America’s Pentecost

© Chris Light | English Wikipedia

Inside the Cane Ridge Meeting House © Chris Light | English Wikipedia

About thirty miles northeast of Lexington Kentucky is the Cane Ridge Meeting House. It sits on the site of what historian Paul Conklin said was “the clearest approximation of an American Pentecost.” From August 6th through August 12th in 1801 thousands of people gathered to celebrate the Lord’s Supper. “It arguably remains the most important religious gathering in all of American history, both for what it symbolized and for the effects that flowed from it.”

The events in Cane Ridge were initially organized as a traditional Scottish and Ulster Presbyterian communion service. Communicants were carefully screened by the presiding ministers, and when approved, given a small lead token to admit them to the communion table. The bread and wine were served as the communicants sat at long tables. If the assembly was large enough, the communion tables were filled repeatedly, with the service continuing until sunset.

The minister described the origins and purposes of the sacrament, blessed the elements, and then took a seat at the head of the table. Those assembled at the tables passed and partook of the bread and wine. They would eat and drink quantities that approximated those of a real meal, and not just consume a mere token amount of bread and wine. After a corporate prayer, they returned to their seats.

Over time, the communion service was expanded into a three to five day affair. There was a day of self-examination with fasting and prayer; Friday and Saturday sermons; and the Sunday communion service. A follow-up thanksgiving service on Monday was common. The preaching and exhortation was more like later revivals, quite different than that of the weekly pastoral sermon. The emotion tenor made it a likely time for conversion. The great communions also became a kind of festival or fair, with thousands of noncommunicant individuals attending. The crowds of spectators required most of the preaching to be outdoors on canopied platforms—tents.

Many of the wilder bodily effects that occurred at Cambuslang Scotland and later at Cane Ridge first occurred in 1625 at a series of services in Ulster Ireland in that have come to be known as the Six Mile Water Revival. In Cane Ridge, Conklin noted how it was the Ulster communions that first reported people fainting dead away and being carried outside in a trance.  “By the 1740s almost all the exercises that Cane Ridge would make famous, including not only sobbing, shouting, and swooning but bodily convulsions or jerks, had erupted in one or more congregations.” Similar revivals were occurring in Scotland, with Cambuslang being the penultimate example (See “Swift as Lightning”).

In Scotland and Ulster, as later in America, these huge regional communions proved very divisive.  The extended communion normally functioned as a routine ritual that was loved by almost all Scottish Presbyterians. . . . But in the three or four waves of revival, the huge rural gatherings, with all the extreme physical exercises, dismayed or frightened possibly a majority of Presbyterian clergymen.

By the mid-eighteenth century criticism of the spectacle at these communion services was taking place. This centered on the spectators who remained on the fringes of the religious services. Some came for fun or socializing, some to observe or ridicule, some to exploit the occasion by marketing goods. Their behavior was largely uncontrollable, despite carefully developed rules. To this crowd, communion was a carnival. Some critics saw the services as an embarrassing throw back to medieval fairs. The Scottish poet, Robert Burns, wrote satirically of these communions in his poem: “The Holy Fair.” But devout Presbyterians held the yearly communion season to be the peak religious experience of the year.

Conklin observed that the Scots-Irish Presbyterians, with their custom of communion seasons described above, were the most suitable institutional setting for periodic revivals in America. Fittingly then, the area around Cane Ridge was settled by a group of Scots-Irish Presbyterians in 1790, who built the meeting house in 1791.  In Logan County, over two hundred miles to the south and west of Cane Ridge, James McGready accepted a call as the minister to three small congregations in 1796. As soon as he arrived, he began preparing his congregations for a revival. He stressed an experiential religion and recommended a day of prayer and fasting each month. He also made use of the traditional four-day Scottish communion service. He timed the communions so that members of the three widely scattered congregations he pastored (named after local rivers: Red, Muddy, and Gasper) could travel to each of the other services, “thus creating the critical mass of people needed for a fervent revival.”

By the spring of 1797, he noted a brief awakening at Gasper River. By the summer of 1800, the Gasper River communion service drew people from distances as much as a hundred miles away. At the opening Friday session, there were already twenty to thirty wagons, with provisions, encamped nearby the meetinghouse. “The number of wagons on the grounds at Gasper River, and the informal tents created around some of the wagons, also gave Gasper River a disputed but pervasive claim to being the first camp meeting in America.” But according to McGready, the final sacrament at Muddy River exceeded that at Gasper River.

Revivals of various types “seemed to be popping up not only all over Kentucky but all over the United States in 1801.” Beginning in early May near the Licking River in northeastern Kentucky, there were a series of communion services leading up to the Cane Ridge service. Barton Stone, the minister of the Cane Ridge church, traveled to several of these, inviting those in attendance to come to his Cane Ridge communion beginning on Friday, August 6th. There had been anticipation for weeks before the service that Cane Ridge would not be “an ordinary summer sacrament.”

Services began on Friday, but rain held back the crowds. By Saturday, the roads were jammed with people traveling to Cane Ridge. The Saturday morning services were “reasonably quiet,” but by the afternoon, the preaching was continual, from both the meetinghouse and the tent. The excitement built, and before dark the noise from the cries and shouts of the penitent, mixed with the screaming of children and crying of babies and the neighing of horses led one visitor to refer to it as the roar of Niagra. “People could hear it as great distances.”

Although only ministers preached prepared sermons, or had allocated times to perform, literally hundreds of people served as exhorters at Cane Ridge. In the tumult the distinction between prepared sermons (with a theme or a text taken from the Bible and carefully developed points or arguments) and more spontaneous exhortations (extemporaneous or even impromptu practical advice, or tearful appeals or warnings) dissolved, particularly when outlying members of the audience could not even hear the sermons.

Some estimates have 20,000 to 30,000 people of all ages coming to the grounds around the Cane Ridge Meeting House on Saturday the 7th or Sunday the 8th of August. Conklin suggested that a more likely and more accurate estimate, mostly for logistical reasons, was there were at most 10,000 people on the grounds at one time. But he did acknowledge there could have been 20,000 at Cane Ridge at some point during the communion weekend and the following six days.

The majority of people at Cane Ridge were casual visitors or outsiders—those who came for the spectacle of the event. However, Conklin said this does not mean that all but a small minority was unresponsive to the religious content of the services. Many came to hear the preaching of able ministers besides observe the event and join in the excitement. While the communion service was orderly enough, the wildest exercises occurred outside the meetinghouse. Conklin said:

Outside, the groaning and falling continued. Some people experienced only weakened knees or a light head. . . . Others fell but remained conscious or talkative; a few fell into a deep coma, with the symptoms of a grand mal seizure or a type of hysteria. Crowds gathered around each person who swooned. Estimates of the number slain rose by Tuesday to 3,000, surely an exaggeration (more modest estimates ranged from 300 to 1,000).

A letter from a minister who was at Cane Ridge described the scene as follows:

Sinners dropping on every hand, shrieking, groaning, crying for mercy, convoluted; professors [of religion] praying, agonizing, fainting, falling down in distress, for sinners, or in raptures of joy! Some singing, some shouting, clapping their hands, hugging and even kissing, laughing; others talking to the distressed, to one another, or to opposers to the work, and all this at once—no spectacle can excite a stronger sensation.

Two ministers who went afterwards to assess the legitimacy of the revival in Kentucky and at Cane Ridge, Samuel McCorkle and George Baxter, had a sense that the extreme physical effects were incidental to what happened spiritually. Baxter has seen them in other revivals. However, McCorkle saw it was easier to be skeptical at a distance, as his own son was struck down in one of the meetings. While he was persuaded there could be a spiritual component to the extreme physical effects, McCorkle discounted the religious significance of the more violent exercises. “Sinners and saints were both susceptible.” McCorkle thought it was irresponsible for ministers to incite such exercises, since they were incidental to religious life.

Such “physical exercises” have occurred periodically within times of Christian revival before Cane Ridge and afterwards. The Cambuslang revival of 1742 and the Azusa Street Revival beginning on April 9, 1906 are two examples of physical exercises associated with times of revival. But the true test of a revival is not in the physical effects that occurred, but in the changed lives afterwards. George Baxter wrote to a fellow minister on January 1, 1802 that where Kentucky had been previously known for its debauchery, “I found Kentucky the most moral place I have ever been in.” Among the after effects of the Western revival, David Rice observed:

A considerable number of individuals appear to me to be greatly reformed in their morals. This is undoubtedly the case within the sphere of my particular acquaintance. Yea, some neighborhoods, noted for their vicious and profligate manners, are now as much noted for their piety and good order. Drunkards, profane swearers, liars, quarrelsome persons, etc., are remarkably reformed.

Ian Murray’s evaluation of the Kentucky revival in his book Revival and Revivalism noted parallels to Jonathan Edwards’ discussion of the Great Awakening. All awakenings are begun with the return of a profound conviction of sin. Many are brought from attitudes of indifference and cold formality to concern and distress so suddenly, that a temporary physical collapse could occur. By its very nature, a revival is bound to be accompanied by emotional excitement. Yet its progress, along with its abiding fruit and purity, is directly related to how such excitement is handled by its leaders.

When the degree of the Spirit’s work is measured by emotional strength, or when physical effects of any kind are considered proof of God’s action, fanaticism will follow. And those who adopt such beliefs suppose that any check on emotion or physical phenomena is equivalent to opposing the Holy Spirit. Murray concluded that the awakening in Kentucky was accompanied by the “chaff” of hysteria. He quoted Archibald Alexander of Princeton Seminary as saying:

It is not doubted, however, that the Spirit of God was really poured out, and that many sincere converts were made, especially in the commencement of the revival; but too much stress was laid on the bodily affections, which accompanied the work, as though these were supernatural phenomena, intended to arouse the attention of a careless world.


Abilify in Denial

© elenarts | stockfresh.com

© elenarts | stockfresh.com

Modern Healthcare reported that Proteus Digital Health, a California company, is partnering with Otusuka Pharmaceuticals to approve an Abilify “smart pill.” When a medication embedded with a sensor reaches the stomach, it sends a signal to a wearable sensor patch. The patch records and time-stamps the information and other information such as rest and activity patterns. Then the information can be relayed to patients on their phones or other Bluetooth-enabled devices; or it can be forwarded to physicians or caregivers.

It was just in July of 2015 that Proteus announced that the FDA had expanded the Indications for Use statement for its Ingestible Sensor technology to be used as an aid in measuring medication adherence. At this point in time, it seems to be the only device with an FDA-sanctioned claim for measuring medication compliance. Proteus and Modern Healthcare pointed to findings from a 2014 article in Risk Management and Healthcare Policy that estimated avoidable healthcare costs from poor medication adherence as between $100 to $300 billion annually in the U.S. That represents 3% to 10% of total U.S. healthcare costs.

Dr. George Savage, the co-founder and chief medical officer of Proteus, said the company hopes to give patients feedback on their adherence so they can improve their health and avoid adverse medication events. Dr. William Carson, the president and CEO of Otsuka Pharmaceuticals said: “We believe this new digital medicine could revolutionize the way adherence is measured and fulfill a serious unmet medical need in this population.” They expect a response from the FDA by April of 2016.

There is reportedly a widespread problem of with non-adherence to taking medications as prescribed, especially with individuals with mental illness. So the FDA suggested to Proteus that the need for an ingestible sensor was most needed by mental health patients. It seems to have been rushed through the approval process, with about nine months from the FDA approved expansion of the Indications for Use statement for Proteus’s Ingestible Sensor to the expected response by the FDA approving the Abiliy “smart pill.” So there are two questions to ask about this. Why the rush? Why is the greatest need for a smart pill with antipsychotics like Abilify?

Abilify went off of patent in October of 2014 and was made available as a generic in April of 2015. The Abilify smart pill would probably be a new molecular entity (NME) and thus eligible for a new patent. While aripiprazole (Abilify) will be available as a generic, only Otsuka and Proteus will be able to sell the smart pill version. Otsuka and its former distribution partner, Bristol-Myers Squibb, grossed $5.5 billion in Abilify sales for 2014.

The pressing need for a smart pill with psychiatric medications to help counter non-adherence issues is because there are serious, and sometimes debilitating side effects from taking them. Here is a link to an advertisement for Abilify as an add-on medication with antidepressants to treat depression. Most of the audio in the 90-second commercial is describing the potential side effects.

The side effects from antipsychotics can include: weight gain, diabetes, pancreatitis, gynecomastia (abnormal breast tissue growth), hypotension, akathesia (a feeling of inner restlessness), cardiac arrhythmias, seizures, sexual dysfuntion, tardive dyskinesia, anticholinergic effects (constipation, dry mouth, blurred vision, urinary retention and at times cognitive impairment). Read more about these and other side effects at: “Side Effect of Atypical Antipsychotics: A Brief Overview”;  “Antipsychotic Drugs, Their Adverse Effects”; “Adverse Effects of Antipsychotic Medications”; and “An Overview of Side Effects Caused by Typical Antipsychotics.”

The website RxISK described some of the reports and first-hand accounts about individuals who had used Abilify in: “Abilify From the Inside Out.” Out of 34 who had used Abilify, only five had taken it for a “psychotic” diagnosis. Fourteen were taking it for depression. Six used it for bipolar disorder; three for other diagnoses; two for “stress”; and three for unknown reasons. Fifteen individuals were taking Abilify in conjunction with antidepressants.

Most patients were on more than one medication, so they could not be sure that if Abilify alone caused these adverse effects. Nevertheless, there were three confirmed suicides and several episodes of severe emotional stress or physical misery. Eight people reported akathisia and six reported unusual anger or aggression. Two of the aggression episodes were violent physical attacks on family members. One woman assaulted her husband when she had “bizarre and frightening thoughts.”

At the other extreme, 14 people reported over-sedation and cognitive slowing, with memory, concentration and word-finding problems.  About half felt a profound emotional numbing, an inability to feel pleasure or care about anything. One man regretted this state, but felt it was better than his prior severe depression.  For the rest, however, it brought new or worse depression.  Three felt trapped at home by “total lack of interest in life” along with anxious depression; loss of the ability to pursue, or even care about, formerly cherished goals was painful for others.  Most reported suicidal thoughts of varying intensity.

Three people had tremors, but of these cases cleared up when they stopped the drug. Four others had tardive dyskinesia. Their symptoms started after using Abilify for at least a year; and they continued despite stopping the drug. “They found their condition painful, debilitating, disfiguring and socially isolating.” Four men reported sexual dysfunction. One man had a gambling problem that began two months after starting Abilify. “Eight people had their worst problems on stopping Abilify.”

Johanna Ryan, who wrote the article on RxISK, said that most antidepressants are metabolized in the liver by the same enzymes that process Abilify. So the resulting “traffic jam” will effectively raise the level of Abilify in your blood. Some SSRIs have also a stronger effect than others on this issue. “Your actual Abilify levels might be 150% to 300% of your official dose.” Side effects such as agitation, anxiety, insomnia and nervousness commonly occur with antidepressants and can increase your chances of akathisia with Abilify.

In other words, the “little baby dose” was an illusion.  Even 2 mg was bigger than it seemed – and doses over 5 mg could put you on a par with patients taking Abilify for psychosis.  (Those patients may be taking excessive doses as well: Two patients with psychotic symptoms in the RxISK group found they did better on half the dose their doctor initially prescribed.)

In “Dodging Abilify” on RxISK, Johanna Ryan related how a psychiatrist had tried to convince her once to try Abilify for her depression.  He told her “these drugs” (referring to Abilify) weren’t really antipsychotics since they were used to treat several kinds of things. “’Oh, come on,’ he coaxed.  ‘We’re talking about little baby doses here, just a fraction what they give people for schizophrenia.’”  Like other antipsychotics, it blocks certain dopamine receptors. Unlike them, it is a “partial agonist,” meaning it activates others.

Now let’s go back to the cute Abilify commercials. This one includes a woman and her umbrella. Listen to see if Abilify is ever referred to as an antipsychotic or neuroleptic. As a matter of fact, it wasn’t. The same is true for the link to the commercial above. Admittedly, these commercials were pushing Abilify as an add-on to antidepressants. But now download the FDA Medication Guide for Abilify, and search through it. You won’t find the word “antipsychotic.” The word “neuroleptic” appears once within the listing of a side effect: neuroleptic malignant syndrome. Abilify is described and presented as an “antidepressant medicine” throughout the medication guide. There were other antipsychotics that seemed to also minimize using these two words (neuroleptic and antipsychotic) in referring to their drug, but not to the same extent as noted for Abilify. My thought is Otusuka decided that referring to Abilify as an antipsychotic or neuroleptic was bad for business.

So Abilify is a neuroleptic that apparently wants to be known as an antidepressant and absolutely HATES to be referred to as an antipsychotic. Yet it has the same kinds of adverse side effects as other neuroleptics. (If it walks like a duck and talks like a duck …) And of all the current antipsychotics on the market, Proteus partnered with Otsuka first to create an Abilify smart pill to facilitate medication compliance with its drug. To borrow a phrase from addiction recovery, it sounds like Abilify is in denial about being an antipsychotic.


Recognizing Your PAWS

© willeecole |stockfresh.com

© willeecole |stockfresh.com

I knew a woman who was staying in a six-month drug and alcohol residential treatment center. She began to forget where she left her cigarettes. At first, it was just frustrating and kind of embarrassing. She would check the cafeteria; the living room; the group room. She’d go upstairs to her bedroom. She’d ask other residents if they saw her cigarettes. She’d check outside at the picnic table where the residents smoked. After awhile, she began to worry that she was losing her mind and even became fearful she could end up in a mental hospital.

There was a guy in his thirties who worked out with free weights in his basement. He’d been doing this since he began playing sports in his teens, but got away from it when his drinking became more important. After a few weeks of abstinence, he decided to start lifting again and went down to his basement. He started out with a fairly light amount of weight and intended to do some bench presses. But he almost dropped the bar on his windpipe. He spent a few days worried that his drinking had physically damaged him to the point that he didn’t have the strength and coordination to lift weights.

Both of these individuals were in the early stages of recovery and both were experiencing problems with post acute withdrawal (PAW) symptoms. Learning about PAW helped each of them see that they weren’t losing their mind, nor had they caught some degenerative muscle disease from their drinking and drug use. The material on PAW that I’ve found to be most helpful is that published by Terence Gorski. He discusses PAW symptoms and how to manage them in Staying Sober, and Straight Talk About Addiction, which are available through Amazon or Herald House Independence Press. You can even find a free comprehensive guide on PAW, excerpted from Staying Sober, on Terry Gorski’s Blog.

“Post acute withdrawal is a group of symptoms of addictive disease that occur as a result of abstinence from addictive chemicals.” PAW symptoms can appear as early as 7 to 14 days into abstinence—just as the person stabilizes from any acute withdrawal symptoms they might experience. They are a combination of the damage done to the nervous system from alcohol and drugs and the psychosocial stress of now trying to cope in life without drugs and alcohol. Gorski said there are six major types of PAW symptoms: 1) inability to think clearly; 2) memory problems; 3) emotional overreactions or numbness; 4) sleep disturbances; 5) physical coordination problems; and 6) stress sensitivity. The PAW Comprehensive Guide on Terry Gorski’s Blog has a helpful discussion of each of these PAW symptoms.

The symptoms of PAW typically grow to peak intensity over three to six months after abstinence begins. The damage is usually reversible, meaning the major symptoms go away in time if proper treatment is received. So there is no need to fear. With proper treatment and effective sober living, it is possible to learn to live normally in spite of the impairments. But the adjustment does not occur rapidly. Recovery from the nervous system damage usually requires from six to 24 months with the assistance of a healthy recovery program.

Gorski noted that research has also shown that PAW symptoms can go through cycles or crop up without any triggers or stressors going on. The classic pattern of slips that seem related to PAW cluster around sobriety dates—30, 60, 90 days; 6 or 12 months. They can occur without an obvious pattern or trigger. People in recovery from long-term opiate or stimulant use have reported times of PAW symptoms for no apparent reason for up to ten years after their abstinence. “Individuals who intend to have consistent long-term recovery must learn to recognize these symptoms and learn how to manage them.”

A helpful tool to do this can be found in Gorski’s Staying Sober Workbook, the Post Acute Withdrawal (PAW) Self Evaluation. I encourage people in early recovery to make a copy of their PAW self evaluation, date it and then hold on to it. If they later experience a time when PAW symptoms reemerge, they can compare it to the earlier time when PAW was in full bloom. This can be helpful in judging just how dangerous the most recent time of PAW is to their recovery. If a stressor after one year of abstinence can trigger PAW symptoms at the level of intensity you were having with only two or three months of abstinence, that’s crucial information for someone in recovery to have.

The booklet The Relapse/Recovery Grid by Gorski is an excellent summary of both his Developmental Model of Recovery and the Relapse Process. There is a handy grid that provides you with a comparison of both the Developmental Model of Recovery and the Relapse Process. I’ve found this grid to be very helpful when doing psycho-educational presentations on both recovery and relapse. One of its features relevant to our discussion here is how the above noted PAW symptoms are the heart of the initial stage of the Relapse Process, Internal Dysfunction. Here is the introductory paragraph on Internal Dysfunction:

When under high stress, many recovering people begin to have difficulty thinking clearly, managing feelings and emotions, and remembering things. One of the main culprits leading to these problems appears to be a tendency to overreact to stressors. Scientists call this neurological augmentation. Many recoverying people refer to this as stress sensitivity. People perceive light to be brighter, sound to be louder, and touch to be intrusive. They startle easily and quickly, and become distracted by things that happen around them. Eventually, the ability to sleep restfully is disrupted. This heightens stress and fatigue to the point where people become accident-prone.

This illustrates the importance for someone to recognize, monitor and manage PAW symptoms throughout recovery. The person who can effectively do so increases the likelihood of never lapsing or relapsing into active drug or alcohol use again because they are neutralizing a relapse in its initial phase. Also look at “Managing Your PAWS.”

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.