01/30/15

Confession and True Repentance

Psalm 51 has repeatedly drawn me back to read and meditate on it over the years. “Create in me a clean heart, O God” has been and will continue to be a foundational part of my prayer life. “For I know my transgression, and my sin is ever before me. Against you, you only, have I sinned and done what is evil in your sight.” David would surely agree with Thomas Watson that the recipe for true repentance must include the ingredient of confession.

This is the third of a series of reflections on The Doctrine of Repentance, by Watson.  We’ve looked at “Counterfeit Repentance” and the first two of six essential ingredients for true repentance in “On the Road to True Repentance.” Here we will see what he has to say about the importance of confession for true repentance.

Thomas Watson David, Job (42:1-6), Isaiah (6:5) knew that when we come before God in true repentance, we must acknowledge our sins. Our confession of sin must be “self-accusing”—“Against you, you only have I sinned”; “I repent in dust and ashes”; “I am a man of unclean lips and I dwell in the midst of a people of unclean lips.” Watson thought that because of this self-accusation, Satan could not indict us before God, as he did with Job—because we have acknowledged that we have sinned and done what is evil in His sight.  He gave four reasons to confess sin.

Confession is necessary in repentance because it reproves those who would rather hide their sins. “Many would rather have their sin covered than cured.”  However the person who confesses and forsakes sin will obtain mercy (Proverbs 28:13). Confession corrects those who would “confess the pennies but not the dollars.” When our heart accuses us of sin, it must be confessed. Confession also reproves those who would use arguments to defend or justify it. “When men commit sin they are the devil’s servants; when they plead for it they are the devil’s attorneys, and he will give them a fee for it.” Confession also reproves those who would try and point to extenuating circumstances for their sin, as Adam did (Genesis 3:12).

They do not deny they are sinners, but they do what they can to lessen their sins: they indeed offend sometimes, but it is just their nature, and it has been such a long time. These are excuses rather than confessions.

If we judge ourselves, truly, we won’t be judged (1Cor. 11:31). Some individuals like Judas and King Saul confess their sin, they judge themselves—but not truly. “Theirs was not a true confession,” according to Watson. He said that for our confession to be “right and genuine,” it must have the following eight qualities.

First, it must be voluntary. It should flow as freely from us as water from a spring. In contrast, the confession of the wicked is extorted, “like the confession of a man upon a rack.”

Second, true confession leaves heart-wounding impressions. Our hearts must deeply resent it. “It is one thing to confess sin and another to feel sin.”

Third, our hearts must go along with our confession—it must be sincere. A hypocrite confesses sin, but still loves it. The truly penitent person is convinced of the sins they confess, and abhors the sins that they are convinced of.

Fourth, true confession will particularize sin. After a diligent inspection of our hearts, if we see that a particular sin has been committed, “point to that sin with a tear.”

Fifth, a true penitent acknowledges the pollution of his nature. “Our nature is an abyss and a seminary of all evil, from which those scandals that infest the world come.”

Sixth, sin is to be confessed with all its aspects and dimensions. Sin soaks down into the marrow of our bones and cannot be confessed generally or superficially.

Seventh, confession of sin does not blame God. “We must acquit him and acknowledge that he has done us no wrong.”

Eighth, in confessing sin, we must resolve not to repeat them. It is vain to confess something sinful and still continue to do it. “Some run from the confession of sin to the committing of sin.”

David knew that God did not delight in the mere outward, tearful show of sacrifice and confession. True repentance requires a sense of brokenness in confession. “The sacrifices of God are a broken spirit; a broken and contrite heart, O God you will not despise.” (Psalm 51:17) The Theological Dictionary of the Old Testament said that the Hebrew word for contrite here is consistently used to refer to someone who is “physically and emotionally crushed because of sin.”

There is no room in true repentance for a showy, tearful eloquent confession of sin if it is not an outward expression of a broken and contrite heart. The legitimacy of a “right and genuine” confession will also take time to confirm. It should be demonstrated within a pattern of progressive steps away from the sin. Too often flashy demonstrations of regret are accepted as true confession. It takes a creative act of God to make a clean heart and renew a right spirit within us. And like David, that process begins with our confession of sin before a holy God.

01/28/15

How to Lie About Research

Copyright : agencyby

Credit: 123RF; copyright : agencyby

According to Charles Seife, “A well-wrapped statistic is better than Hitler’s ‘big lie’; it misleads, yet it cannot be pinned on you.” Twenty-some years ago I bought and read Darrell Huff’s little gem of a book: How to Lie with Statistics. And it seems I wasn’t the only one, particularly when I read about some of the problems with medical science and psychology research. Huff said that while his book might appear to be a primer in the ways to use statistics to deceive others, honest people must also learn them in self-defense.

Thesaurus.com gave 48 synonyms for the verb form of “lie,” including: deceive, mislead, misrepresent, exaggerate, fabricate, misstate, fudge and BS. One or more of these synonyms will be found regularly in the discussion (and linked articles) that follow. But make no mistake—the discussion is still about how the public can be lied to in what they read health science news.  Along with a previous article, “The Reproducibility Problem,” this is meant in inform. So let’s look at some of the ways that we are lied to about psychology and medical science research news.

Gary Schwitzer wrote about the problem of exaggeration in health science news releases. He commended an editorial by Ben Goldacre and a research paper by Sumner et al. published in the BMJ, a peer reviewed medical journal, on exaggerations in academic press releases and the news reporting they generate. Sumner et al. found that most of the exaggerations identified in their study did not occur ‘de novo’ in the media reports, but were “already present in the text of the press releases produced by academics and their establishments.” And when press releases contained misleading statements, it was likely that the news would be as well. “Exaggeration in news is strongly related with exaggeration in press releases.”

The study’s three main outcome measures of exaggeration were: whether causal statements were made about correlational research; if there was advice to readers about behavior changes; and were there inferences made to humans from animal studies that went beyond those already accepted in the literature. The authors concluded:

Our findings may seem like bad news but we prefer to view them positively: if the majority of exaggeration occurs within academic establishments, then the academic community has the opportunity to make an important difference to the quality of biomedical and health related news.

Goldacre noted that while some fixes to the problem were in place, they were routinely ignored. He further suggested that press releases should be treated as part of the scientific publication and then subjected to the same accountability, feedback and transparency of the published research. “Collectively this would produce an information trail and accountability among peers and the public.” Schwitzer noted to how the academic community had the opportunity to “make an important difference to the quality of biomedical and health related news.”

A review of 2,047 biomedical and life-science research articles by Fang, Steen and Casadevall indicated that only 21.3% of retractions could be attributed to error. A whopping 67.4% were attributable to misconduct, including fraud or suspected fraud (43.4%). The percentage of scientific articles retracted since 1975 for fraud has risen 10-fold. “We further note that not all articles suspected of fraud have been retracted.”

But these weren’t the only problems with the current academic research and publication process. A November 2014 article in Nature described a peer-review scam, where journals were forced to retract 110 papers involved in at least 6 instances of peer-review rigging. “What all these cases had in common was that researchers exploited vulnerabilities in the publishers’ computerized systems to dupe editors into accepting manuscripts, often by doing their own reviews.” Recommendations in the article were also made for changing the way editors assign reviewers, particularly the use of reviewers suggested by a manuscript’s author. Cases of authors suggesting friends and even themselves—using a maiden name—were noted.

A further concern is with p-hacking, also known as: data-dredging, fishing, and others. Uri Simonsohn and Joe Simmons, who jointly coined the term, said p-hacking “is trying multiple things until you get the desired result.” They said p-hacking was particularly likely in “today’s environment of studies that chase small effects hidden noisy data.” Their simulations have shown that changing a few data-analysis decisions can increase the rate of false-positives to 60%. Confirming how widespread this is would be difficult. But they found evidence that “many published psychology papers report P values that cluster suspiciously around 0.05, just as would be expected in researchers fished for significant P values until they found one.”

According to Charles Seife, a journalist and author with degrees in mathematics from Princeton and Yale, a “p-value” is a rough measure of how likely your observation could be a statistical fluke. The lower the p-value, the more confident you are that your observation isn’t a fluke. Generally, statistical significance is a p<0.05. The YouTube video of Seife’s talk is about 45 minutes, with another twenty some minutes of question and answer. It gives an understandable presentation of how statistics, including p-hacking, can be misused.

Simonsohn and Simmons devised a method consisting of three simple pieces of information that scientists should include in an academic paper to indicate their data was not p-hacked. Whimsically, they suggested these three rules could be remembered as a song (they need to work on their musical composition skills). First, they preach to the choir. You’ll recognize the “melody” they used when you read the lyrics:

Choir: There is no need to wait for everyone to catch-up with your desire for a more transparent science. If you did not p-hack a finding, say it, and your results will be evaluated with the greater confidence they deserve.

If you aren’t p-hacking and you know it, clap your hands.

If you determined sample size in advance,say it.

If you did not drop any variables,say it.

If you did not drop any conditions,say it.

A mere 21 words, included in the Methods section of a paper would declare the above: “We report how we determined our sample size, all data exclusions (if any), all manipulations, and all measures in the study.”

Scientific theories are in principle subject to revision. And sometimes people’s desires drive them to find explanations that harmonize with their desires and with a worldview that reinforces those desires. (Vern Poythress, Redeeming Science)

 
01/26/15

Meth is Coming to YOUR House

Congratulations, Walter White. Methamphetamine production (meth, speed, crank crystal meth, “ice” and others) has gone international … big time.  There has been a seizure of 2.8 tons of drugs, worth more than $1.5 billion dollars in Australia. There were 1,917 kilograms of MDMA and 849 kilograms of methamphetamine. This made it the largest seizure of meth in Australia and the second largest seizure of MDMA. The previous record for meth seizures was 580 kilograms.

To put this in context, the entire amount of all drugs seized last year by Customs and Border Protection in Australia, was about 5 tons. The Commissioner of the Australian Federal Police, Andrew Colvin, said: “By any measure this is an enormous seizure of illicit narcotics that have been removed from distribution on our streets.” The investigation is ongoing and they expect to arrest more than the initial six Australians currently in custody. “This obviously has linkages overseas that will take us, I’m sure, into Europe and parts of Asia.” They expect to have a number of people and a number of organized crime groups involved.

The drugs were concealed with furniture and other belongings within a sea cargo container that came from Hamburg Germany. The Australian authorities are working closely with the German federal police and Interpol. The message the authorities wanted to send to the “Breaking Bad” individuals involved in this operation was: “Go somewhere else, go to another country. Don’t bring your evil poison here to Australia.”

The UNODC (the United Nations Office on Drugs and Crime) Global SMART Update, Vol. 12, said that in North America, meth production has been primarily within the U.S. and Mexico. The movement in the U.S. to control the precursors for cooking meth, such as pseudoephedrine and ephedrine, led the Mexican drug cartels to begin manufacturing it in large quantities. In February of 2012 Mexican soldiers overran an abandoned ranch south of Guadalajara and found 15 tons of methamphetamine. There was, of course, a laboratory and another seven tons of the precursor chemicals used to manufacture meth. “The cheap and potent meth they supply now provides some three quarters of the drug consumed in America.”

East and South East Asia has been another center for the manufacture and distribution of meth. In 2011 and 2012, eleven countries in the region reported methamphetamine laboratories, “with China (46 percent) and New Zealand (39 percent) accounting for the largest share.” Although Myanmar has reported finding only small-scale meth labs, it is one of the main destinations for trafficked preparations containing ephedrine and pseudoephedrine. This suggests that industrial-scale meth production is going on within that country.

In Africa, the illicit manufacture of meth had been confined to South Africa. But since 2010, laboratories have been reported in Egypt, Nigeria and Kenya. In 2011 and 2012, five large-scale labs were discovered and dismantled in Nigeria. In May of 2012, Nigerian drug enforcement agents raided a building on the outskirts of Lagos and discovered a factory capable of producing 25 kg of crystal meth every few hours. Four large-scale labs have been found in Nigeria. In 2013, Kenya reported that it had dismantled its first meth lab.

In 2008, meth or sheesheh/shishe (Farsi for “glass”) was introduced to Iran. By 2010, Iranian meth manufacturing operations expanded their reach into Japan, Malaysia and Thailand. In 2011 and 2012 Iran reported seizing bulk amounts of ephedrine. By 2012, Iran was the world’s fourth largest importer of pseudoephedrine (used to manufacture meth). Iran spends around 1 billion dollars per year on anti-drug operations. Since 1979, almost 4,000 Iranian law officers have been killed in the country’s fight against the drug trade. In part, this results from severe punishments given out. “Nearly 80% of prosecuted traffickers are given the death penalty.”

One of the primary reasons the use of meth has spread so quickly in Iran is the lack of information. Azarzksh Mokri, a psychiatrist who teaches at Tehran University of Medical Sciences, said: “We really had a hard time convincing people that this is addiction.” Drug use and addiction in Iran is now the second highest cause of death after traffic accidents.

The Global SMART Update Vol. 12 said that illicit methamphetamine manufacture in Europe seems to be concentrated in Central Europe (the Czech Republic, Germany and Slovakia) and the Baltic States, mostly in Lithuania. The Czech Republic typically has small-to medium scale operations that sell their product locally, as well as in Austria and Germany. Conversely, Lithuania has medium-to large-scale laboratories that supply the demand for meth in the Nordic countries and the United Kingdom.

There is a series of twenty segments, or brief reports on global meth operations in the 2014 Global Smart Report. Here is a sampling of three of them. London Police have found a suspected meth lab in a residential area of West London in February. Again in February, a joint operation by U.S. agencies and the Australian Federal Police prevented 60kg of “black ice” methamphetamine from being shipped to Australia. In May, Guatemalan authorities dismantled a lab estimated to manufacture nearly 3 tons of drugs per month.

“Imagine this:
Ice is coming to YOUR house.
Can you HEAR it knocking?
Are you ready?
What will YOU do?”
Cornelia Connie D. DeDona

01/23/15

On the Road to True Repentance

Repentance always brings a man to this point: ‘I have sinned.’ The surest sign that God is at work is when a man says that and means it. Anything less than this is remorse for having made blunders, the reflex action of disgust at himself. (My Utmost for His Highest, December 7th)

This short quote from Oswald Chambers has been a personal favorite of mine for a number of years. Mostly, because I need to be reminded of it’s truth. But also because it captures the reality that true repentance demands more than a simple verbal response. To use a well-known recovery saying, you have to walk your talk. Getting a clear sense of what true repentance looks like and feels like is foundational for personal spiritual growth; and it is crucial when discipling and counseling others.

I’ve looked at Thomas Watson’s sense of “Counterfeit Repentance” in his work, The Doctrine of Repentance.  Now I want to reflect on what he says about true repentance. According to Watson, “Repentance is a grace of God’s Spirit whereby a sinner is inwardly humbled and visibly reformed.”  He proposed a recipe with six special ingredients for true repentance. “If any one of these is left out, repentance loses its virtue.” For now, we’ll look at the first two ingredients:

1. Sight of sin                    4. Shame for sin

2. Sorrow for sin              5. Hatred for sin

3. Confession of sin         6. Turning from sin

The Sight of Sin

Watson said the person must first recognize and consider what her sin is, and know the plague of her heart, before she can be duly humbled by it. Just as the first thing that God created was light, the first thing in a penitent is illumination. She must see her sin. “For at one time you were darkness, but now you are light in the Lord. Walk as children of the light” (Ephesians 5:8).

“Where there is no sight of sin, there can be no repentance.” People are blinded by ignorance and self-love. Therefore they do not see what deformed souls they have. They see faults in others, but none in themselves. They don’t know their own heart, and don’t realize what a hell they carry around with them. “They do not see any evil in [their] sin.”

The Sorrow for Sin

There is a multi-facetted sense to sorrow for sin in true repentance. Watson suggests five aspects to true, repentant sorrow.

  1. This sorrow is not superficial. It is a holy agony whose purpose is to make Christ precious; to drive out sin; and to make way for solid comfort. Remember that not all sorrow is evidence of true repentance. “There is as much difference between true and false sorrow as between water in the spring, which is sweet, and water in the sea, which is briny.”
  2. Godly sorrow is inward. It goes deep, like a vein that bleeds inwardly. Its grief is for heart-sins that never blossom into action. “A wicked man may be troubled by scandalous sins; a real convert laments heart-sins.”
  3. Godly sorrow is sincere—it sorrows for the offense rather than the punishment. Here lies the heart of counterfeit repentance. “Hypocrites grieve only for the bitter consequence of sin.”
  4. Godly sorrow is intermixed with faith. “Just as our sin is ever before us, so God’s promise must ever be before us.” Sorrow apart from faith is the sorrow of despair, not the sorrow of repentance.
  5. Godly sorrow is sometimes joined with restitution. If you are able, you should recompense the person with whom you had fraudulent dealings. If you are not able to repay what you have taken, promise full satisfaction to the wronged party if the Lord makes you able.

So it is necessary to recognize and be sorrowful for sin in true repentance. Repentance requires that we die to self. We must see that we are not just a bit off track, but that we are utterly lost. The first step is to recognize and correct this misdirection, according to C.S. Lewis. “If you are on the wrong road, progress means doing an about-turn and walking back to the right road.”

Lewis also noted that we are not just imperfect creatures in need of improvement—we are rebels who must surrender our arms. This laying down of arms, this surrender—saying we are sorry and admitting that we were heading in the wrong direction—is repentance.

Now repentance is no fun at all. It is something much harder than merely eating humble pie. It means unlearning all the self-conceit and self-will that we have been training ourselves into for thousands of years. It means killing part of yourself, undergoing a kind of death. (C.S. Lewis, Mere Christianity)

After making an about-turn and beginning to walk back to the right road, the repentant person will need to stay alert for the return of their self-conceit and self-will. And when they see it—work to avoid it at all costs. When you see this process at work, you know you’re on the road to true repentance.

 

 

01/21/15

The Frankenstein Monster of ECT

Stockfresh image by Shevs

Stockfresh image by Shevs

In his article on electricity and 19th century medicine, Dr. Matthis Krischel argued that Mary Shelley’s novel, Frankenstein, could be read as a Victorian science fiction novel that sought to imagine the medical possibilities of electricity. In the era where the scientific method was established within the biomedical sciences, Shelley’s novel raised the question of what the experimenter could ethically do to living, as well as dead bodies. That very same question continues to be debated today over the use of ECT (electroconvulsive therapy) to treat depression.

Krischel asked what physicians can learn from 19th century’s medical experiments with electricity. He commented that like the early 19th century, new technologies and therapies can instill fear in the public or individual patients. “Medical practitioners must take these reactions seriously and address them as well as use the tools of their trade responsibly in order not to turn loose another Frankensteinian monster.”

When reading the literature critical of ECT, I had an eerie déjà vu experience of Krischel’s description of the 19th century experiments with electricity in medicine. Philip Hickey reviewed an article by Max Fink, a supporter of ECT, celebrating 80 years of convulsive therapy. Even a mostly positive history of ECT written by Norman Endler in 1988, “The Origins of Electroconvulsive Therapy (ECT)”, acknowledged that ECT was controversial. The nature of ECT treatment, its history of abuse, unfavorable media presentation (Think “One Flew Over the Cuckoo’s Nest”), and compelling negative testimony by former patients paints a Frankenstein-like atmosphere at times.

Disturbingly, in “ECT: shock, lies and psychiatry,” Yvonne Jones and Steve Baldwin reported that during the very first ECT experiment on a human, the patient’s very clear objections were ignored. “Despite the man’s expressed wishes, Cerletti proceeded with his experimentation, and using a higher voltage, induced a convulsion.”

Peter Breggin has been a long time activist against ECT, going back to before his 1979 book, Electroshock. Dr. Breggin made this book, along with more than 125 scientific articles on injury from ECT, available on his ECT Resources Center website.  He has also provided links to information on ECT from other sources, including his website, blogs and scientific articles he’s written.

In a 2010 article on ECT, Breggin noted that ECT therapy, and “the machines that deliver it,” have never been tested by the FDA for safety and efficacy. He gave an overview of several disturbing findings with ECT.

  • The “treatment” process of ECT delivers sufficient trauma to the brain to cause a severe grand mal seizure. “There can be no scientific doubt that ECT harms the brain and mental function. The only controversy surrounds the severity and persistence of the harm.”
  • New evidence (here and here) confirms that ECT produces lasting memory dysfunction and other cognitive deficits. It contradicts claims by shock advocates “that ECT does not cause brain damage.”
  • ECT is frequently used with the elderly, where it causes even more severe dysfunction to the fragile, older brain.
  • Despite several decades of effort, no lasting improvements from ECT can be demonstrated. “The Consensus Development Conference on ECT found that controlled clinical trials failed to demonstrate any positive effect beyond four weeks.” There’s no clear evidence of a reduction in suicide risk. Several studies have shown that a placebo ECT procedure produces as much improvement as ECT itself, “without any of the risks.”

In a 1998 article, Dr. Breggin gave an extensive review of the problems resulting from ECT treatment. One of the more disturbing ones to me was that of iatrogenic [caused by medical treatment or examination] helplessness and denial. Consistent with other individuals with central nervous system damage, ECT patients minimize or deny their real losses of mental function. Think of someone you know with dementia or Alzheimer’s. “Interviews with family and friends of patients often disclose that they are painfully aware of the damage done to their loved ones. Often, the psychiatrist is the only one who consistently and unequivocally denies the patient’s damaged state.”

At the Consensus Conference on ECT in 1985, critics and advocates debated whether there was any benefit from ECT. “The advocates were unable to come forth with a single controlled study showing that ECT had a positive effect beyond 4 weeks.”  Breggin commented how this confirmed the brain-disabling principle of ECT, since “4 weeks is the approximate time for recovery from the most obvious mind-numbing or euphoric effects of the ECT-induced acute organic brain syndrome.”

Matthis Krischel correctly observed that Frankenstein could be read in a way that imagined the medical possibilities of electricity. Shelley eloquently captured the just discussed temporary mood-lifting effects of ECT:

For a moment my soul was elevated from its debasing and miserable fears to which these sights were the monuments and the remembrances. For an instant I dared to shake off my chains, and look around me with a free and lofty spirit; but the iron had eaten into my flesh, and I sank again, trembling and hopeless, into my miserable self.” (Mary Shelley, Frankenstein)

01/19/15

The Yin-Yang of High Risk Situations

Jin and yang mask by  sognolucido

Jin and yang mask by sognolucido

We’d discussed a plan to keep Andrea as safe as possible. Her brother had urged her to come to the family Christmas celebration and she didn’t feel she could say no. Many of her family members were drinkers, but she was going with her fiancée and neither one of them would be drinking. Most family members knew she’d just got out of rehab at the beginning of December and were supportive of her abstinence. Her brother had vowed to tell their heavily drinking uncle to keep his distance from her. She also wanted to show her family what the sober Andrea looked and acted like. Last Christmas has been a disaster.

She had talked ahead of time to her sponsor about going and agreed to call her at least once during the celebration and after she had returned home. She arranged with Chad, her boyfriend, and Matt, her brother to approach them and say she had to leave if she felt triggered by anything. Andrea and Matt rode together to the party, so they could leave whenever they needed. Her sponsor had also told her about a late night meeting she could get to as well. The party was great. She wasn’t triggered. Even Uncle Al seemed to have been more sober than usual.

A few days later, she had a phone call from a friend’s mother telling her that the woman’s niece had overdosed the night before. Andrea had known the woman, and even talked to her when they met at the grocery store, just after Andrea had got out of rehab. Although she was freaking out on the inside, she felt she had to listen to the friend’s mother and try to comfort her. Andrea still felt guilty that she had introduced the woman’s daughter to heroin. The first anniversary of the girl’s death from a car crash had come while Andrea was in treatment.

When Andrea got off the phone fifteen minutes later, she was shaking. She didn’t want to call her sponsor again; they’d talked earlier in the day and she knew her sponsor was going to be at a family dinner. She told Chad what had happened and said she was going to take a walk to clear her head—alone. Down the block, she decided to walk to the convenience store for a pack of cigarettes; she was almost out. Standing in line with her back to the front door and replaying the conversation with the friend’s mother in her head, she didn’t see a drug dealer she knew until he tapped her on the shoulder and called her name.

Andrea was in two situations that could be dangerous to her recovery. The first was one of her choosing; the second she didn’t see coming. Nevertheless, they both fit what Terence Gorski would describe as a High Risk Situation (HRS). Gorski said that a high risk situation is: 1) any experience that causes you to either move away from support for your recovery; or 2) leads to you going around people, places and things that would support your return to addictive use. He then specified this yin-yang of people, places and things and addiction further by giving a list of ten criteria:

To be more specific, a high risk situation can be described as any experience that meets one or more of the following criteria. The more criteria that are part of the experience, the higher the risk of starting addictive use.

Andrea’s first situation, going to the family Christmas party, would have met numbers 2, 3 and 4 on Gorski’s list. She was around people who would support her return to drinking (Possibly Uncle Al, maybe others who didn’t understand why she couldn’t just one drink to celebrate). She had easy access to alcohol. She was around other people who were acting out on their addiction (at least Uncle Al). But she had a plan to minimize the high risk criteria.

As Gorski noted in his article, having a plan to extract yourself from a high risk situation and then getting in contact people supportive of your abstinence can help you get away from it without using. Andrea went with her fiancée, who also wasn’t drinking. Her brother and others at the party knew she was abstinent and were supportive of her recovery. She had a plan to get to a meeting if indeed she did start to have thoughts or cravings to use. She told others of her planned emergency exit strategy. She went into a high risk situation with a plan and got out without using.

The second situation is less obviously a high risk situation because of the chance encounter Andrea had with the drug dealer. Does this mean she can never be out alone? Gorski said that in relapse prevention there are “Apparently Irrelevant Decisions that put people in high risk situation that seem to happen by chance.” In Andrea’s case, she felt she needed to try and comfort her friend’s mother even though she was freaking out inside. She should have ended the conversation or had Chad try and console the woman. She also chose not to call her sponsor—even though it made sense not to do so at the time. She went out alone and then decided to go for cigarettes—again alone—while she was still upset by her phone call.

These seeming irrelevant decisions on her part led to Andrea being alone while she was around a person who would support her drug use and even supply what she needed to get high. All the while she was still struggling to control strong feelings and emotions from her phone conversation. She also had limited options available to cope with or get out of the situation. The scenario doesn’t say what she did, but even before we speculate how she could respond, Andrea has met five of Gorski’s ten criteria. And remember, the more criteria that are part of the experience, the higher the risk of using.

Andrea are her situations are fictional, but the various pieces of each of them have really happened to people I’ve known in early recovery. Sometimes it can almost feel like an improbable scene scripted in a bad Hollywood movie. So how does Andrea keep herself prepared for the unexpected high risk situation? Simply reverse Gorski’s two yin-yang criteria—move away from people, places and things that support your return to addictive use; and put yourself around the people, places and things that support your recovery. Apply it to Andrea’s situation and see what you think she should do.

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 articles based upon the material available on his blog and website.

01/16/15

Whatever You Treasure Has Your Heart

“Greed is a fat demon with a small mouth and whatever you feed it is never enough.” (Janwillem van de Wetering)

The following passage contrasts the pursuit of material wealth to that of heavenly riches. Modern wealth or treasure often means possessing “money” or valuables containing precious metals. So many English translations since William Tyndale use “rust” to translate a Greek word which can also mean: “eating” or “consuming.”  Following this sense, the word translated “money” in verse 25 is better understood as more broadly as material wealth.

Do not lay up for yourselves treasures on earth, where moth and rust destroy and where thieves break in and steal, but lay up for yourselves treasures in heaven, where neither moth nor rust destroys and where thieves do not break in and steal. For where your treasure is, there your heart will be also.The eye is the lamp of the body. So, if your eye is healthy, your whole body will be full of light, but if your eye is bad, your whole body will be full of darkness. If then the light in you is darkness, how great is the darkness!“No one can serve two masters, for either he will hate the one and love the other, or he will be devoted to the one and despise the other. You cannot serve God and money.  (Matthew 6:19-25)

Wealth to the audience who heard the Sermon on the Mount would have more likely been excess provisions of food and resources like cloth. So vermin or insects that would get into your stored grain and materials could destroy or ruin your treasure. Thieves could also steal it from you. But earthly treasures can also be things that bring an individual power, prestige or wealth. So there is a broad range of things that we can covet or “store” up that would qualify as earthly treasure.

And here lies the first bombshell of the passage: whatever you treasure has your heart.

The next two verses, 6:22-23, can be difficult to understand. The metaphor of the eye being the lamp to our body doesn’t speak clearly to a modern audience. Craig Blomberg, suggests that it is a restatement of the previous paragraph. So the meaning is that the way people handle their finances affects every part of their lives:

Just as the “heart” (v. 21) forms the center of one’s affections and commitments, the “eyes” enable the whole person to see. Good and bad eyes probably parallel a good and bad heart and thus refer, respectively, to storing up treasures in heaven versus storing them up on earth.

I think that Jesus is extending his statement about treasure, rather than just restating it. In his time, as today, it would likely have been understood that extreme examples of greed were ungodly. But there is nothing morally wrong with trying to improve your financial status, is there? So saying: “where your treasure is, there your heart will be also”, could have been readily affirmed—but not fully understood. His hearers, then and now, could have missed a crucial point.

So Jesus extends and clarifies his statement about treasure by using another metaphor, how the eye is the lamp of the body; the eye lets in light. Here, as Leon Morris observed, there is a spiritual parallel with Jesus speaking of the eye as the source of light to the body. So, if you have “good,” healthy eyes, your body has light. If your eye is not healthy, you will be in darkness. So far Jesus has described the one half of the metaphor that everyone knows—blind people are in darkness. The second half of the metaphor now equates “light” entering a person as spiritual or moral “darkness,” and then declared “how great is the darkness” if the “light” that enters you is “darkness!”

It asks the question, “What do you have your eye on?” If your eye is on some kind of treasure, that is where your heart is. If your eye is on the things of God, then your body is full of the light of God. If your eye is on other things, you have let “darkness” in—and how great is that darkness! So, no one can serve two masters; you cannot serve God and earthly treasure in any form.

Twelve Step recovery is steeped in the knowledge that pursuing earthly treasures leads to destruction. In the “Step Seven” essay in Twelve Steps and Twelve Traditions, Bill W. noted how alcoholics for thousands of years have been demanding more than their share of security, prestige—the things of material achievement or earthly treasure. Success meant dreaming of more; frustration or failure meant drinking for oblivion. “Never was there enough of what we thought we wanted.” Never was there “thought of making honesty, tolerance, and true love of man and God the daily basis of living.”

As long as individuals attempted to live by their own strength and intelligence, a working faith was impossible. “This was true even when we believed that God existed.” Here, the Twelve Stepper and the follower of Christ stand in agreement: “We could actually have earnest religious beliefs which remained barren because we were still trying to play God ourselves.” As long as we place self-reliance first, a genuine reliance on God was impossible. “That basic idea of all humility, a desire to seek and do God’s will, was missing.” Whatever you treasure has your heart.

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.”

01/14/15

The Reproducibility Problem

Copyright : Fernando Gregory (Follow)

Copyright : Fernando Gregory (Follow)

In January of 2014, a Japanese stem cell scientist published what looked like groundbreaking research in the journal Nature that suggested stem cells could be made quickly and easily. But as James Gallagher of the BBC noted, “the findings were too good to be true.” Her work was investigated by the center where she conducted her research amid concern within the scientific community that the results had been fabricated. In July, the Riken Institute wrote a retraction of the original article, noting the presence of “multiple errors.” The scientist was later found guilty of misconduct. In December of 2014, Riken announced that their attempts to reproduce the results had failed. Dr. Obokata resigned saying, “I even can’t find the words for an apology.”

The ability to repeat or replicate someone’s research is the way scientists can weed out nonsense, stupidity and pseudo-science from legitimate science. In Scientific Literacy and the Scientific Method, Henry Bauer described a ‘knowledge filter’ that illustrated this process. The first stage of this process was research or frontier science. The research is then presented to editors and referees of scientific journals for review, in hopes of being published. It may also be presented to other interested parties in seminars or at conferences. If the research successfully passes through this first filter, it will be published in the primary literature of the respective scientific field—and pass into the second stage of the scientific knowledge filter.

The second filter consists of others trying to replicate the initial research or apply some modification or extension of the original research. This is where the reproducibility problem occurs. The majority of these replications fail. But if the results of the initial research can be replicated, these results are also published as review articles or monographs (the third stage). After being successfully replicated, the original research is seen as “mostly reliable,” according to Bauer.

So while the stem cell research of Dr. Obokata made it through the first filter to the second stage, it seems that it shouldn’t have. The implication is that Nature didn’t do a very good job reviewing the data submitted to it for publication. However, when the second filtering process began, it detected the errors that should have been caught by the first filter and kept what was poor science from being accepted as reliable science.

A third filter occurs where the concordance of the research results with other fields of science is explored. There is also continued research by others who again confirm, modify and extend the original findings. When the original research successfully comes through this filter, it is “mostly very reliable,” and will get included into scientific textbooks.

Francis Collins and Lawrence Tabak of The National Institute of Health (NIH) commented that: “Science has long been regarded as ‘self-correcting’, given that it is founded on the replication of earlier work.” But they noted how the checks and balances built into the process of doing science—that once helped to ensure its trustworthiness—have been compromised. This has led to the inability of researchers to reproduce the initial research findings.  Think here of how Obokata’s stem cell research was approved for publication in Nature, one of the most prestigious science journals.

The reproducibility problem has become a serious concern within research conducted into psychiatric disorders. Thomas Insel, the Director of the National Institute of Mental Health (NIMH), wrote a November 14, 2014 article in his blog on the “reproducibility problem” in scientific publications. He said that “as much as 80 percent of the science from academic labs, even science published in the best journals, cannot be replicated.” Insel said this failure was not always because of fraud or the fabrication of results. Perhaps his comment was made with the above discussion of Dr. Obokata’s research in mind. Then again, maybe it was made in regard to the following study.

On September 16, 2014, the journal Translational Psychiatry published a study done at Northwestern University that claimed it was the “First Blood Test Able to Diagnose Depression in Adults.”  Eva Redei, the co-author of the study said: “This clearly indicates that you can have a blood-based laboratory test for depression, providing a scientific diagnosis in the same way someone is diagnosed with high blood pressure or high cholesterol.” A surprise finding of the study was that the blood test also predicted who would benefit from cognitive behavioral therapy. The study was supported by grants from the NIMH and the NIH.

The Redei et al. study received a good bit of positive attention in the news media.  It was even called a “game changing” test for depression. WebMD, Newsweek, Huffington Post, US News and World Report, Time and others published articles on the research—all on the Translational Psychiatry publication date of September 16th.  Then James Coyne, PhD published a critique of the press coverage and the study in his “Quick Thoughts” blog. Coyne systematically critiqued the claims of the Redei et al. study. Responding to Dr. Rediei’s quote in the above paragraph, he said: “Maybe someday we will have a blood-based laboratory test for depression, but by themselves, these data do not increase the probability.”

He wondered why these mental health professionals would make such “misleading, premature, and potentially harmful claims.” In part, he thought it was because it was fashionable and newsworthy to claim progress in an objective blood test for depression. “Indeed, Thomas Insel, the director of NIMH is now insisting that even grant applications for psychotherapy research include examining potential biomarkers.” Coyne ended with quotes that indicated that Redei et al. were hoping to monetize their blood test. In an article for Genomeweb.com, Coyne quoted them as saying: “Now, the group is looking to develop this test into a commercial product, and seeking investment and partners.”

Coyne then posted a more thorough critique of the study, which he said would allow readers to “learn to critically examine the credibility of such claims that will inevitably arise in the future.” He noted how the small sample size contributed to its strong results—which are unlikely to be replicated in other samples. He also cited much larger studies looking for biomarkers for depression that failed to find evidence for them. His critique of the Redie et al. study was devastating. The comments from others seemed to agree. But how could these researchers be so blind?

Redie et al. apparently believed unquestionably that there is a biological cause for depression. As a result, their commitment to this belief effected how they did their research to the extent that they were blind to the problems pointed to by Coyne. Listen to the video embedded in the link “First Blood Test Able to Diagnose Depression in Adults” to hear Dr. Redie acknowledge she believes that depression is a disease like any other disease. Otherwise, why attempt to find a blood test for depression?

Attempts to replicate the Redei et al. study, if they are done, will raise further questions and (probably) refute what Coyne said was a study with a “modest sample size and voodoo statistics.” Before we go chasing down another dead end in the labyrinth of failed efforts to find a biochemical cause for depression, let’s stop and be clear about whether this “game changer” is really what it claims to be.

01/12/15

Can Addicts Stop Using Without Help?

Image by kikkerdirk

Image by kikkerdirk

Maia Szalavitz wrote on Substance.com that she stopped shooting coke and heroin when she was 23. “I quit at around the age when, according to large epidemiological studies, most people who have diagnosable addiction problems do so —without treatment.” Although she personally got treatment help, her article was about people who stop without treatment or assistance from self-help, 12-Step programs. It was provocatively titled: “Most People with Addiction Simply Grow Out of It: Why Is This Widely Denied?” She’s currently finishing her sixth book, Unbroken Brain, “which examines why seeing addiction as a developmental or learning disorder can help us better understand, prevent and treat it.”

Szalavitz referenced an epidemiological study, which suggested that a significant proportion of individuals achieve remission from addiction at some point in their lifetime. This study by Lopez-Quintero et al. found that “half of the cases of nicotine, alcohol, cannabis and cocaine dependence remitted approximately 26, 14, 6 and 5 years after dependence onset, respectively.” An article by Gene H. Heyman reviewed four studies, including the Lopez-Quintero one, and suggested that: “most addicts were no longer using drugs at clinically significant (emphasis added) levels by the age of 30.” According to Heyman:

The idea that addiction is a disease characterized by compulsive (involuntary) drug use goes hand in hand with the belief that addicts require lifelong treatment and that treatment is necessary for recovery. However, the epidemiological results indicate that most addicts do not take advantage of treatment; nevertheless, most quit. The logical inference is that remission from drug dependence does not require treatment.

The implications of Heyman’s and Szalavitz’s interpretation of the research studies they cited has far reaching consequences, particularly for the addiction treatment industry. So I want to take a look at these epidemiological studies that led them to conclude that most addicts quit drug or alcohol use (or enter remission) on their own. Heyman’s review article looked at four national epidemiological surveys of the prevalence of psychiatric disorders. Szalavitz seems to cite references to these same four studies or other articles by Heyman. So my interaction will be with the discussion in Heyman’s article: “Quitting Drugs: Quantitative and Qualitative Features.”

Hyman presented data from four large national epidemiological studies that reported high remission rates of diagnosed substance-related disorders. The studies and their remission rates were as follows: 76% for NCS, the National Comorbidity Survey; 83% for the NCS-R, the National Comorbidity Survey Replication; and 81% for the NESARC, the National Epidemiological Survey on Alcohol and Related Studies. Another study, the Epidemiological Catchment Area (ECA) survey reported a lower remission rate of 57%, but had combined the criteria for substance abuse and substance dependence into one category. He concluded: “The results do not support the often heard claim that addiction is a chronic, relapsing disease.”

Now I also have problems with defining addiction in pure medical/disease model terms and would be happy to see a more socially and cognitively nuanced definition of addiction become mainstream. But those self-generated remission rates seemed awfully high. How was this remission quantified?

First, let’s look at a critique of epidemiological miscounts by Allen Frances. Frances was the chair appointed by the American Psychiatric Association for the fourth edition of the DSM, the Diagnostic and Statistical Manual of Mental Disorders used by the epidemiological researchers to quantify their definition of “remission.” He initially pointed to an article by Regier et al., “Limitations of Diagnostic Criteria and Assessment Instruments for Mental Disorders” published in the journal, Archives of General Psychiatry in 1998. The Regier et al. article abstract raised concerns with “significant differences in mental disorder rates from 2 large community surveys”—the ECA and the NCS, two of the studies cited and discussed by Heyman.

Frances also presented his critique of epidemiological studies that use DSM diagnoses in Saving Normal. There he pointed to the “inherent limitations” of defining clinical cases in epidemiological studies. They used lay interviewers who make “diagnoses” by symptom counts, with “no consideration of whether the symptoms are severe or enduring enough to warrant diagnosis or treatment.” As a consequence, the judgment of a clinician is missing. “This results in rates that are always greatly inflated.” Symptoms “that are mild, transient and lacking in clinical significance” are mistakenly diagnosed as symptoms of psychiatric disorder.

They should never be taken at face value as a true reflection of the real extent of illness in the community. Unfortunately, the exaggerated rates are always reported without proper caveat and are accepted as if they are an accurate reflection of the real prevalence of psychiatric disorder. (Saving Normal, p. 86)

Another problem with these studies was how they defined “remission.” Remission was simply not reporting the required number of symptoms to meet the diagnosis over the previous year. Remission had a broader meaning than just “quitting” or abstinence.

The diagnostic criteria for substance abuse and dependence found in the DSM-IV were used by all the studies reported in Heyman. The ECA study, as noted above, included individuals who were “substance abusers” and “substance dependent.” The other studies only looked at those who were “substance dependent.” Remission for the ECA study was defined as no reported symptoms, while in the others, it was defined as two or less. This was based upon the separate criteria needed for each diagnosis—only one from the list for substance abuse, but three for substance dependence.

In Mad Science, Kirk, Gomory and Cohen noted how the DSM’s diagnostic criteria are the de facto definitions of mental disorder in the U.S. However, they said that describing a set of behaviors and labeling them as symptoms or diagnostic criteria does not establish the presence or absence of an illness or disorder.

Descriptive diagnosis is a tautology that distracts observers from recognizing that DSM offers no indicators that establish the validity of any psychiatric illness, although they may typically point to distresses, worries or misbehaviors (Mad Science, p. 166).

So the importance of clinical judgment, pointed to by Frances, in making a diagnosis of the existence or remission of substance dependence or substance abuse is essential. Following the critique of Frances and Regier et al. and their concerns with inconsistencies and limitations of using diagnostic criteria in epidemiological studies, the reported incidence rates of both substance dependence AND remission are likely to be greatly inflated in the studies reviewed by Heyman.

The conclusion that large populations of individuals with diagnosable addiction problems (substance dependence, according to Heyman) can stop or remit without help in such high percentages is suspect. In addition, the “diagnosis” of individuals as substance dependent in these studies is probably inaccurate for many of them. It is likely that many of those labeled as substance dependent in the studies were only substance abusers. According to Carlton Erickson in The Science of Addiction, substance abusers are more likely to make changes in their substance use because of “significant impairment or distress in their life as a consequence of their use.” They may quit on their own, without treatment. They may even go back to moderate or controlled drinking or mature out of the habit.

 

01/9/15

Does Anybody Really Know What Time Is?

I have at least one clock in the five main rooms of my house—for a total of eight if I count my computer, cell phone and wristwatch. Today, when I opened my eyes, the first thing I did was look at my clock: it was 6:36 am. After drinking my morning coffee and reading the online news, I fixed my breakfast and read my morning devotions and daily bible passages. About two hours later, I took a shower, dressed and gave my brother a ride to work. He was early, because I had to drop him off on my way to church. I too was early, getting there about twenty minutes before the 10:30 am service. There was time for another cup of coffee.

My life is very time-oriented. Even the counseling I do typically has a time-orientation: sessions are scheduled for an hour. Focusing on the “objective” passing of time as shown by a clock is what Vern Poythress described in Redeeming Science as a clock orientation. Another, more subjective experience of time focuses on the rhythms of human events. Here, we interact with one another or with created things (like now with my computer). These interactions have natural groupings of beginnings, middles and ends; and they end when they are over. Poythress called this an “interactive orientation.”

All human beings are aware of both kinds of time orientation. We can have interactive experiences of time in which we “lose track of time” and then realize it is later than we thought. I have been in counseling sessions where I lost track of time and felt I had to apologize to the next scheduled person who I kept waiting 10 or 15 minutes. Poythress said this is a consequence of our postindustrial American culture, which has a strong clock orientation.

Preindustrial societies have an interactive time orientation. Meetings start when everyone is there and end when the participants are “finished.” There isn’t an overt or implicit attention to objective time. Robert Levine commented in his book A Geography of Time that “life on the clock is clearly out of line with virtually all of recorded history.” Poythress said in Redeeming Science:

Clock time is more merciless than nature’s obvious rhythms. In the ancient world before the arrival of mechanical clocks, you experienced the rhythm of the seasons and the rhythm of day and night, but not the mechanical rhythm of the ticking clock.

Parallel with the progress of science and technology, a clock orientation has increasingly become an integral part of how we view the world and even how we read our bibles.

Poythress noted that if you went to Genesis 1 with a clock orientation, your focus would be on how long (according to a clock) it took to complete the creation account. But if you approached Genesis 1 with an interactive orientation, you’d ask what important events took place, and what their meaning could be. Remember that humans don’t appear until day six. But God was present “working with a rhythm like that of human work.” Immediately he’d know that it took six days; “six human-like cycles of work and rest, followed by a seventh day of longer rest.”

The pattern that would strike him would be the rhythm of work and not the rhythm of the ticking clock. And the days are truly days because of their correspondence to the human rhythm of the workday: “And there was evening and there was morning …” How long the days took as measured by a clock was a secondary issue.

Americans, because of their strong clock orientation, have a tendency to press the “question of clock ticks” since it is so much a factor in American culture. So when someone is asserting that the days of Genesis 1 were “ordinary days,” the person “is claiming the days were ordinary by clock time.” A person with an interactive time orientation would never call them “ordinary.” In terms of what took place within them, “they were among the most extraordinary days in all of history!”

Poythress suggested that when insisting upon a strict 24-hour-day viewpoint for Genesis 1, its proponents had adopted a clock orientation of time and perhaps “unconsciously given in to the philosophical primacy of a modern scientific orientation toward precise, quantitative measurement of time.”

Placing the 24-hour-day view of Genesis 1 as a cornerstone doctrine for conservative Christians has never sat right with me. So when I read the discussion of a distinction between clock orientation and interactive orientation by Vern Poythress in Redeeming Science, I wanted to make it available to a wider audience.

There can be a lack of grace and narrow-minded critique of individuals who disagree with a young earth creationist, 24-hour-day view of the Genesis days of creation. I see this in what Ken Ham wrote in his blog post about Hugh Ross, who has a day-age-view of the days in Genesis. Ken Ham is the president of Answers in Genesis, a self-described apologetics ministry with a young earth creation view. I think Deborah Haarsma, the President of the Biologos Foundation, has the right response, in her blog: have a gracious dialogue with those who differ on this view; it’s a disagreement among believers.

Vern Poythress noted how the Genesis account of creation and the Fall in Genesis chapters 1-3 provides a foundation for the doctrines of God, nature, humanity, sin and the Sabbath. And in terms of basic theology, the principal approaches to interpreting the Genesis creation account have the same outcome. They all affirm the same theological truths. And the exact amount of time that it took to accomplish creation makes no theological difference to these basic truths.

The theology of creation, and the theology of God’s control and goodness displayed in creation, remain fundamentally the same, however short or long the timing for the various acts of creation (Vern Poythress, Redeeming Science, 114).