personality disorder is lifelong, enduring and maladaptive in most or all of the settings in which a person finds themselves in life. But even if a person does not have a pervasive personality disorder, their predominant personality traits can be a poor interactive fit with the particular social circumstances s/he finds h'self embedded, such as the Army or a war, at a given moment.

Where the article goes wrong, in attributing a small number of problems to a small number of 'sick' individuals, is in ignoring that an illegal and immoral war based on reckless and calculated violation of the rights of others without compunction, for personal gain with no appreciaton of the moral consequences, is a perfect interactive fit for antisocial traits. Even if the recruiters and the basic trainers were good at screening out those with a preexisting fullblown antisocial personality disorder (which would typically have declared itself, unless the recruiters are desperate for anyone, in that the person would likely have had a history of getting themselves into trouble in civilian life), the current conditions will precisely select for, encourage and engender an antisocial style of thinking and behaving. Much as the article I linked to the other day suggested that the conditions of the war make the Army a haven for right wing racialist extremism, the Iraq war is a breeding ground for antisocial behavior and 'cold and deliberate war crimes'. I argued when the revelations about Abu Ghraib broke that both the perpetrators' understanding of their mission (aiding in desperate intelligence-gathering at all costs) and the permissiveness of the entire culture of the US military intervention shaped the torture. The scapegoating of the (admittedly depraved) perpetrators was a convenient smokescreen obscuring their superiors' responsibility, right up to the Pentagon and the White House. The same is true, even moreso, of the current crop of coldblooded massacres and murders. A war that is generally considered just (to the extent that any war can be said to be), where the decision to go to war and support the war effort is a national consensus, is a framework within which the psychological stability of combatants is more preserved, behavior in accordance with the accepted ethical standards of warfare is facilitated, and civilian massacres and detainee torture are much less — or not at all — a way of doing business.

The other point I quibble with is the author's assertion that there is a relatively low frequency of psychiatric breakdowns in Iraq. This has little to do with the psychological health of the recruits or the impeccabe supportiveness, nurturance and protectiveness of the command structure. Rather, it is a matter of the Army's callous indifference to the psychological distress suffered both on the battlefield and in returning combat veterans. In Iraq, psychological disterss is ignored or stigmatized and affected individuals bullied back onto patrol, as I have described here in earlier posts. And most psychiatric professionals, especially those who work with combat trauma, project an unprecedented proportion of Iraq veterans will need treatment for post-traumatic conditions. Perhaps the only soldiers immune are precisely those who have been selected for the effective use of antisocial traits, those who are unable to feel any compunctions for the immoral horror they inflict by their invading and occupying presence.

7/11/2006 10:59:00 PM   •  

Message From Mouse to Mouse: I Feel Your Pain 

'Emotional Contagion as a Primitive Precursor to Human Empathy?: "Pets, homeowners and exterminators show little sympathy toward rodents, but that does not mean the little scavengers lack feelings for one another.

Last week, scientists studying the experience of pain in mice found strong evidence (Science Magazine ) of empathy in those who saw a fellow creature suffering." (New York Times )

7/11/2006 10:18:00 PM   •  

Rogue Giants at Sea 

"Enormous waves that sweep the ocean are traditionally called rogue waves, implying that they have a kind of freakish rarity. Over the decades, skeptical oceanographers have doubted their existence and tended to lump them together with sightings of mermaids and sea monsters. But scientists are now finding that these giants of the sea are far more common and destructive than once imagined, prompting a rush of new studies and research projects. The goals are to better tally them, understand why they form, explore the possibility of forecasts, and learn how to better protect ships, oil platforms and people. The stakes are high. In the past two decades, freak waves are suspected of sinking dozens of big ships and taking hundreds of lives. The upshot is that the scientists feel a sense of urgency about the work and growing awe at their subjects." (New York Times ) I have long been fascinated by these monsters, perhaps because as a child I had recurring nightmares of watching a towering wave bear down inexorably toward me from the beach. I used to think I was talking about tsunamis, but when the December 2004 tragedy hit the Indian Ocean, I realized I was wrong; I learned that the latter have bulk and power but not necessarily such height, often gaining no rise until they crash ashore. 'Rogue waves', on the other hand, are monstrously high — perhaps as much as 200 ft. — but never come close to shore, because of the physical limitations of the process. Recent estimates suggest that at any given moment ten of these giants are roaring across the sea. Just another nail in the coffin of our arrogant lack of humility in the face of natural forces...

7/11/2006 10:15:00 PM   •  

The Inner Circle Contracts 

The Lonely American Just Got a Bit Lonelier : "A recent study by sociologists at Duke and the University of Arizona found that, on average, most adults only have two people they can talk to about the most important subjects in their lives — serious health problems, for example, or issues like who will care for their children should they die. And about one-quarter have no close confidants at all.

'The kinds of connections we studied are the kinds of people you call on for social support, for real concrete help when you need it,' said Lynn Smith-Lovin, a sociologist at Duke and an author of the study, which analyzed responses in interviews that mirrored a survey from 1985. 'These are the tightest inner circle.'" (New York Times )

7/11/2006 10:06:00 PM   •  

Read my lips 

The taunt that made Zidane snap: intense speculation, fantasizing, projecting and, yes, attempts at lipreading off the video clips are consuming many. Suffice it to say, from this U.S. vantage point, that compared to whatever went down on that football field, we here are by comparison woefully inadequate at hurling insults!

7/11/2006 10:04:00 PM   •  

Mystic mushrooms spawn magic event 

(Terrible headline, by the way...) "People who took [a single dose of psilocybin] reported profound mystical experiences that led to behavior changes lasting for weeks -- all part of an experiment that recalls the psychedelic '60s." (CNN)

And this is suposed to be news??! How far away from the psychedelic era we have ended up, I felt as I read this report of the study, partially federally funded and published in the journal Psychopharmacology. Touted by some as a landmark, it is said to be the first study to 'rigorously' study the subjective experiences of hallucinogen users. Charles Schuster, a professor of psychiatry and behavioral neuroscience at Wayne State University in Detroit, Michigan, and a former director of the National Institute on Drug Abuse, commented: "We've lost 40 years of (potential) research experience with this whole class of compounds," he said. Now, with modern-day scientific methods, "I think it's time to pick up this research field." Despite the fact that hallucinogens have been used since time immemorial in spiritual ceremonies in all but the most uptight societies, the new work is said to demonstrate drug effects in a new way. Given that users report intense mystical experiences, proponents of the study say they may have a window into the religious experience, for example by doing fMRIs of people under the influence of psilocybin or other hallucinogens. Ah, the ludicrous tragedy of feeling it is somehow more valid to study the 'subjective' 'objectively'! Again, the article talks as if this establishes that hallucinogens might be useful for the treatment of drug addicts or depression in the terminally terminally ill. Of course, these two categories are picked because they are areas in which there is already clinical hallucinogen research and established evidence of effectiveness.

7/11/2006 10:00:00 PM   •  

R.I.P. Syd Barrett 

Founder of Pink Floyd dies at 60 (Yahoo! News). Mercurial but troubled, his work was why Pink Floyd grabbed the attention of the progressive music scene. He left the band, to be replaced by David Gilmour, long before much of Pink Floyd's commercial success, and lived a reclusive life in Cambridge, UK, continuing to receive royalties.

7/11/2006 05:34:00 PM   •  

Sunday, July 9

SETI, the Fermi Paradox and The Singularity: 

Why our search for extraterrestial intelligence has failed: "The Fermi Paradox was first stated by Enrico Fermi in 1950 during a lunch time conversation. Fermi, a certified genius, used some straightforward math to show that if technological civilizations were common and moderately long-lived, then the galaxy ought to be fully inhabited [10]. The vast distances of interstellar space should not be a significant barrier to any such civilization --assuming exponential population growth and plausible technology.

'Contact' should thus be completely inevitable; we ought to find unavoidable evidence of 'little green men' all about us. Our Search for Extraterrestrial Intelligence (SETI) should have been quickly successful.

We don't. It hasn't been. That's the paradox.

This paradoxical failure is sometimes called 'The Great Silence'. The Great Silence suggests that space traveling technological civilizations are extremely rare (or very discrete [8]). There have been a number of explanations for the why such civilizations might be rare. I list four explanations below. You can choose the one you like; they are as close to destiny as we are likely to get...."

This is from John Faughnan, whose weblog I just found by accident and who seems to resonate with many of my interests. The Fermi paradox is one of his preoccupations, it seems.

7/09/2006 10:54:00 PM   •  

Are You Reading This on Medlogs.Com? 

For readers of FmH — unless you read the comments under the post to which this link points on my weblog Follow Me Here, you would probably not know that FmH is syndicated at medlogs.com.

For readers via Medlogs — I am posting this largely for you. Recently, an anonymous Medlogs reader, in the midst of a mutually rather acrimonious exchange with me in the comments section of FmH, let me know on FmH that s/he has complained to the sysop of Medlogs about my posts syndicated there. She/he claimed that the problem was the volume of posts with non-medical content originating from FmH; I think the issue is really that s/he does not like my political position. Her/his original derogatory comment on FmH did not even mention any supposed concern about medlogs.com:

(Anon): "Maybe it has to do with an idiotic leftist content that you provide. Maybe it has to do with your overwhelming paranoia. Maybe we just don't have the time to read pages and pages and pages of garbage by you, someone we don't know. If it's not good, its not fun, it's not relevant, it's not interesting, it's not original, it's not touching, then it's not worth to read. Ever thought about it?"

Only when s/he became defensive after pressed about her/his demeanor did the commenter mention that s/he felt I was hogging the bandwidth at Medlogs:

(Me): "Anon -- first off, thank you for your opinion, but you do not seem to be a very close reader of the post to which you are responding! You seem to be answering a question I wasn't even asking, which is why I don't have more readers. Read my post again, and see if you make another stab at understanding whether that is important to me.

But, more important, why in the world are you reading FmH? I'd suggest you stop, for your own welfare! Otherwise, what does it say about your life that you visit a site that is "idiotic", "garbage", "not fun", "not interesting", "not original", "not touching", not worthwhile?

Sorry you do not seem receptive to what is offered here. Ah, maybe I understand what FmH does for you! You need a place to vent your spleen! ...in which case you are welcome to get yer rocks off by coming here. And, in the process, thanks for being a perfect illustration of the futility of dialogue with rightward-twisted wingnuts whose discourse consists only of namecalling.

(Anon): "I don't read your idiotic rants. Unfortunately, this garbage overwhelms Medlogs.com with asinine political content of yours. And you betcha, I did complain about it to Jacob Reider. On some days, Medlogs.com looks like left-idiot's-rants.com. I would suggest that for the sake of respecting other people's work (in this case, Jacob's), you delist your garbage off Medlogs.com. Then, some of us will ever (sic) see it again."

You can read the rest of the exchange by scrolling down from here. (Not me at my best...)

(Ironically, this complaint about the volume of my posts and the offensiveness of my politics was in response to an item I had put up on FmH considering the decreasing volume of my posts at this point in my weblogging career. In particular, I am posting less political material, as I explain in the post in terms of "Bush fatigue.")

But back to the issue at hand. My impression is that medlogs.com is not a weblog for medical posts but rather a weblog syndicating medical webloggers' posts; as you can see, an important distinction. To my way of thinking, it is a dull medical professional who is interested in nothing but medical content, and most medical professionals I know are interested in a broader range of their colleagues' thoughts. That's my notion of the medical community crystallized by medlogs.com. FmH represents a cross-section of the thoughts and interests of a psychiatrist (albeit a leftwing antiwar anti-Bush one); seemed to have a place on Medlogs.

I would imagine that if I was offbase in that respect I would have long since heard from Jacob Reider or other Medlogs readers. The page to add a site to Medlogs says, "We will get to feed requests ASAP." I take that to mean that Reider reviews sites applying for admission to medlogs.com to see if they are appropriate; for just this reason, it would be a great gamble not to do so. In that case, my content was deemed to be in the acceptable ballpark. In any case, I wrote to Reider about this difference of opinion and asked him to clarify. I told him that, although he might be reluctant to kick me off in response to concerns about my content because the action might have the appearance of political censorship, I offered that I would voluntarily withdraw FmH from Medlogs syndication if he thought it would be the right thing to do . I have yet to hear back from Reider.

I am posting this now because I think it would be responsible of me to solicit other Medlogs' readers opinions about whether I am sullying their reading experience and whether I should leave Medlogs. Do you share the concerns of the scurrilous, anonymous complainant? Do you find my posts on Medlogs out of place or is the content I add acceptable in light of what you understand Medlog's raison d'etre to be? I know there is some selection bias in phrasing a question in this manner; I ask sympathetic readers to consider replying as readily as others might do it in antipathy. You can let me know by going to the copy of this post on FmH and entering a comment. Please identify yourself as a Medlogs reader (and don't share the complainant's cowardice by remaining anonymous, please). Thank you for your input, and I would be happy to leave Medlogs if the preponderance of opinion supports that. I would be happy to see Anon. eat crow if the preponderance of the evidence supported that outcome... (but I will not hold my breath).

7/09/2006 09:03:00 PM   •  

What Shamu Taught Me About a Happy Marriage 

"The central lesson I learned from exotic animal trainers is that I should reward behavior I like and ignore behavior I don't. After all, you don't get a sea lion to balance a ball on the end of its nose by nagging. The same goes for the American husband.

...I was using what trainers call "approximations," rewarding the small steps toward learning a whole new behavior. You can't expect a baboon to learn to flip on command in one session, just as you can't expect an American husband to begin regularly picking up his dirty socks by praising him once for picking up a single sock. With the baboon you first reward a hop, then a bigger hop, then an even bigger hop. With Scott the husband, I began to praise every small act every time: if he drove just a mile an hour slower, tossed one pair of shorts into the hamper, or was on time for anything.

I also began to analyze my husband the way a trainer considers an exotic animal...." — Amy Sutherland (New York Times )

The only problem is that Ms. Sutherland acts as if she has discovered these verities. Karen Pryor's brilliant but neglected (because it had the appearance of being a dog training manual) Don't Shoot the Dog went over the same revolutionary ground, applying reinforcement-based teaching and training to human relational problems, two decades ago.

7/09/2006 09:30:00 AM   •  

Hate Groups Are Infiltrating the Military, Group Asserts 

"We've got Aryan Nation grafitti in Baghdad..." "A decade after the Pentagon declared a zero-tolerance policy for racist hate groups, recruiting shortfalls caused by the war in Iraq have allowed 'large numbers of neo-Nazis and skinhead extremists' to infiltrate the military, according to a watchdog organization.

The Southern Poverty Law Center, which tracks racist and right-wing militia groups, estimated that the numbers could run into the thousands, citing interviews with Defense Department investigators and reports and postings on racist Web sites and magazines." (New York Times )

The growing unpopularity of the war creates an incentive for quota-burdened recruiters to appeal to the basest sentiments in the American mentality, the xenophobia and reptilian tribalism that turn into torture and massacre. But it is misleading although convenient to focus as this report does on recruiting shortfalls as the cause; they only highlight the deeper issue. As this report makes clear, it was folly for the Pentagon to believe that it could eliminate extremism with regulations or policy when the mission of this war as shaped at the highest levels of administration policy is itself xenophobic, manipulative, dishonest and jingoistic.

7/09/2006 09:14:00 AM   •  

The Myth of the New India 

"Many serious problems confront India. They are unlikely to be solved as long as the wealthy, both inside and outside the country, choose to believe their own complacent myths." (New York Times op-ed)

7/09/2006 09:05:00 AM   •  

A Job With Travel but No Vacation 

"It's summer now, and countless travelers are fumbling their way around the globe, heads buried in guides published by Let's Go, Lonely Planet, Rough Guides and Frommer's among others. Probably few stop to consider what goes into producing travel guides or even who wrote them. And as it turns out, many of the intrepid young writers scouring the planet doing research for next year's crop of guidebooks never stopped to consider what those jobs would entail, other than the romantic — and often overstated — prospect of being paid to travel." (New York Times )

7/09/2006 09:03:00 AM   •  

R.I.P. Joseph J. Schildkraut 

Brain Chemistry Researcher Dies at 72. (New York Times ) Schildkraut, if anyone, deserves to be known as the father of biological psychiatry, with seminal contributions to both the catecholamine (norepinephrine and serotonin) theory of depression and the dopamine theory of schizophrenia. His methodology, for better or worse, has been the dominant one in the field for four decades — you look at the changes in brain chemistry that result from treatment with a drug known to have clinical benefit to a psychiatric condition. If a particular change is consistently associated with clinical improvement (e.g. an increase in low catecholamine levels after antidepressant treatment), you infer that that change is responsible for the improvement. You go further and conclude that the original abnormality, in this case the low catecholamine levels, was the cause of the condition.

This way of doing things, indeed biological psychiatry as a whole, has several problems. First, it it has enshrined reductionism at the heart of psychiatric theory and solidified the error of mistaking correlation for causation. The observed chemical abnormality in a mental illness may be an epiphenomenon of other, more causal, neurochemical changes in the condition, not the cause itself. As a corollary, it constrains new drug development. If you believe catecholamine deficit is the root cause of depression, the only new substances you are going to screen for clinical effectiveness as antidepressants are those shown in the laboratory to increase brain catecholamines. If you believe that dopamine excess is the root cause of schizophrenia, the only medications you are going to screen for utility as antipsychotics are dopamine blockers. We have many counterexamples, discovered by accident, of antidepressants and antipsychotics that, while clinically effective, do not appear to work by the required biochemical mechanisms. Perhaps, if a different paradigm had dominated drug development over the last forty years, we would have many more.

Most profoundly, it has solidified a divide between those, patients and practitioners, who struggle with the meaning of mental suffering in a patient's life and those who merely throw pills at that suffering. The notion that their illness has been caused by a 'chemical imbalance', as numerous patients and families have come to believe, has become a barrier to experiencing themselves as having any control over their recovery. This is a profound problem because the alteration of experience and sense of self in various mental illnesses is all about loss of agency, responsibility and locus of control in the first place.

Schildkraut himself was no such reductionist, however. Another of his areas of interest in mental illness was the relationship between depression and creativity, and he observed in 1994 that depression in artists "may have put them in touch with the inexplicable mystery at the very heart of the tragic and timeless art they aspired to produce."

7/09/2006 09:00:00 AM   •