10/7/15

Psychiatry, Diagnose Thyself! Part 2

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© lightwise | 123rf.com

Similar to what happened to Robert Spitzer, just as Jeffrey Lieberman released his “untold story of psychiatry” in Shrinks and began his book tour, the very themes he presented as the uncensored truth about psychiatry were being challenged by others. Whose story about psychiatry and its history would the public believe? Although Lieberman did acknowledge in his CBC interview that he was “unfortunately” familiar with Robert Whitaker, he didn’t elaborate on how far back their acquaintance goes.

Like his description of David Rosenhan in Shrinks, Lieberman attempted to discredit what Whitaker and T. M. Luhrmann had to say by his ad hominem assessment of them (see “Psychiatry, Diagnose Thyself! Part 1”). Luhrmann’s work on psychiatry, Of Two Minds, received several awards, including the Victor Turner Prize for Ethnographic Writing and the Boyer Prize for Psychological Anthropology. Anatomy of an Epidemic by Whitaker won the 2010 Investigative Reporters and Editors book award for best investigative journalism. And in 1998, he co-wrote a series on psychiatric research for the Boston Globe that was a finalist for the Pulitzer Prize for Public Service. It was while writing this series of articles that Lieberman and Whitaker first became acquainted with each other.

The first installment of the series, “Testing Takes Human Toll” was published on November 15, 1998. In this article, Whitaker and others described how beginning in 1972, psychiatric researchers used a variety of agents such as methylphenidate (Ritalin, Concerta), ketamine, and tetrahydrocannabinol (THC) “to deliberately provoke psychotic symptoms in more than 1,200 schizophrenic patients.” In some cases, the level of psychosis experienced by these patients was called “severe.” Jeffrey Lieberman was one of those researchers. He conducted methylphenidate challenge tests for more than a decade.

Here is a sampling of three articles where Lieberman was a co-author of studies where methylphenidate was given to schizophrenic patients in order to activate psychotic symptoms.

In a 1987 study, 34 stable outpatients receiving neuroleptic treatment were given an infusion of methylphenidate and then withdrawn from their neuroleptic medication. Three weeks after they were withdrawn from their psych meds, they were given another infusion of methylphenidate. Then the unmedicated patients were followed up for 52 weeks—or until they relapsed; in other words their symptoms returned.

A 1994 study had a similar methodology, 41 stable patients receiving neuroleptic treatment were given an infusion of methylphenidate. They were also withdrawn from their neuroleptic meds and followed for 52 weeks, or until relapse.

In a 1990 study, 38 patients who met the criteria for schizophrenia or schizoaffective disorder were given an infusion of methylphenidate, followed by a regimen of standard acute neuroleptic treatment. This time the patients were individuals who were experiencing their first acute episode of psychosis. The methylphenidate produced an increase in psychopathology reflected by a worsening of their symptoms.

Another 1987 article with Lieberman as a co-author was a meta-analysis of 36 studies that used psychostimulants (PS) in schizophrenia. The authors noted that non-amphetamine drugs like methylphenidate appeared to have a greater “psychotogenic potency.” In other words, they elicited a greater psychotic reaction than amphetamine drugs. “Approximately 40% evidence a psychotogenic response to PS administration in doses that are subpsychotogenic in normal’s.” Don’t miss the fact that Lieberman knowingly used a psychostimulant in his own studies that he knew would elicit a greater, more intense psychotic reaction than amphetamine drugs.

Psychologist Bruce Levine gave a scathing response to Lieberman’s “menace to society” remark concerning Whitaker. He unpacked the pre-1994 studies and questioned the claim that the subject and family members were willing and able to sign informed consent. Levine said: “Who in their right mind would give consent for themselves or for a family member for a procedure that was hypothesized to make a patient worse?”

When Whitaker interviewed Lieberman for the first article in the Boston Globe series, “Testing takes human toll,” Lieberman admitted that the induced symptoms were sometimes “scary and unpleasant.” He even acknowledged that some patients get worse. “But in my experience, the symptoms never exceeded the range of severity that occurred in the course of their illness previously.” Ironically, Lieberman was entirely silent on the topic of schizophrenic challenge studies in Shrinks. They weren’t even discussed as one of the positive examples of how modern psychiatry “now practices an enlightened and effective medicine of mental health.”

Dr. Davis Shore, who was doing ketamine challenge studies for the NIMH, minimized the harm done to patients in challenge studies.  He argued that the increase in symptoms was very short-lived in patients who had experienced them over years. ‘”To say that increasing a particular symptom – like hearing voices for a couple of hours in somebody who has been hearing voices for 10 years – is causing [suffering] rather seems like a stretch.” Here is a 1987 account of one such “stretch” Whitaker saw reported in the scientific literature. The individual was a patient with bipolar disorder who was injected with methylphenidate.

Within a few minutes after the infusion, Mr. A experienced nausea and motor agitation. Soon thereafter he began thrashing about uncontrollably and appeared to be very angry, displaying facial grimacing, grunting and shouting … 15 minutes after the infusion, he shouted, ‘It’s coming at me again, like getting out of control. It’s stronger than I am.’ He slammed his fists into the bed and table and implored us not to touch him, warning that he might become assaultive. Gradually over the next half hour, Mr. A calmed down and began to talk about his experience.

Whitaker’s 1998 series for the Boston Globe is still a worthwhile read. Part 2, written by Deborah Kong, gives more details on “Debatable forms of consent.” She noted how researchers have conceded in court documents that they did not tell mentally ill patients the whole truth for fear of scaring them away from enrolling in the experiments. Part 3 by Robert Whitaker, Lures of riches fuels testing, looks at the influence of the pharmaceutical industry on drug research. In Part 4, “Still no solution in the struggle on safeguards,” Dolores Kong wrote about how the psychiatric community has argued that challenge and washout studies are important avenues to understanding the underlying biology of mental illness. “To this day, some psychiatric specialists are conducting medical experiments in which research subjects are allowed to grow sicker.”

On May 6, 2015, Robert Huber received a letter of apology from the University of Minnesota saying that the university was sorry that his “rights and welfare were compromised.” In July of 2007, Huber was admitted to the University of Minnesota Medical Center with symptoms of schizophrenia, where he was for two weeks. During that time, he was recruited daily to volunteer for a drug trial for an experimental drug called bifeprunox. He was repeatedly told the drug was safe, even though determining safety was one of the goals of the study. In the process of his recruitment for the study, he was also shown “the cost of his hospital care if he didn’t sign up and have the study pick up the tab.”

But there were problems. He experienced severe abdominal pains, which required two ER visits. His records indicated that the doctor in charge of the study thought it unlikely that they were due to the medication. At one point, he contemplated suicide because of the pain. In August of 2007, the FDA decided to not approve bifeprunox, but Huber was not informed of that decision and remained in the study until he withdrew in October of 2007. The university also acknowledged that he was not informed in his consent form of the risks of a medication washout that was necessary before starting the new medication, bifeprunox.

There are several concerns with these kinds of psychiatric research methods. The giving and withholding of medication may create unique risks for the subject. Individuals diagnosed with schizophrenia are at a greater risk of suicide during relapses. Adverse events of all types are more likely to occur as medications are increased or decreased in dosage. George Annas, chair of Health Law Department at Boston University School of Public Health said: “We let researchers do things to people with mental illness that we would never let them do to people with physical illness.”

There are three basic research designs with medications in psychiatry: placebo, washout (where medication is tapered and withdrawn), and challenge (symptoms are provoked in some way). In “Ethics in Psychiatric Research: Study Design Issues,” Gordon DuVal gave a helpful summary of these three research designs. His conclusion was:

Despite a history that has included serious abuses, psychiatric research is important—not least to those who suffer from mental illness. Clinical psychiatric research creates challenging ethical dilemmas. The choice of research design can have significant implications for subject safety and must be carefully considered. While these issues are not necessarily unique to this context, the particular vulnerabilities attending psychiatric illness merit close attention in the design of research involving persons with psychiatric disorders.

DuVal singled out challenge studies as particularly risky, despite the potential research benefits. The risk is that someone who is already sick or vulnerable to a negative response to the challenge “may have harmful symptoms provoked or exacerbated or may suffer a relapse.” He said it was unclear whether the balance of risks and potential benefits can ever justify people in studies where “potentially harmful responses are intentionally induced.” But this is exactly what schizophrenic challenge studies done by Lieberman and others were designed to do. They often have a washout element, which heightens the ethical concerns. “Finally, for practical reasons, challenge studies often require that subjects be deceived, or at best partially informed, about the details of the study.”

A search in Google Scholar found 1,030 entries for “challenge studies”, psychiatry since 2011. This suggests that some psychiatric specialists are still conducting medical experiments in which individuals with various mental illnesses are allowed to grow sicker, and even triggered to so do, in the name of science. This technique is seen as a valuable and necessary element in psychopharmacological research. D. C. D’Souza and J. H. Krystal said in 2001 that: “Psychopharmacological challenge studies have made significant contributions to understanding the neurobiological basis of psychiatric disorders.” They may continue to provide an important method of testing pathophysiologic mechanisms and studying potential pharmacotherapies.

So here’s what I’m thinking. Dr. Jeffery Lieberman writes a book that is supposed to be the untold story of psychiatry for the general public. But he is totally silent in Shrinks about research where psychiatric symptoms are triggered in patients by challenge agents. It’s not given as an example of the scientific standing of the field or the revolutionary process in psychiatry over the past fifty years. His past use of the methods, coupled with his silence, also suggests he still believes that it has a place in psychiatric research. And it certainly is not given as an example of psychiatry’s “long sojourn in the scientific wilderness” in Shrinks along with lobotomies, coma therapy, and fever cures.

Could he have decided to not mention challenge studies, because he thought the public would not accept them or would misunderstand their importance? Worse still, similar to the Rosenhan study, would they be seen as an example of the bankruptcy of psychiatry? Robert Whitaker could connect the dots for the general public between Lieberman and his past challenge studies, so did he become a particular target for marginalization and discrediting by Lieberman? Another possibility is that discussing challenge studies complicates the story of progress and heroism Lieberman wanted to tell in Shrinks. His goal does seem to have been a retelling of the same old rhetoric put forth by the APA since 1980. As Whitaker observed in his review of Shrinks, this mantra was:

The disorders in the DSM are real diseases of the brain; the drugs prescribed for them are quite safe and highly effective; and psychiatric researchers are making great advances in discovering the biology of mental disorders. Therapeutic and research progress are to be found at every turn.

It will be interesting to see what the future holds for psychiatry. Does the given rhetoric of the APA hold sway, or will the growing questions about psychiatry and diagnosis lead to another revolutionary change. Will the public continue to believe Lieberman’s version of the untold story of psychiatry; or will they begin to see it in light of what Whitaker has written? Stay tuned.

09/30/15

Psychiatry, Diagnose Thyself! Part 1

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© lightwise | 123rf.com

Wow. I can hardly believe he said the things he did. Dr. Jeffery Lieberman, a former president of the American Psychiatric Association and the Chairman of the Department of Psychiatry at the Columbia University College of Physicians and Surgeons, took umbrage at an op-ed article written in The New York Times on January 17, 2015 by Stanford anthropologist T.M. Luhrmann, “Redefining Mental Illness.”  Luhrmann referred in her article to a report by the British Psychological Society, “Understanding Psychosis and Schizophrenia,” that suggested interpreting paranoid feelings and hearing voices as symptoms of mental illness was only one way of thinking about them. She indicated the report said antipsychotic medications were sometimes helpful, but “there is no evidence that it corrects an underlying biological abnormality.” It went on to warn about the risks of taking these medications over the long term.

In a Medscape video “What Does The New York Times Have Against Psychiatry?” Lieberman referred to the NYT publication of her article as “journalistic opportunism.” He chided the editors for thinking that “providing a platform for this would be useful.” With regard to Luhrmann, he cited the title of her books, whose subject areas dealt with religion and God, witches, and psychiatry. Yes, they were eclectic topics, but how does that then lead him to this comment:

The equating of psychiatry with these other topics suggests that she thinks of psychiatry not as a hard science but as something that is either a philosophical or religious discipline, has a supernatural or religious dimension, or is in the realm of the supernatural.

I’ve read two of her books, Of Two Minds and When God Talks Back, and for the life of me I cannot follow how he can make that connection. There was not association of psychiatry with witchcraft or religion on Luhrmann’s part in her NYT article; I can only conclude the association was somehow in Lieberman’s mind, not Luhrmann’s article.

But she did comment how there was plenty of scientific evidence for the report’s claims. She then had the audacity to mention that the National Institute of Mental Health (NIMH) announced in 2013 that it would no longer pursue diagnosis-driven research. Under a program called Research Domain Criteria (RDoC), all research would begin from a matrix of “functional dimensions, grouped into broad domains such as cognition and reward-related systems.” One example she gave from the RDoC site was how psychiatric researchers would no longer study people with anxiety. Rather they would study fear circuitry.

Lieberman went on to name some additional publications by Lurhmann, and said: “This hearkens back to the days when psychiatry had only fanciful theories about the mind and what caused mental illness in people.” Thankfully, he said we are well past that.  Articles like Luhrmann’s, according to Lieberman, are a throwback to the days of ignorance and fear; and they spread stigma.

Why would The New York Times do this? It is very disturbing that we still live in an age when the stigma of mental illness and the lack of interest in trying to present medical science as it deserves and needs to be for an informed public, is still preyed upon by this kind of journalistic opportunism.

Then Lieberman was interviewed on CBC radio podcast, “The Sunday Edition” on April 26, 2015. He was there to promote his new book, Shrinks, a history of psychiatry for the general public. After playing an excerpt of an interview he did over a year ago with Robert Whitaker, the host asked Lieberman to comment on what Whitaker had said in the excerpt. Lieberman said: “What he says is preposterous. He’s a menace to society because he’s basically fomenting misinformation and misunderstanding about mental illness and the nature of treatment.”

But he wasn’t finished. Lieberman went on to say how Whitaker “ostensibly considers himself to have been a journalist.” Whitaker has won awards for his journalism and was even a finalist for a Pulitzer in Public Service. But Lieberman lamented: “God help the publication that employed him.” Lieberman also thought Whitaker’s comments that some unmedicated patients did better than medicated ones were absolutely wrong. If you did a randomized, controlled study of any of the various psychiatric illnesses, using whatever is state of the art in psychiatry, including medication, Lieberman said: “the outcomes will be extraordinarily superior in the treated group.”

This led to “A Challenge to Dr. Lieberman” by Whitaker on his website for Lieberman to provide a list of randomized studies that show how medicated patients have a much better long-term outcome than unmedicated patients. He noted how he had posted the abstracts of the studies he cited in his book, Anatomy of an Epidemic on his website, madinamerica.com. “So here is you chance to point to the studies I left out.”

1 Boring Old Man commented on this outburst by Dr. Lieberman and Whitaker’s reply, observing how Lieberman sees himself as the spokesman and champion for “Psychiatry.” His article also described the Lieberman rant against Lurhmann and also cited several articles written by Lieberman over the past few years with the same theme. I’d just finished reading Lieberman’s book and was struck in reading 1 Boring Old Man’s article by how it seemed Lieberman was casting himself in a role similar to the one he gave Robert Spitzer in Shrinks. Spitzer was portrayed there as an unlikely hero and a psychiatric revolutionary who, in effect, saved psychiatry from imploding during the 1970s. Psychiatry today seems to be in similar situation, with questions being raised about the current validity and reliability of DSM diagnosis, and the credibility of psychiatry itself.

So if Lieberman sees himself as a modern psychiatric hero, then Robert Whitaker would be a natural pick by Lieberman as an antipsychiatry foil, replacing David Rosenhan, who was a “foe” of psychiatry in the 1970s. In Shrinks, Lieberman discussed the controversies over the DSM-5, saying the APA hadn’t experienced that kind of public pressure since the early 1970s, “when the Rosenhan study, the homosexual controversy, and the antipsychiatry movement compelled the APA to move away from psychoanalysis and endorse a radically new paradigm for psychiatric diagnosis. See “A Censored Story of Psychiatry, Part 1, Part 2” and “The Quest for Psychiatric Dragons, Part 1, Part 2” for more on Spitzer, Rosenhan and these issues.

In his role as a “foe of psychiatry,” Whitaker has published three well-received books by both the general public and individuals within the mental health profession that are critical of the current state of psychiatry and mental healthcare. His most recent book, Psychiatry Under the Influence, was just released on April 23, 2015.

So we have these successive actions: Lurhmann’s article published in the NYT on January 17th. Three days later Lieberman recorded his Medscape response, which was published online on February 18, 2015. The release date for Lieberman’s book, Shrinks, was on March 10, 2015. Whitaker’s review of Shrinks appeared on his website, Mad in America on March 19th. The release date for Whitaker’s book, Psychiatry Under the Influence, was on April 23rd. Lieberman’s CBC interview was on April 26, 2015. Whitaker’s invitation to Lieberman was on April 26th as well.

I don’t think he’ll take Whitaker up on his challenge. He can’t. The science doesn’t support his position. Go to madinamerica.com and read through the abstracts mentioned above by Whitaker to confirm this. But why would one of the top psychiatrists of our time write and say such obvious drivel?

It’s all PR. In his review of Shrinks, Whitaker noted how Shrinks doesn’t tell a previously unknown tale. Rather, it “relates a story that the American Psychiatric Association has been telling the American public ever since it published DSM III in 1980.” Whitaker and Cosgrove noted in Psychiatry Under the Influence that by adopting a disease model and insisting psychiatric disorders were discrete illnesses in the 1970s, the APA simultaneously responded to its antipsychiatry critics and addressed its image problem by presenting itself to the public as a medical specialty. “Metaphorically speaking, psychiatry had donned a white coat.” Whitaker pointed out in his review how Lieberman wore a doctor’s white coat for a promotional video he did on YouTube, where he discusses his book. I noticed that he did the same thing for his Medscape video critique of Lurhmann and the NYT.

Whitaker said Shrinks provided a revealing self-portrait of psychiatry as an institution. Lieberman repeats the same story the APA has been telling the public since the publication of the DSM-III. “And it is this narrative, quite unmoored from science and history, that drives our societal understanding of mental disorders and how best to treat them.” He observed that Lieberman diagnosed the Freudians as extravagant, grandiose and having irrational faith in its world-changing powers. The same symptoms seemed to be present in Shrinks.

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?

 

07/18/14

How God Became Real for Two Modern People

Soon after Bill admitted himself to the Towns Hospital for what would be the last time, he cried out: “If there be a God, let Him show Himself!” His hospital room was filled with a white light. He was seized with an “ecstasy beyond description.” In his mind’s eye, he stood on the summit of a mountain, where a great wind of spirit blew right threw him. “Then came the blazing thought: ‘You are a free man.’” He became aware of a Presence, like a sea of living spirit. “This,” he thought, “must be the Great Reality. The God of the preachers.” Bill Wilson never took another drink. He had started down the path to become one of the cofounders of Alcoholic Anonymous.

Within our modern culture, “sensory override” encounters with the supernatural are met with skepticism or viewed as the ravings of fanatical individuals and groups. But rejecting the reality of the supernatural contradicts what William James described in The Varieties of Religious Experience and what T. M. Luhrmann reported in When God Talks Back.  Bill Wilson read VRE to help him make sense of his encounter with the God of the preachers. And Bill would later refer to James as a “cofounder” of A.A.

Like William James, Luhrmann persuasively validated these experiences of the supernatural in When God Talks Back. She even provided some experimental evidence that “sensory override” experiences were not pathological. See a description here in “How Does God Become Real for Modern People?

I have never worshipped in a Vineyard church. But I did spend some time in charismatic evangelical churches after my own personal encounter with God. A friend challenged me to read the book, More Than A Carpenter, by Josh McDowell. He said it had played a role in his own conversion. I remember being surprised by McDowell’s effective use of logical argument. But, I still wasn’t persuaded, as my friend had been.

One Saturday afternoon, I found myself wondering why McDowell said the death, resurrection and ascension of Jesus Christ was necessary for the redemption of humanity. Then in my mind (not audibly) I heard a voice say: “There was no other way.” I immediately knew the statement was true. And I immediately knew that voice was God.

I grew up in the Roman Catholic church, but had never been told that God would speak to you like that. Ironically, at that time one of the individuals I counseled actually believed he was Jesus Christ when he was in a psychotic state. I returned the book to Jerry, not saying anything about God speaking to me. My plan was to never speak of that experience to anyone. A few months later, some further, less profound experiences led me to acknowledge Jesus as my savior and Lord. I eventually did contact Jerry and tell him about God talking to me; and I have periodically told others of the experience as well.

God speaking to me is a part of my personal spiritual journey. But it is not an experience that I intentionally sought to cultivate (then or now), like the members of the Vineyard Christian Fellowship. This was over thirty years ago, and I have not had a spiritual experience of the divine that has ever come close to this encounter since then. I agree with T. M. Luhrmann that: “the problem of faith is not finding the idea of God plausible but sustaining that belief in the face of disconfirmation.”

You don’t have to have God talk to you in order to believe in Him. But if He does, it can make Him real to you in a profound way. Thanks Tanya for helping me to better understand my personal encounter with God. I look forward to your next project. And I have some suggestions, if you’re interested.

Have you had any sensory override experiences of your own?

07/4/14

How Does God Become Real for Modern People?

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image credit: lightstock

Several years ago I read a fascinating study of psychiatry, Of Two Minds, by T. M. Luhrmann. Her insights brought clarity to how I view modern psychiatry and how it has changed since the 1970s. So I looked forward to reading When God Talks Back, where she sought to explain to nonbelievers how God becomes real for modern people. What I didn’t expect was to find new insight into how God became real to me over thirty years ago. In a future post, “How God Became Real for Two Modern People,” I describe two examples of what Luhrmann calls sensory override encounters with God, one of which happened to me personally.

Luhrmann spent time with members of two separate churches in the Vineyard Christian Fellowship. She intentionally chose a style of evangelical Christianity whose belief system would be difficult for ordinary Americans to accept. Members of Vineyard churches are encouraged to see God as someone who “interacts with them like a friend”; someone who speaks to you—at times with an audible voice. God is someone who you can hang out with; or go on a date with. Someone who wants you ask for specific things, like a particular score on your medical boards: “God just doesn’t want to know that you want to pass the MCAT. . . . God wants a number.”

According to Luhrmann, the relationship with God within a Vineyard church represents a shift towards “a more intimate, personal and supernaturally present” encounter with the divine that has developed in American spirituality over the last forty years. This style of evangelicalism wants Jesus to be as real in their lives as He was in the lives of the disciples. And it “involves an intense desire to experience personally a God who is as present now as when Christ walked among his followers in Galilee.”

God becomes “hyperreal.” He is “so real that you are left suspended between what is real and what is your imagination.” In literature, film and art, this is known as “magical realism.” Here the supernatural is seamlessly and unexpectedly blended into the natural world. Some film examples of this would be: “Stranger Than Fiction” and several Woody Allen movies, including: “Midnight in Paris” and “To Rome With Love.”

Luhrmann’s thinks that understanding or experiencing God in this way helps believers manage the doubts posed to such a belief within Western culture where reality is explained in terms of natural, physical laws. God becomes so real and so present that “the supernatural is presented as the natural.” In other words, individuals report sensory perceptions of the immaterial: of God. These “sensory overrides” are odd moments of hearing a voice when you are alone; seeing something that isn’t there; smelling or tasting something that isn’t present.

She systematically and even experimentally demonstrated how these sensory overrides were not pathological. Unlike hallucinations, these experiences of the immaterial were typically rare, brief, and not distressing. Luhrmann pointed to examples in the Bible and a long Christian tradition of individuals reporting they heard or saw the supernatural. But these sensory overrides are not limited to purely religious experiences. Like William James, in The Varieties of Religious Experience, Luhrmann successfully described what James said was the instinctive belief of humankind: “God is real since He produces real effects.”

Are people seeking “a more intimate, personal and supernaturally present” experience of God?

06/20/14

Groanings Too Deep for Words

My personal spiritual journey includes experiences of God talking to me; words of knowledge or discernment; praying in tongues and prophetic utterance. But I do not see myself as a charismatic or Pentecostal Christian. Nor do I think these experiences are more profound than insight gained from reading and studying the Bible. Well, maybe the time God talked to me should be reserved as a more profound experience; especially since it didn’t occur as a result of ingesting psychedelic drugs.

Recently I discovered an online dialogue about these experiences stemming from T. M. Luhrmann’s book, When God Talks Back. I think she has given us some great insight into the psychic mechanisms by which we encounter God. Here is my attempt to add two cents worth to that discussion: We need to recognize a distinction between discursive and non-discursive thought.

In her classic work Philosophy in a New Key, Susan Langer said that all language has a form that requires us to string out our ideas as if we were hanging them on a clothesline; even though these ideas may actually nest one within the other like layered clothing on a cold, windy day. This property of verbal symbolism is called discursiveness. And only when our thoughts are arranged discursively can they be spoken. “Any idea which does not lend itself to this ‘projection’ is ineffable, incommunicable by means of words.” Langer added that this was why the laws of reasoning are sometimes known as the “laws of discursive thought.”

Non-discursive expressions of our inner mental life are not linguistically structured. They exist in an incommunicable, largely unconscious mental state of emotions, feelings and desires. Some expressions of this inner mental life are seen in tears, laughter, or profanity. Langer said this leads to two basic assumptions: 1) that language is the only means of articulating thought, and 2) everything that is not speakable thought is feeling.

Langer then said that human thought is like a tiny, grammar-bound island in the midst of a sea of feeling. This island has a periphery of “mud”—a mixture of factual and hypothetical concepts broken down by the emotional tides into a “material” mode: a mixture of meaning and nonsense. Most of us live our lives on this mud flat. In artistic moods we will take to the deep, “where we flounder about with symptomatic cries that sound like propositions about life and death, good and evil, substance, beauty and other non-existent topics.” I’d substitute the word “immaterial” for Langer’s term “non-existent.” She then said:

So long as we regard only scientific and “material” (semi-scientific) thought as true cognitions of the world, this peculiar picture of mental life must stand. And if we admit only discursive symbolism as a bearer of ideas, “thought” in this restricted sense must be regarded as our only intellectual activity. It begins and ends with language; without the elements, at least, of scientific grammar, conception must be impossible.

Building on this discussion, I’d agree with Langer that conscious thought, which we use to structure the world around us, is essentially discursive. Our unconscious thought life of feelings, emotions and desires is then mostly non-discursive and largely not available to us, unless it somehow manages to press its way through to the conscious, discursive world.

A biblical expression of this distinction is found in Romans 8:26: “Likewise the Spirit helps us in our weakness. For we do not know what to pray for as we ought, but the Spirit himself intercedes for us with groanings too deep for words.”

There is a human tendency to give greater significance to discursive impressions that appear suddenly, fully formed out of our unconscious thought life. I think this is true religiously as well as psychologically. Oftentimes these insights appear while the person is concentrating on something entirely different; and also when they are dreaming.

Charismatic and Pentecostal Christians see discernment, prophetic utterance and speaking in tongues as miraculous manifestations of God’s presence. But they could simply be unexpected encounters with God that take place as they go swimming in the sea of their immaterial, unconscious thought life.

Psychological theorists such as Sigmund Freud and Carl Jung similarly place a high value on the content of dreams as manifestations of the unconscious thought life of the individual. But they are no more significant that the material gathered by the practice of discursive “talk therapy.”

Have you ever given too much importance to impressions that appear suddenly in your conscious thought life?