08/29/14

Don’t Blow Your Own Horn

The spiritual substance of anonymity is sacrifice. . . . Moved by the spirit of anonymity, we try to give up our natural desires for personal distinction. . . . We are sure that humility, expressed by anonymity, is the greatest safeguard that [we] can ever have.”

Matthew 6:1 cautions against the practice of a public display of righteousness or piety, because if you do, that is all the reward you get. Verses 2 to 18 then looks at three basics aspects of Jewish piety: almsgiving or charity (2-4), prayer (5-15) and fasting (16-18). These three are representative of all other “acts of righteousness.” The message is clear. If you make a public display of your piety, you aren’t actually being pious.

There wasn’t social security or welfare in Biblical times. Deuteronomy 15:11 said there would always be poor people. “Therefore I command you, ‘You shall open wide your hand to your brother, to the needy and to the poor, in your land.’” So voluntary charity and contributions to the poor were one of the three most important demonstrations of Jewish piety. But when you gave to charity, Jesus said, don’t make a big deal about it—don’t blow your own horn. “Beware of practicing your righteousness before other people in order to be seen by them.” (Matt 6:1)

Individuals who didn’t give anonymously were fake—they were play-acting. They were hypocrites.  Their words and actions were done for effect and not truly because they had a concern for others. What they were really trying to do was gain a reputation for righteousness. “Thus, when you give to the needy, sound no trumpet before you as the hypocrites do in the synagogues and in the streets, that they may be praised by others.” (Matt 6:2)

The Mishnah (the written record of the Judaism’s Oral Torah) spoke of a “Chamber of Secrets” in the temple where the devout Jew could leave gifts in privacy. The poor of a good family would come later to receive help without knowing who their benefactor was.  Leon Morris in his commentary on Matthew noted that the Torah said: “A man who gives charity in secret is greater than Moses our Teacher.” So someone making a big deal about giving to charity was violating the spirit of the commandment in Deuteronomy at the same time they were fulfilling the letter of the commandment. “But when you give to the needy, do not let your left hand know what your right hand is doing.” (Matt 6:3)

The standard set by Jesus here in the Sermon on the Mount out-midrased even the Chamber of Secrets in the temple: Give so anonymously that even your left hand does not know what your right hand is doing! There was no wiggle-room. When you made a public display of your giving, you were not being charitable.

D. A. Carson referred to this as “pseudo-piety.” Christians, he said, must not delude themselves that all giving is pleasing to God, or that giving itself is an act of righteousness. “The human heart is too crafty to allow so simple a suggestion to stand.” Anonymous piety or spirituality neutralizes the instinctual action of the human heart to say: “Look at me!” And anonymous spirituality is the heart of Twelve Step programs like Alcoholics Anonymous, A.A.

One of the spiritual parallels between A.A. and the church is the teaching on anonymity found within Matthew 6:1-4 and A.A.’s Twelfth Tradition: “Anonymity is the spiritual foundation of all our traditions, ever reminding us to place principles before personalities.” Both Twelve Step recovery and biblical Christianity see anonymity as essential for true spirituality. The above opening quote was from Bill Wilson’s essay on Tradition Twelve in Twelve Steps and Twelve Traditions. The only change was where I substituted the word “we” for “Alcoholics Anonymous” in the original essay.

In July of 1955 Sam Shoemaker, an Episcopal minister, spoke at the convention commemorating the 20th anniversary of A.A.’s founding. He believed A.A. was one of the great signs of spiritual awakening in our time. Shoemaker also thought A.A. had indirectly drawn its inspiration and motivation from the insights and beliefs of the church. When Bill Wilson had introduced Sam to the convention, Wilson acknowledged that Shoemaker himself was the connection between A.A. and the church: “It is through Sam Shoemaker that most of A.A.’s spiritual principles have come.” In his closing remarks, Shoemaker said:

Perhaps the time has come for the church to be reawakened and revitalized by the insights and practices found in A.A. I don’t know any fields of human endeavor in which the Twelve Steps are not applicable and helpful. I believe A.A. may yet have a much wider effect upon the world of our day than it has already had and may contribute greatly to the spiritual awakening which is on the way.”

One of the best ways someone can be reawakened and revitalized is by applying the A.A. principle of anonymity to their spiritual life. The discussion here looked at how it was applied by Jesus in his teaching on alms giving. But anonymity is relevant to all other expressions of piety—even prayer and fasting. Don’t let your left hand know what your right one is doing! Practice your piety before God, not other people. Don’t blow your own horn.

Where could you apply the principle of anonymity to your spiritual life?

This series is dedicated to the memory of Audrey Conn, whose questions reminded me of my intention in seminary to look at the various ways the Sermon on the Mount applies to Alcoholics Anonymous and recovery. If you’re interested in more, look under the category link “Sermon on the Mount.”

08/27/14

In Pharmakon We Trust

Christina and her husband, Sonny, separated in July of 2013. During a visit on December 18th,—his daughter’s birthday—Sonny strangled his 14 year-old son and then hung himself.  Sonny and Gunnar’s bodies were found in his apartment by Sonny’s girlfriend.  On December 19th Christina kept a previously scheduled appointment with a psychiatrist who she had been seeing for a couple of weeks.

BEFORE her appointment at the University Health Center, Christina’s doctor had placed the University of Vermont police on standby to take her into custody if she refused to admit herself to the psych unit in Fletcher Allen, the UV affiliated medical center. She did decline, so she was detained. A UVM police report showed that there was a delay of several hours before the officers could transport Christina to Fletcher Allen because the mental health staff didn’t have the proper paperwork to legally transport her! Five weeks later, Christina was finally released.

Justina Pelletier suffers with a rare disorder—mitochondrial disease. In February of 2013, at the recommendation of her doctor, she was taken to Boston Children’s Hospital by her mother.  Justina’s gastroenterologist had recently moved there from Tufts. The team at Children’s disputed the mitochondrial disease diagnosis and concluded Justina suffered from somatoform disorder—a psychiatric disorder in which symptoms are real, but have no underlying cause. Some reports indicated this re-diagnosis was first made within a matter of hours or minutes of Justina’s arrival at Children’s and was done without consultation with her treating physicians.

When her parents tried to have her discharged from Boston Children’s, the hospital contacted DCF, who took custody of Justina and accused her parents of medical child abuse. Justina remained a ward of the state until June 18, 2014. Most of that time she spent on a locked psychiatric ward. While in state custody, Justina only saw her family once per week for a supervised hour of visitation and spoke with them once a week on the phone.

In his essay, “Strategies of Psychiatric Coercion,” Jeffrey Schaler commented that treatment providers forcibly “treat” people they consider to be a danger to themselves or others in the name of compassion and care. In effect, psychiatrists and mental health professionals empowered by the state to commit someone involuntarily to a psychiatric hospital argue that the person is a child. Although not literally a child, he is a metaphoric child. “He does not, in their opinion, exercise responsibility for himself because he cannot do so.”

The coercion is supposedly done to protect him from himself. He “needs” to be deprived of his constitutional rights in the name of treating his “mental” illness. And the more a person objects to being coerced into treatment, “the more likely he is to be diagnosed with serious mental illness.”

Los Angeles recently decided to expand a pilot program from 20 to 300 slots that will allow a family member, treatment provider or law enforcement officer to pursue court-ordered outpatient treatment for individuals with serious mental illness. “Those who don’t comply can be taken into custody on a 72-hour psychiatric hold. Patients can’t be forced to take medication under law, but there are other mechanisms for court-ordered medication.”

In his 1963 book, Law, Liberty and Psychiatry, Thomas Szasz predicted the birth of what he called the therapeutic state: “Although we may not know it, we have, in our day, witnessed the birth of the Therapeutic State. This is perhaps the major implication of psychiatry as an institution of social control.” He even went further and coined a new term for this union of psychiatry and the state: pharmacracy.

Inasmuch as we have words to describe medicine as a healing art,  but have none to describe it as a method of social control or political rule, we must first give it a name. I propose that we call it pharmacracy, from the Greek roots pharmakon, for ‘medicine’ or ‘drug,’ and kratein, for ‘to rule’ or ‘to control.’ … As theocracy is rule by God or priests, and democracy is rule by the people or the majority, so pharmacracy is rule by medicine or physicians.

I don’t think we are a therapeutic state … yet. We aren’t a pharmacracy … yet. But I do think we need to be aware of the warnings given by Thomas Szasz. If you need more information before you decide whether the United States is in danger of becoming a therapeutic state, spend some time on the following websites:

PsychRights

Mad in America

ToxicPsychiatry

By the way, a UN report thinks that forced psychiatric treatment is torture:

Deprivation of liberty on grounds of mental illness is unjustified. Under the European Convention on Human Rights, mental disorder must be of a certain severity in order to justify detention. I believe that the severity of the mental illness cannot justify detention nor can it be justified by a motivation to protect the safety of the person or of others. Furthermore, deprivation of liberty that is based on the grounds of a disability and that inflicts severe pain or suffering falls under the scope of the Convention against Torture.

Do you think we are in danger of becoming a therapeutic state?

08/25/14

Chained to a Dragon

By the time Stephanie (not her real name) had been seen for her first “counseling” appointment, she had already been activated as a client at the methadone clinic. She met the required criteria: 18 or over (she was 18); previous failed drug treatment (as an adolescent who smoked pot she had failed to complete an outpatient drug treatment program); she reported using heroin for a year (with her older boyfriend); she was eligible for Medicaid. Heroin addiction is considered a “life threatening medical condition” for which a doctor had already signed and completed the necessary paperwork for the clinic to get paid; and Stephanie to receive additional medical care. She didn’t realize she has just chained herself to a dragon.

Methadone maintenance is considered by many to be the “gold standard” for opiate/opioid use disorders. And leaving methadone treatment is seen as ill advised in the literature. “Methadone Maintenance Treatment: (MMT)” by Herman, Stancliffe and Langrod, said that: “Methadone maintenance reduces and/or eliminates the use of heroin, reduces the death rates and criminality associated with heroin use, and allows patients to improve their health and social productivity.” Leaving Methadone Treatment” by Magura and Rosenblum, cautioned that: “The detrimental consequences of leaving methadone treatment are dramatically indicated by greatly increased death following discharge.”

But let’s flip this gold standard over and look at the other side. A 2005 review of the MMT literature, “Eyes Wide Shut?” suggested that rigorous evaluation of MMT programs is rare. The evidence for the effectiveness of MMT is mixed; and largely partial and only over the short term. “The quality of existing MMT research, and evidence for its general effectiveness are limited.”

An HBO documentary, “Methadonia,” painted a bleak picture of the life of several MMT patients in NYC. Steve, one of the persons followed in the film, who was trying to get off of methadone, said: “Once they get you hooked, you’re nothing but a junkie. Come get your fix in the morning.” You can view “Methadonia” online for free here and here. It is also available through Netflix. At one point in the film, Steve nods out repeatedly in the middle of speaking to the camera.

A recovering heroin addict I know told me about a classroom discussion he participated in about the pros and cons of methadone maintenance. My friend was for abstinence-based recovery; a classmate who was in a MMT program was pro medication-assisted recovery. In the middle of a statement on the benefits of MMT, the classmate nodded out for several seconds, picked right back up where he’d stopped speaking and finished his statement. My friend’s comment was: “I rest my case.”

According to Magura and Rosenblum, a large percentage of those who attempt to taper off of methadone will either resume active heroin use or resume MMT. They pointed to the considerable evidence that individuals who left methadone treatment had a high rate of relapse to opiate use. “Until we learn more through research, it is unwise to structure methadone programs … to discourage or impede long-term maintenance, and at the same time to pressure patients overtly to accept abstinence.” Herman et al. said: “It may be necessary for patients to remain in treatment for indefinite periods of time, possibly for the duration of their lives.”

A recent article in the New England Medical Journal strongly advocated for expanded access to medication-assisted therapies (MAT) like methadone maintenance, saying: “Expanding access to MATs is a crucial component of the effort to help patients recover.” But the authors fail to clearly distinguish between opioid MATs like methadone and buprenorphine and non-opioid naltrexone.

Further, while the “abuse liability” of buprenorphine is acknowledged by the authors as a disadvantage, the “abuse potential” of methadone is not! The opioid addicts I’ve known with experience using or abusing methadone and buprenorphine have always testified of the exponentially greater difficulty they have withdrawing or tapering off of methadone and “bupe” than they have with heroin.

Steely Dan, in their classic song “Time Out of Mind”, sung about “chasing the dragon.” This was a reference to the technique of using a straw or tube to inhale the vapor from heroin that had been placed on a piece of tinfoil and heated. The metaphor is an allusion to the hope that the next dose of heroin will return the user to the nirvana of their first high. But continued use never quite lives up to the promise. Each use leads to diminishing positive effects, leading to a fruitless chasing of the dragon to recapture the initial high. That is what the promise of methadone maintenance is like—chasing a chained dragon. To learn more, see my paper “Chasing a Chained Dragon: Methadone Abuse and Misuse.”

Do you see any value to expanding access to methadone maintenance treatment programs?

Also read, “The Consequences of Ignoring the Past.”

08/22/14

The Heart of an Evangelical

Sword On Old Bible

image credit: iStock

When I was in my early teens, my father went into the hospital because he was having heart problems, probably from smoking cigarettes. His doctors recommended what was then a radical surgical procedure: a coronary artery bypass. It wasn’t known if he would survive the operation, so he was permitted to come home for what could be his last Christmas. He survived the bypass operation and never smoked again.

The heart of evangelical, Christian thinking is the authority of Scripture. Belief that the Bible is the Word of God pumps the lifeblood of the Spirit within us. “In Him we live and move and have our being.” (Acts 17:28) But there is an ongoing debate about whether this evangelical heart needs its own bypass operation.

The arteries of Genesis on Creation and the Fall, of understanding the relevance of Pauline statements on gender role (and others) are thought to be blocked by the plaque of traditional interpretations. It is believed that, as these arteries are less and less able to carry the lifeblood of the Spirit to the body of Christ, the church will eventually have a “heart attack.” So some evangelical heart specialists are recommending a kind of coronary bypass operation.

One of these evangelicals is Peter Enns, currently at Eastern University. In an interview with The Christian Post, Enns said people within evangelicalism desperately want to defend the Bible against its challengers by questioning the very foundations of evangelicalism:

What they’re saying is what some of the bad guys say about the Bible makes sense, whether its evolution, whether it’s Canaanite genocide, whether it’s human sexuality, whatever. They’re saying they want to rethink some of those issues, but they’re doing it from the point of view of having a deep connection with the tradition they were raised in. They don’t want to just leave it. … They want to transform and continue the evangelical journey.

Supposedly younger evangelical Christians want to rethink what it means to be an evangelical, but are being held back by the movement’s older leadership. According to Enns, this reluctance is out of fear of the repercussions. In other words, the leaders are afraid the bypass operation won’t take. “So much hinges on getting the Bible right that giving ground on issues like evolution runs the risk of upsetting the entire system.”

Returning to the heart metaphor, if we don’t maintain a healthy sense of the ultimate authority of the Bible, of its universal and eternal truth, then the evangelical church will have a heart attack and die. It’s not just a matter of the old guard holding on to its power. “Getting the Bible right” is a life-and-death issue for evangelicalism. Francis Schaeffer understood what was at stake. In a letter he wrote to a frequent visitor at L’Abri about the knife-edged balance required in the modern evangelical world he said:

What we must ask the Lord for is a work of the Spirit . . . to stand on a very thin line: in other words, to state intellectually (as well as understand, though not completely) the intellectual reality of that which God is and what God has revealed in the objectively inspired Bible; and then to live moment to moment in the reality of a restored relationship with the God who is there, and to act in faith upon what we believe in our daily lives. (Letters of Francis A. Schaeffer, p. 82)

So let there be a consultation among the evangelical heart specialists. Let us have a respectful hearing of the various procedures proposed to clear the blocked arteries. But let us not forget that an evangelical will always have the objectively inspired Bible as its heart. And if it stops beating, we die. We don’t want a success operation that ultimately kills the patient.

For further information on what it means to be an evangelical, see the National Association of Evangelicals and the Evangelical Alliance. Also look at: “What is an Evangelical?” on this website.

Is belief in the authority of Scripture the heart of evangelicalism?

08/20/14

Suicide is NOT Painless

iStock_000030427100Small

image credit: iStock

Recently we all heard of the successful suicide of Robin Williams. The media aftermath has stirred up a shit-storm of debate and controversy. I asked someone who lost a loved one to a completed suicide how they reacted to the news. The person’s hope was that since Robin Williams was a celebrity, that a constructive dialogue would occur and help someone else decide not to try suicide. So I want to introduce you to some suicide statistics that relate directly to the tragic loss of Robin Williams. And perhaps start us thinking about how we can help prevent other people from trying to end their life.

The Center for Disease Control and Prevention (CDC) maintains a wealth of statistics on suicide at “National Suicide Statistics at a Glance.”  Among the trends in suicide rates for males between the age of 45 and 64, suicide by firearms were most common, 15.52 per 100,000 in 2009. Suicide by suffocation was second. “Suffocation suicide rates among males aged 45 to 64 years have increased 103.5% since 2001 from 2.91 to 5.92 suicides per 100,000 in 2009.”

“From 1991 to 2009 the suicide rates were consistently higher among males 65 years and older compared to the younger age groups.” But they were decreasing, from 40.12 per 100,00 in 1991 to 29.09 in 2009. HOWEVER, the rates of males between 25 and 64 increased from 21.27 per 100,000 in 2000, to 25.37 per 100,000 in 2009.

I then looked at the latest census figures available on the US census website for males between the ages of 25 and 64 to estimate the number of males these suicide statistics would reflect. Roughly 2,000 men like Robin Williams between the ages of 25 and 64 successfully completed suicide—480 who did so by suffocation—in 2009, the last year statistics were available. So there were 479 other families who suffered the pain of a completed suicide, as does the family of Robin Williams.

What can you do to help prevent more suicides? Look at the website for the National Strategy for Suicide Prevention  (NSSP) for information. The NSSP has a number of goals and objectives to facilitate suicide prevention:

  • Foster positive public dialogue; counter shame, prejudice, and silence; and build public support for suicide prevention;
  • Address the needs of vulnerable groups, be tailored to the cultural and situational contexts in which they are offered, and seek to eliminate disparities;
  • Be coordinated and integrated with existing efforts addressing health and behavioral health and ensure continuity of care;
  • Promote changes in systems, policies, and environments that will support and facilitate the prevention of suicide and related problems;
  • Bring together public health and behavioral health;
  • Promote efforts to reduce access to lethal means among individuals with identified suicide risks;
  • Apply the most up-to-date knowledge base for suicide prevention.

From the revised NSSP, the Action Alliance selected four priorities in suicide prevention that, if accomplished, they hope will help the group reach its goal of saving 20,000 lives in the next five years. These priorities are:

  1. Integrate suicide prevention into health care reform and encourage the adoption of similar measures in the private sector.
  2. Transform health care systems to significantly reduce suicide.
  3. Change the public conversation around suicide and suicide prevention.
  4. Increase the quality, timeliness, and usefulness of surveillance data regarding suicidal behaviors.

One agency I worked for required counselors to complete the background paperwork and have the necessary forms signed during the initial session with a new client NO MATTER WHAT. In a way that was understandable, because if the person never returned and you didn’t have the right forms signed, the agency wouldn’t get paid for the time you spent with the individual. But it made it difficult for the counselor if someone was in crisis, or needed some encouragement. One time I broke that rule and inadvertently helped prevent a suicide.

The more information and forms I completed, the greater was my impression that the woman was discouraged and hopeless. So I stopped the paper pushing and really talked with her about her problems. She had struggled off and on with drug use for over twenty years and didn’t have much hope at that moment that she could stop and get her life together. Her last relapse had led to the breakup of a long-term relationship. We talked and I was able to help her see she could re-establish abstinence; maybe even reconcile the relationship. There was some hope.

When she returned for the second appointment we completed the required paperwork that I didn’t do during the first session. And then she told me she had decided before our first counseling session that if she felt as hopeless after the session as she did before it, she had intended to kill herself. People will sometimes say that they intended to kill themselves, but not really have more than the idea of suicide. But she has a prior history of attempts; and she had a plan that would have been successful if she attempted it.

We have a responsibility to be with one another, to make space for one another, to be kind to one another… and hopefully through doing so, we make life that much more bearable. We do our best suicide prevention by letting go of the goal of suicide prevention, and, instead, creating alternatives.

I think this quote’s essay is headed in the right direction for suicide prevention. Maybe the best technique is to simply be committed to letting people know that you care enough about them to enter their darkness and help them move out into some light.

What more can you do to help prevent the pain of suicide?

 
08/18/14

Sigmund Freud was a Cocaine Evangelist and Addict

Sigmund FreudSo here is the continuing story on Sigmund Freud and cocaine begun in “Raising the Stakes in the War on Cocaine Addiction.” To give a quick recap, Freud began experimenting with cocaine in April of 1884. He used it to treat depression, saying it was a “magic drug.” He hoped that with his help cocaine could “win its place in therapeutics by the side of morphine.”

According to Paul Vitz, Freud’s evangelism of cocaine seems to have been driven by three things:

  1. his intense desire to get married to his fiancée and fear of losing her (a separation anxiety, in Freudian terms);
  2. his drive to become a medical success story in championing the positive effects of a new drug, thus advancing his career and financial prospects (so he could marry); and
  3. to treat his personal struggle with depression (largely induced by his separation anxiety).

When describing his personal experiences in treating his depression with cocaine, Freud said he felt “exhilaration and lasting euphoria, which in no ways differs from the normal euphoria of the healthy person.” He saw an increase in his self-control and capacity for work. He had no unpleasant after effects, as with alcohol and “absolutely no craving” for more cocaine, even after repeated use. “In other words, you are simply normal, and it is soon hard to believe that you are under the influence of any drug.”

He recommended cocaine to family, friends and professional colleagues alike. A friend of Freud’s, Dr. Ernst Fleischl became addicted to morphine while attempting to treat a painful neurological disease. Freud attempted to counteract his morphine addiction with cocaine. At first, cocaine was a helpful substitute for the morphine.

But Fleischl had to increase his cocaine dose as tolerance set in. After one year of cocaine use he was taking a full gram of it daily—TWENTY TIMES the dose Freud personally used. Fleischl was now dually addicted to opiates and cocaine. He soon developed a full-fledged cocaine psychosis, with visions of “white snakes creeping over his skin.”

Freud and other physician friends had little success in weaning Fleischl from his drug use. By June of 1885, Freud thought his friend had about six months to live. Fleischl remained alive for another six pain-filled years. Freud later acknowledged he might have hastened his friend’s death, by “trying to cast out the devil with Beelzebub.”

In July of 1885 a German authority on addiction began publishing a series of articles on cocaine as an addictive drug. A friend of Freud’s, originally favorable towards cocaine, reported that it produced severe mental disturbances. One prominent doctor said Freud had unleashed “the third great scourge of mankind.” The first two were opium and alcohol.

By 1890, the addictive and psychosis producing nature of cocaine was well documented. Freud had moved on in his search for fame and fortune to other interests. And when he co-authored Studies on Hysteria with Joseph Breuer in 1895, psychoanalysis was born. However, Freud continued to use and prescribe cocaine until at least 1896.

Freud 1893 script

image credit: Robert Edwards Auctions.

A handwritten prescription for a “white powder”, signed by Sigmund Freud in 1893, is evidence of his continued cocaine use. In 2004, Robert Edwards Auctions sold this prescription for $2,875.

Freud’s letters to a friend and fellow cocaine user, Wilheim Fleiss, contained several references to his ongoing cocaine use. On January 24, 1895, Freud described to Fleiss how a “cocainization” of his left nostril helped him to an amazing extent. He wrote on April 20, 1895 that he pulled himself out of a miserable (depression?) attack with a cocaine application. On June 12th, 1895, Freud wrote: “I need a lot of cocaine.”

Several scholars have debated whether Freud’s use of cocaine influenced his developing theories. Both Fredrick Crews and E. M. Thornton have argued that Freud’s use of cocaine had a significant influence on his developing theories, especially their emphasis on sex. Thornton claimed that Freud’s psychological theory was the natural outcome of his extensive cocaine usage.

Paul Vitz took a more nuanced approach in Sigmund Freud’s Christian Unconscious, stating that much of Freud’s psychology was evident before he began using cocaine. Freud’s cocaine use may have contributed to sloppy thinking at times. It could have contributed to his preoccupation with sex, or made his depressions darker and more difficult to fight. “But cocaine did not create the primary content and structure of Freud’s mind and thought.”

Yet Thorton presented some rather convincing evidence of Freud’s cocaine “problem” and its potential influence on his theories. Freud himself said that psychoanalysis began with his research into hysteria: “The Studies on Hysteria by Breuer and myself, published in 1895, were the beginnings of psycho-analysis.” Freud began to have heart problems (one of the side effects of cocaine abuse) early in 1894. He suffered from “fainting” spells—four of which were publically witnessed by others. He had an obsession with dreams; some paranoid traits and a tendency towards grandiosity.

In The Interpretation of Dreams, Freud recounted a dream he had in 1895 where he saw a patient with scabs on her turbinal bones, which recalled a worry he had about his own health:

At the time I frequently used cocaine in order to suppress distressing swellings in the nose, and I had heard a few days previously that a lady patient who did likewise had contracted an extensive necrosis of the nasal mucous membrane. In 1885 it was I who had recommended the use of cocaine, and I had been gravely reproached in consequence. A dear friend, who had died before the date of this dream, had hastened his end by the misuse of this remedy.

By 1895 Freud had probably been using cocaine (nasally) for over two years. Physically, the effects of this heavy usage would have been essentially identical to the catalogue of symptoms noted by Fleiss as those for “nasal reflex neurosis” (headache, vertigo, dizziness, acceleration and irregularity of the heart, respiratory difficulties, etc.). So the physical problem that Freud treated with cocaine (nasal reflex neurosis) was essentially caused by his use of cocaine.

His paranoia was evident in the public breakups he had with formerly close associates like Breuer—with whom he wrote Studies in Hysteria (1894), Fliess (1900), and Jung (1913). Freud’s interpretation of Jung’s dream in 1907, just after they met face-to-face for the first time, was that Jung wished to dethrone him and take his place in the psychoanalytic movement.

Do you think that Freud’s cocaine use had any influence on his psychoanalytic theories?

 
08/15/14

Judging Others is a Two-Way Street

“To escape looking at the wrongs we have done another, we resentfully focus on the wrong he has done us.” Bill Wilson wrote this in his Twelve Steps and Twelve Traditions essay on Step Eight. But the wisdom of these words applies to all of us who resentfully judge others. In the Sermon on the Mount, it seems that Jesus agrees with Bill.

In Matthew 7:1-6, Jesus taught about the consequences of judging others. In essence, he begins by saying in verses one and two: “First you have to realize that if you aren’t judgmental of others, then you won’t be judged harshly yourself.” This discussion seems to be a more narrow application of the golden rule set forth in verse 7:12: “So whatever you wish that others would do to you, do also to them, for this is the Law and the Prophets.”

Doing to others what you want them to do to you summarizes the spiritual teaching of the Scriptures on how we should relate to others. Another way this is expressed is by the command to “love your neighbor as yourself,” originally found in Leviticus 19:9. In Matthew 22:39, Jesus said that loving your neighbor was the second greatest commandment after loving God.

The word translated as “judge” in Matthew 7:1-2, krinõ, is used with the sense that the act of judgment is done in order to somehow influence the life and behavior of another. Judging is then a two-way street. When you judge others, you are saying to God that you also want to be judged or influenced by Him. So be careful in your judgment of others, because you’ll get the same thing back. What goes around, comes around.

In the next three verses Jesus uses hyperbole (the speck and log language) to illustrate what too often happens with judgment aimed at influencing others.  In his commentary on Matthew, Craig Blomberg said we often criticize others when we have much more serious shortcomings in our own lives. Particularly when we treat fellow believers (brothers) that way, we are hypocrites; phonies or pretenders. Nevertheless, we are not off the hook entirely. “Rather, once we have dealt with our own sins, we are then in a position gently and lovingly to confront and try to restore others who have erred.”

In counseling, I simplify this teaching by telling people the following. Whenever you find yourself wanting to point a finger at someone else, stop and look at yourself first. There may be one finger pointing at the other person, but there are three fingers pointing back to you.  What’s going on with you that you want to point a finger at someone else?

Verse six is an odd expression, and perhaps even opposed to what Jesus has just said in verses one through five. It seems that he is addressing the opposite extreme to what came before. In Matthew 7:1-5 Jesus addressed the error of being too harsh when judging others. Here he cautions against being too lax. So you can think of what is being said by adding the phrase On the one hand …” before 7:1-5; and then “But on the other hand …”before verse six.

There is a literary structure called a chiasm in verse six, that was used in both biblical Greek and Hebrew to reinforce the message of what was being said. A chiasm (or chiasmus) is a writing style that uses a specific repetitive pattern for emphasis. So the chiastic structure of verse six would be:

“Do not give what is holy to the dogs,

and do not throw your pearls in front of pigs,

lest they trample them with their feet

and [lest they, the dogs] turn and tear you to pieces.”

This then communicates more sensibly that the dogs are doing the turning and tearing, while the pigs are doing the trampling. Craig Blomberg noted how the terms “dogs” and “pigs” were both regularly used as derogatory epithets for Gentiles in ancient Judaism. There is also the possibility that Jesus is quoting or paraphrasing a proverb, much as we hear the saying “don’t cast your pearls before swine” used in modern English. Jesus thus commands us here not to give what is holy, what is from God, to dogs and pigs; they won’t appreciate it.

There seems to be a contrasting parallel here between “brothers” and “dogs,” which is similar to that of the “wise” and “fools” (or scoffers) in Proverbs. So then here Jesus is giving advice similar to that found in Proverbs 13:1 (and other passages): “A wise son hears his father’s instruction, but a scoffer does not listen to rebuke.” Then the Matthew passage is saying, don’t be judgmental of others or think of yourself as better than them. Take care of your own faults before trying to point out where someone else has a problem.  You get back what you give to others. On the other hand, be careful to whom you give advice. They may turn on you or totally disregard what you have to say.

 

Where have you found yourself pointing a finger at someone else and what they did?

 

This series is dedicated to the memory of Audrey Conn, whose questions reminded me of my intention in seminary to look at the various ways the Sermon on the Mount applies to Alcoholics Anonymous and recovery. If you’re interested in more, look under the category link “Sermon on the Mount.”

08/13/14

The Dumbest “Diagnosis” Ever

Is your child drowsy/sleepy at times? Do you see signs of daydreaming, mental confusion, slowed thinking or behavior, lethargy or apathy? Don’t worry; it may just be the early signs of Sluggish Cognitive Tempo (SCT)! By some estimates, SCT is present in two million children. While still not acknowledged as an official psychiatric disorder, the January 2014 issue of The Journal of Abnormal Child Psychology devoted the entire issue to SCT. Be patient, it will eventually become an official childhood psychiatric disorder, if its advocates have their way. And then you will have a brand new reason to give your son or daughter stimulant medications.

If you think this satire is too off-the-wall, read the April 11, 2014 article in the NYT by Alan Schwartz, “Idea of New Attention Disorder Spurs Research, and Debate.” Schwartz said that “Experts pushing for more research into sluggish cognitive tempo say it is gaining momentum toward recognition as a legitimate disorder—and as such, a candidate for pharmacological treatment.” He added that some of the identified symptoms so far in the research “have helped Eli Lily investigate how its flagship A.D.H.D. drug might treat it.” The psychiatric drug industry has excelled at expanding the market for its drugs, generating tremendous wealth for many.

Becker, Marshall and McBurnett did a search of journal articles (for their own article in January 2014 issue of The Journal of Abnormal Child Psychology) and found that “very few papers explicitly examined or even mentioned SCT between 1985 and 1999.” Since then there has been a steady increase in the articles that either focused on SCT or mentioned it in the body of the paper. They observed that while symptoms of under-arousal and low levels of mental energy were noticed to be part of attention deficit as early as 1798, it wasn’t until the 1970s that inattention was seen as causing even more impairment than hyperactivity. By the mid-1980s, “empirical support for the SCT dimension separate from inattention emerged.”

Russell Barkley, one of the most influential advocates for ADHD, noted in his article for the special issue of The Journal of Abnormal Child Psychology that there was a dearth of studies on SCT. Students now entering the profession could make a successful research career specializing in the research of SCT. He felt there would surely be an increased demand for such empirically-based research in view of the clinical referrals already occurring; and the anticipated increase in the near future as the general public becomes aware of SCT. “The fact that SCT is not is not recognized as yet in any official taxonomy of psychiatric disorders will not alter this circumstance given the growing presence of information on SCT at various widely visited internet sites such as YouTube and Wikipedia, among others.”

Alan Schwartz reported in his NYT article that Barkley has said that SCT “has become the new attention disorder.” Barkley also has financial ties to Eli Lily, receiving $118,000 from 2009 to 2012 for consulting and speaking engagements. He has also published a symptom checklist to identify adults with the condition. The forms are available for $131.75 apiece from Guilford Press. Oh, and Barkley also edits sluggish cognitive tempo’s Wikipedia page. The SCT Wikipedia page carried the following note at the top of the page on June 20th, 2014: “A major contributor to this article appears to have a close connection with its subject. It may require cleanup to comply with Wikipedia’s content policies.”

One of the SCT researchers, David McBurnett, said a scientific consensus on SCT could be many years in the future. “We haven’t even agreed on the symptom list—that’s how early on we are in the process.” And yet, Dr. McBurnett recently conducted a clinical trial funded and overseen by Eli Lilly to see if the proposed SCT diagnosis could be treated with Straterra, the company’s primary ADHD drug. Published in The Journal of Child and Adolescent Psychopharmacology in November of 2013,his study concluded: “This is the first study to report significant effects of any medication on SCT.”

This process with SCT reminded me of what Robert Whitaker depicted in Anatomy of an Epidemic. He showed that in order to sell our society on the benefits of psychiatric drugs, “Psychiatry has had to grossly exaggerate the value of its new drugs, silence its critics, and keep the story of poor long-term outcomes hidden.” This has meant telling a false story to the American public, and then actively hiding research results that reveal the poor long-term outcomes with a drug-centered paradigm of care. Whitaker said it was a conscious, willful process that exacts a horrible toll on our society.

The number of people disabled by mental illness during the past twenty years has soared, and now this epidemic is spreading to our children. Millions of children and adolescents are being groomed to be lifelong users of these drugs. This grooming happens by twisting childhood behaviors like daydreaming, slowed thinking or behavior, and lethargy into symptoms of a new so-called childhood psychiatric disorder.

Allen Frances, chair of the fourth edition of the DSM, said that “’Sluggish Cognitive Tempo’ may possibly be the very dumbest and most dangerous diagnostic idea I have ever encountered . . . .The risk that it could do great harm is real . . . .The last thing our kids need is to be misdiagnosed with ‘Sluggish Cognitive Tempo’ and bathe in even more stimulants.”

Still not convinced? Listen to this pod cast by Peter Breggin where he interviews psychologist Fred Ernst about Sluggish Cognitive Tempo and the “psychiatric assault” on children through psychiatric medication.

Are you concerned with the growing tendency to medicate childhood behaviors?

08/11/14

Déjà Vu All Over Again

Leo (not his real name) walked into our outpatient clinic with a daypack over his right shoulder smelling strongly of booze. He would later show us the half-empty bottle of vodka he carried inside of it. Three of the treatment staff did an impromptu “intervention” and at one point he almost gave us the bottle. Sadly the vodka was more alluring to him at the time. He kept the bottle.

We knew and liked Leo. He had been in our partial treatment program at least 2 or 3 times before. He demonstrated personal change; helped others with their own drug and alcohol use problems; and usually completed the treatment program. But he repeatedly lapsed or relapsed into active drinking.

He wasn’t angry or belligerent. He didn’t even get upset when we told him if he walked out of the office we would call the local police. He just quietly got up and left—with his daypack. I followed him outside and watched him walk away. The last time I saw him that day he was fifty yards away; slinging his daypack off of his back as he disappeared behind some trees.

Sarah (not her real name) had completed her third or fourth outpatient treatment few months after she turned twenty. This time she had a very good sponsor; had several other women with solid recovery in her sober support system; and seemed to really be trying to remain abstinent. Then we heard that she had announced to everyone that she intended to celebrate her 21st birthday with a pub-crawl. Several people tried to talk her out of this crazy idea, but she wasn’t budging.

I got permission to hold a birthday party for her at the aftercare group I oversee. And then I invited Sarah and anyone in her sober support system that wanted to come. We had a quarter-sized sheet cake and ice cream. Sarah didn’t come, but I saved her a piece of cake and put it in my freezer. About a month later on her birthday, she went on a pub-crawl with her friend. The friend ended up in the hospital with alcohol poisoning. Sarah kept drinking and using drugs for another six or seven months.

When she came back to the Aftercare group, I told her I had a piece of birthday cake for her in my freezer.  When she achieved one year of abstinence, I’d give her the birthday cake. She returned after her one-year anniversary and I gave her the piece of cake. I haven’t heard from her for a few years, but the last news I had was that she was still sober.

Relapse into active drug or alcohol use is, sadly, a common occurrence in recovery. But it doesn’t always have to be. Like the new Tom Cruise science fiction movie, “Edge of Tomorrow,” persistence and repeated battle against addiction can be an opportunity to eventually overcoming this personalized alien invader. But if it’s addiction and not the Mimics that you battle, I suggest you trust in Terence Gorski and not Tom Cruise for your deliverance.

Among the many tools developed by Gorski for this battle is the AWARE (Advance WArning of RElapse) Questionnaire.  It was designed and refined as a measure of the warning signs of relapse. It is simple to use and interpret: the higher the score, the greater the number of relapse warning signs being reported. It was developed through research funded by the National Institute on Alcohol Abuse and Alcoholism (NIAAA). So it is in the public domain and may be used without specific permission; so long as the proper recognition is given as to its source.  You can read Gorski’s original blog post on the AWARE Questionnaire. And you can download a printer-friendly version of it that I’ve put together here.

Does the frequency of relapse among alcoholics and addicts suggest there is a flaw in abstinence-based treatment and self-help groups?

I have read and used Terence Gorski’s material on relapse and recovery for most of my career as an addictions counselor. I’ve read several of his books and booklets; and I’ve completed many of his online training courses. He has a blog, Terry Gorski’s blog, where he graciously shares much of what he has learned, researched and written over the years. This is one of a series of blog posts based upon the material available on his blog and website.

08/8/14

Abandoning the Spring of Living Waters

ancient cistern image credit: iStock

ancient cistern
image credit: iStock

Have you done something appalling lately, anything? Has there been something you did that so shocked you that it feels like your hair is standing on end when you think about it? Has what you did meant that some aspect of your life was so devastated, that it is in utter ruins? Keep reading then. The prophet Jeremiah has something to say to you.

Jeremiah 2:9-13 is a “lawsuit” that the Lord brings against His people. From the island of Cyprus in the west, to the land of Kedar in the east, nothing like this has ever happened before. No nation has ever been disloyal to their gods, even though those gods are not really gods! Yet God’s people exchanged the God of glory for gods that cannot help them (Jer. 2:10-11).

10 For cross to the coasts of Cyprus and see, or send to Kedar and examine with care; see if there has been such a thing.

11 Has a nation changed its gods, even though they are no gods? But my people have changed their glory for that which does not profit.

So be appalled; be shocked and utterly devastated. The people of God—His people—have committed two evils. First, they have abandoned the Lord who brought them into the promised land—He who is the spring of Living Water. Second, they have hewn out cisterns for themselves. But these were broken (cracked) cisterns that could not hold water (Jer. 2:12-13).

12 Be appalled, O heavens, at this; be shocked, be utterly desolate, declares the Lord,

13 for my people have committed two evils: they have forsaken me, the fountain of living waters, and hewed out cisterns for themselves, broken cisterns that can hold no water.

The metaphor of fresh flowing water here is contrasted with that of a self-made cistern with cracks in its plastered sides. The captured, brackish water in the cistern would then seep out through the cracks and be lost into the porous limestone. The broken cistern couldn’t hold water. Yet it was preferred to the living waters. To a desert people, this would have been complete and utter foolishness, making it a powerful image of senseless waste. Despite the example of Israel, Judah was making the same idolatrous mistake that brought about the destruction of the Northern Kingdom of Israel (Ezek. 16:44-52; 23:1-48).

image credit:

image credit: BibleScreen.com.

I first studied Jeremiah 2:12-13 in seminary, where I wrote a paper on how I believed Larry Crabb misused the verses. In his book, Inside Out, Crabb said the text suggested that while “God assumes His people are thirsty … He never condemns them for that thirst.” My professor, who knew Larry personally, agreed that the verse didn’t really say what Crabb said it did. He then proceeded to give me three or four other passages in Scripture that did.

One of those passages was Psalm 42:1-2: “As a deer pants for flowing streams, so pants my soul for you, O God. My soul thirsts for God, for the living God.” Here God does not condemn us when we thirst after Him, the living God. And we can also say that God assumes His people are thirsty. But we have to ask, what am I thirsty for?

In Jeremiah 2:9-13, the answer was that Judah, the people of God, had thirsted after other gods. They forsook the fountain of living waters and exchanged Him for “that which does not profit.” So God does condemn His people when we thirst after other gods. Believers today don’t exchange Christianity for Baal worship. But we will idolize just about anything else. John Calvin commented that: “the human mind is, so to speak, a perpetual forge of idols.” What have you made an idol in your life? “Such are not gods!” (Jeremiah 16:20)

Returning to Jeremiah 2:13, we see that the second evil done by God’s people was to try and capture the fountain of living waters in self-made cisterns. So you can thirst for God, and even turn to the living waters to slack your thirst, but sin in trying to capture or store it. God does not slack our thirst from wells or cisterns that we fashion by our own efforts. “Everyone who drinks of this water will be thirsty again.” He invites us to drink from the fountain of living water and never be thirsty again. “The water I give him will become in him a spring of water welling up to eternal life.” (John 4:9-14)

Now ask yourself: How do you slack your spiritual thirst? Do you return to the fountain of living waters or try to drink from a self-made cracked and broken cistern?

Do not abandon the spring of Living Waters. Whether you have devastated or ruined part or all of your life; when you have behaved in an appalling manner; when the hair on your head stands on end in thinking about what you have done, return to the fountain of living waters in Jeremiah 2:13. Drink the living water from which you will never be thirsty again.

Where have you abandoned the spring of Living Waters?