09/5/14

The Limits of the Soul

“That’s it. I’m dead.” These were the thoughts Joe Simpson had when he realized the pain he felt from his fall on Siula Grande in the Andes meant his leg was broken. But that wasn’t the end. His climbing partner, Simon Yates repeatedly lowered him almost three thousand feet down the mountain; at night; in a snowstorm. And with what might have been their last lowering, Joe went off an overhanging ice wall.

The wind and the storm meant they had no way of communicating with each other. Simon just held on. About an hour after Joe went over the drop, Simon was slowly losing his grip on the rope. He realized he couldn’t hold on much longer and couldn’t stop it from slipping from his grasp.  “The thought overwhelmed me. . . . I was being pulled off.” And then he did the unthinkable—he cut the rope.

When Simon came down off the ice wall the next morning, the storm had lifted and he could see where Joe had fallen into a crevasse. There was no thought to look for him; of course Joe was dead. As he descended, Simon felt a sense of menace. “It was as if the mountains were holding their breath, waiting for another death. Joe had died. The silence said so; but must they take me as well?” But Simon didn’t die on Siula Grande. He made it back to their camp. And Joe wasn’t dead either.

In the bottom of the crevasse, at first Joe thought that he wouldn’t get out. “I just cried and cried. I thought I’d be tougher than that.” He said he had been brought up as a devout Catholic, but had long since stopped believing in God.

“I always wondered if things really hit the fan, whether I would under pressure say a few Hail Mary’s and say: ‘Get me out of here.’ It never once occurred to me. It meant that I really don’t believe. And I really do think that when you die, you die. There really is no afterlife; there’s nothing.”

But Joe did climb out of the crevasse. And after getting out of the crevasse and looking at the glacier he had to descend, he thought, “There’s just no way you’re going to physically do that.” And then he began to crawl back to their camp. “I didn’t crawl because I thought I’d survive. I wanted to be with somebody when I died.”

It was as if there were two minds within him. “The voice was clean and sharp and commanding. It was always right, and I listened to it when it spoke and acted on its decisions.” The other mind was a disconnected series of images, memories and hopes. “The voice (emphasis in the original) told me exactly how to go about it, and I obeyed while my other mind jumped abstractedly from one idea to another.”

The voice would tell him to reach a certain point in half an hour and he obeyed. Other voices wondered what people were doing back home in Sheffield. He hoped his Ma was praying for him as she always did. The lyrics to a pop song filled his head. Then the voice would say he was late, and then he would wake and start to crawl again. “I was split in two. A cold clinical side of me assessed everything, decided what to do and made me do it. The rest was madness.”

He continued crawling until he realized he’d crawled into the latrine area of their camp. So he called out; but there was no answer. “And when I shouted and they weren’t there, I knew I was dead then. That moment, when no one answered the call; it was … I lost me.”  But Simon and another man were there and they heard him.

Joe Simpson was climbing again within two and a half years. He wrote the story of this climb in what has become a classic tale in the world of mountaineering, Touching the Void. In a movie by the same name (which is available on Netflix), Joe said: “It was fun; it was just brilliant fun. And every now and then it went wildy wrong; and it wasn’t.”

There is a religious impulse in me that wants to rush in, point to the voice, and say “Look, Joe! That was God!” But if God had wanted Joe to recognize Him in the voice, He would have spoken clearly then to Joe. Biblically, then, this stands as an example of the truth of Romans 1:19, “For what can be known about God is plain to them, because God has shown it to them.” Joe’s incredible story of survival can be used as a parable of how God hears and saves us when we finally know we’re lost; or not.

If you balk at finding God here, reflect on the mysteries this epic reveals about the human soul. The Greek philosopher Heraclitus said: “You will not find the limits of the soul, though you take every road; so deep is the tale of it.” I think T. M. Luhrmann’s thoughts as she concluded her book When God Talks Back could also be helpful:

In the end, this is the story of the uncertainty of our senses, and the complexity of our minds and the world. There is so little we know, so much we take on trust. In a way more fundamental than we dare appreciate, we must each make our own judgments, about what is truly real, and there are no guarantees, for what is, is always cloaked in mystery.

What do you think the voice was?

 

09/3/14

Psychiatry Has No Clothes

On April 29th of 2013, there was an astounding blog post by Thomas Insel, the Director of the National Institute of Mental Health (NIMH). He said that although the DSM-5 was due to be released in a few weeks, the NIMH would be “re-orienting its research away from DSM categories.” He noted that while the DSM has been referred to as a “Bible” for the field of mental health, “It is, at best, a dictionary, creating a set of labels and defining each.” Did you get that? The Director of the NIMH said the DSM was a “dictionary” that created “labels.” It was not, then functioning adequately, in his opinion, as its title suggests: as a Diagnostic and Statistical Manual of Mental Disorders! (emphasis added)

Insel said its strength had been “reliability”, meaning that it provided a way for clinicians to use the same terms in the same way. Its weakness was that it lacked validity. DSM diagnoses are based upon a consensus about clusters of symptoms and not any objective laboratory measure. “In the rest of medicine, that would be equivalent to creating diagnostic systems based on the nature of chest pain or the quality of fever.”

Insel was not using “reliability” in a statistical sense. In “The Myth of the Reliability of DSM,” Stuart Kirk and Herb Kutchins demonstrated conclusively that the DSM-III and DSM-IIIR were not statistically reliable. In fact, using the same statistic that Robert Spitzer used to justify the major changes to the DSM in the 1970s, they demonstrated that:

The reliability problem is much the same as it was 30 years ago [before the DSM-III]. Only now the current developers of the DSM-IV have de-emphasised the reliability problem and claim to be scientifically solving other problems.

Unfortunately, the tables in Figures 1 and 2 have been removed from the online version of their article. But the tables are still available in the original article found in the Journal of Mind and Behavior, 15 (1&2), 1994, p. 71-86. These tables plainly showed how the DSM statistical reliability was not what it was claimed to be. The Selling of the DSM (1992) by Stuart Kirk and Herb Kutchins has the tables. And there is a graphic comparison of the data within Mad Science (2013) by Stuart Kirk, Tomi Gomory, and David Cohen.

Insel went on in his blog to say that the NIMH will be supporting research projects that “look across current categories” or sub-divide them in order to begin to develop a better system. “We are committed to new and better treatments, but we feel this will only happen by developing a more precise diagnostic system.” In order to work towards that goal, the NIMH launched the Research Domain Criteria (RDoC). RDoC is only a research framework for now; a decade-long project that is just beginning. You can learn more about RDoC here (on the NIMH website).

Robert Whitaker, author of Anatomy of an Epidemic, said in a March 2014 interview that Insel stating that the DSM lacked validity was an acknowledgement the “disease model” has failed as a basis for making psychiatric diagnoses.

When Insel states that the disorders haven’t been validated, he is stating that the entire edifice that modern psychiatry is built upon is flawed, and unsupported by science. That is like the King of Psychiatry saying that the discipline has no clothes. If the public loses faith in the DSM and comes to see it as unscientific, then psychiatry has a real credibility problem on its hands.

Two weeks later on May 13, 2013, a joint press release was made by Thomas Insel and Jeffrey Liebermann, the President-elect of the American Psychiatric Association (APA). They said that the NIMH and the APA had a shared interest to ensure that patients and healthcare providers had “the best available tools and information” to identify and treat mental health issues.

Today, the American Psychiatric Association’s (APA) Diagnostic and Statistical Manual of Mental Disorders (DSM), along with the International Classification of Diseases (ICD) represents the best information currently available for clinical diagnosis of mental disorders. . . . The National Institute of Mental Health (NIMH) has not changed its position on DSM-5. As NIMH’s Research Domain Criteria (RDoC) project website states: “The diagnostic categories represented in the DSM-IV and the International Classification of Diseases-10 (ICD-10, containing virtually identical disorder codes) remain the contemporary consensus standard for how mental disorders are diagnosed and treated.”

The DSM and RDoC were said to be complementary, not competing frameworks. As research findings emerge from RDoC, they may be incorporated into future DSM revisions. “But this is a long-term undertaking. It will take years to fulfill the promise that this research effort represents for transforming the diagnosis and treatment of mental disorders.”

Saul Levine, the CEO and Medical Director of the APA said on May 5, 2014 that the DSM and the RDoC will “begin to come together” as the research from NIMH is included into the way they diagnose mental illness. They know that mental illness and substance use disorders are a bio-psycho-social illness. “We work very well together with NIMH. And I think that the whole field is looking to the science coming out of NIMH to include it as a way to help get better treatment for patients in this country.”

So the APA and NIMH affirm they are working towards the same goals as complementary research frameworks. Someday the research findings of RDoC may even be included into the DSM. But until then, the NIMH will have to continue to “ooh and aah” at the APA’s DSM and ignore the nay-sayers crying: “Look at the DSM; look at the DSM!”

Does it seem that psychiatry is trying to promote an unreliable, invalid—perhaps invisible—system of diagnosis?

Also see my blog post, “Psychiatry’s Mythical Phoenix.”

 

09/1/14

There is Nothing New Under the Sun

d59f7a12c5e5d41226adcc7aa6bcf234

Impression from a Sumerian cylinder seal from 2600 BC. Persons drinking beer are depicted in the upper row.

I have never used any mind altering drug that was not pharmaceutical grade. People who put drugs of unknown composition and purity in their bodies are either ignorant (they don’t know the real risks to the brain and mind), stupid (they know the risk and choose to ignore it), or addicted (they know the risk, want to stop, but find that they can’t). ~ Timothy Leary, in a private conversation with Terence T. Gorski.

Terence Gorski posted this quote at the end of a brief essay, “Poison as a Preferred Pleasure.” He first expressed his amazement with how many people today view alcohol and marijuana as harmless. Even more frightening to him was the willingness of people to experiment with new, largely unknown substances in the pursuit of getting high. See my essay on Playing Chemical Whack-a-Mole.

From the earliest times of culture and civilization, humans have pursued intoxication. According to Ronald Siegal, “Throughout our entire history as a species, intoxication has functioned like the basic drives of hunger, thirst and sex. . . . It is as bold and inescapable as the drug stories that dominate today’s headlines.”

The first mention of drunkenness in the Bible is when Noah became intoxicated after he planted a vineyard and ate some of the grapes. He gets naked, passes out and is seen by one of his sons, Ham. But I’m intrigued by the commentary on this story within a Hebrew midrash, Midrash Tanuma. There, the story is that Noah and Satan entered into a business arrangement to plant a vineyard. It was through this partnership, that Noah learned about the intoxicating qualities of wine. Satan’s contribution was to slaughter a lamb, a lion, a pig and a monkey and fertilize the vineyard’s soil with each in turn. What Noah learned from this was:

If a man drinks one glass, he is as meek as a lamb; if he drinks two glasses, he is boastful and feels as strong as a lion; if he drinks three or four glasses, then behaves like a monkey, he dances around, sings, talks obscenely and does not know what he is doing; and if he becomes intoxicated he resembles the pig.

The process of fermenting beverages like wine and beer runs parallel with the transition of humanity from hunter-gatherers into farmers, and eventually to cities and civilization. Beer was most likely a staple of human diets before wine was. It has even been argued that the discovery of the intoxicating effects of beer was a motivating factor for our hunting-gathering ancestors to settle down and become farmers.

2954474f708cf44b07237af4d40e46e7By the time that writing was invented, beer was no longer just an agricultural product of the rural villages. It was one of the surplus products important to the centralized economy of Sumerian city-states. The discovery of administrative cuneiform documents of the production and consumption of beer illustrates the important economic role beer played in Sumerian culture. The earliest known written documents are Sumerian wage lists and tax receipts which contain the symbol for beer, one of the most common words in the documents.

cuneiform tablet depicting beer allocation, c. 3000 b.c. British Museum Photograph: takomabibelot on Flickr

cuneiform tablet depicting beer allocation, c. 3000 b.c. British Museum Photograph: takomabibelot on Flickr

From the beginning, beer had an important social aspect. Sumerian depictions from the third millennium BCE (like that above) show two people drinking through straws from a shared vessel. The technology to filter out the grain, chaff and debris from beer had been developed, but the continued use of straws suggested this was a ritual that persisted even after straws were no longer needed. Perhaps sharing a drink was a symbol of hospitality and friendship. “It signals that the person offering the drink can be trusted, by demonstrating that it is not poisoned or otherwise unsuitable for consumption.”

Beer had a religious role in Sumerian culture as well. The Hymn to Nakasi was simultaneously a song of worship to the goddess of beer and a recipe for brewing beer! See section 6.1 of the article on Sumerian Beer for the text of the hymn. Nevertheless, Sumerian beer was likely consumed in taverns, similar to medieval times. At the end of the hymn, the goddess Nakasi pours out beer for the drinkers, giving her the role of both brewer and tavern-keeper.  Women were typically the ones who brewed and sold beer in ancient Mesopotamia.

The Egyptians also excelled in the arts of fermenting wine and brewing beer. Not only were such intoxicants for the living, they were said to be used by the dead in the afterlife. Menquet, the Egyptian goddess of beer, was pictured as a woman holding two jars of beer. Hathor, represented as a sacred bull, was the god of wine. He was duly honored on a monthly “Day of Intoxication.”

The Preacher in Ecclesiastes can help put the latest intoxicant fad with synthetic drugs or new psychoactive substances into perspective: There is nothing new under the sun. From the time human beings first settled down into villages, they have looked for new and better ways of getting high.

What has been is what will be, and what has been done is what will be done, and there is nothing new under the sun. Is there a thing of which it is said, “See, this is new”? It has been already in the ages before us. There is no remembrance of former things, nor will there be any remembrance of later things yet to be among those who come after. (Ecclesiastes 1:9-11)

Do you agree with Timothy Leary that people who put drugs of unknown composition and purity in their bodies are either ignorant or stupid?

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.