Monthly Archives: October 2014

10/31/14

In Him We Have Our Being

image credit: stockfresh; by solarseven

image credit: stockfresh; by solarseven

“The self-attesting Christ of Scripture has always been my starting point for everything I have said.” (Cornelius Van Til, Jerusalem and Athens)

I’ve thought for a long time that many of the theological disputes about Scripture stem from misunderstandings that occur because God’s eternal truths are being revealed in the space-time of our existence. Some things that are true about God and his creation cannot be made fully comprehensible to creatures who exist in space-time because God and his eternal truth are outside of time and space. Even here the words I have to use are inadequate, because into, outside and before all refer to space-time conditions. How can we conceptualize something existing outside of the universe we live in?

The distinction between God as the Creator and everything else (the creation; the heavens and earth) is a fundamental Christian belief. Starting with an acknowledgement of this distinction is essential for clear thinking about God, Scripture and theology. While I assume that most if not all Christians would agree in principle with what I’ve said here about the Creator-creation distinction, they can come up with radically different ideas about what God revealed in creation and said in Scripture, let alone how that revelation should be applied to our lives.

An analogy would be a photograph of a large three-dimensional object like the Cathedral of Learning in a two-dimensional world. It could really be a photo of the Cathedral, but it would not capture the grandeur of seeing the structure with your own eyes in three dimensions. But you couldn’t ever do that, because you exist in two dimensions. For creatures who live and move and have their being within two-dimensions, the photos of the three-dimensional Cathedral of Learning would at times seem contradictory and at odds with one another.

Even the photo thought to be the clearest representation of the Cathedral of Learning, would have inherent limitations. You can’t completely capture a three-dimensional object in a two-dimensional photo. You can’t comprehensively portray a three-dimensional object in a two-dimensional world.

Nevertheless, we could still say that each of the different pictures was really a picture of the Cathedral. But that would require a starting point that existed in three dimensions—like a photographer—to take the pictures. And we would need to trust that photographer to communicate to us honestly and truly in two dimensions what actually existed in three dimensions. In Christian theology, the God of Scripture is that starting point.

We could illustrate these ideas in the following way. I’ve borrowed the concept of connected circles to represent the Creator-creature distinction from the work of Cornelius Van Til. The additions are my own.

creator

 

There is a necessary distinction between God and creation, meaning the entire universe. We exist within that created order, where God has embedded truth about Himself within the very fabric of creation. So whether we study the irreducible complexity of biochemical systems within the human body or the incredible fine-tuning of the universe for human life, we see the evidence of His hand in the design and functioning of the cosmos. In Him we live and move and have our being.

But this evidence in creation is open to some interpretation. The fine-tuning of the universe can lead you to the conclusion of a Designer and God. Or it could lead you to hypothesize the existence of multiple universes, where the probability of one “just right” for life and devoid of the benign hand of a Designer is more statistically probable. The first concludes there is a God. The second finds Him unnecessary.

We were given specific, direct communication about God and His eternal truths in the Word of God—the Word written and the Word revealed in Jesus Christ. Both the written Word and the embodied Word possess a duality of being in the sense that they simultaneously exist within and outside created space-time. There is even more potential here for misunderstanding—partly because of the entrance of eternal truth of the Word into space-time. Apply the above Cathedral of Learning analogy here. So another fundamental Christian belief is that God reveals Himself to us in creation and communicates to us through his Word; and  we can trust these revelations.

If the general revelation of God in creation is denied or distorted, then we lose the ability to truly comprehend the glory and majesty of its Creator. When we misconceive the entrance of the divine Word (written or revealed in Christ) into creation, we lose the ability to commune with our Creator. If God existed without our ability to know Him in these two ways, then He truly would be unnecessary.

Another issue that contributes to the misinterpretation of Scripture is that we don’t want to be beholden to special revelation from God in order to understand anything—ourselves, creation and even God or His eternal truths. The story of the Fall in Genesis indicates how humanity wanted to be like God, knowing good from evil. So here is a third fundamental Christian belief—the rebellion of humanity. But that is a topic for another time.

10/29/14

Creating Chemical Imbalances

“Rather than fix chemical imbalances in the brain, the drugs create them.” (Robert Whitaker, Anatomy of an Epidemic)

One of the most enlightening books I’ve read recently was Anatomy of an Epidemic, by Robert Whitaker. In the foreword, Whitaker said he originally believed that psychiatric drugs were like “insulin for diabetes.” He believed that psychiatric researchers were discovering the biological causes of mental illnesses and that this led to the development of a new generation of psychiatric drugs that helped “balance” brain chemistry. Then he stumbled upon some research findings that challenged that belief, “and that set me off on an intellectual quest that ultimately grew into this book.”

What follows is a collection of quotes from Anatomy of an Epidemic and a chart containing data on psychiatric medications.  There is little additional commentary by me. The power of the quotes is underscored by the sales and prescription data in the chart.

Some of the quotes were handily gathered together for me on Goodreads. My chart is a combination of a listing of the top 25 prescribed psychiatric medications in 2013 found on PsychCentral and data for 2013 pharmaceutical sales on Drugs.com. It follows the rank order given by John Grohol on PsychCentral for the top 25 most prescribed psychiatric medications in 2013.  I then included the sales data found on Drugs.com from its list of the top 100 pharmaceutical drugs by gross retail sales for the listed drugs.

Drug

Prescriptions-2013

Use

Sales-2013

Xanax (alprazolam)

48,465,000

Anxiety

Zoloft (sertraline)

41,416,000

Depression, anxiety, OCD, PTSD, PMDD

Celexa (citalopram)

39,445,000

Depression, anxiety

Prozac (fluoxetine)

28,258,000

Depression, anxiety

Ativan (lorazepam)

27,948,000

Anxiety, panic disorder

Desyrel (trazodone)

26,242,000

Depression, anxiety

Lexapro (escitalopram)

24,920,000

Depression, anxiety

Cymbalta (duloxetine)

18,573,000

Depression, anxiety, fibromyalgia, diabetic neuropathy

5,083,111,000

Wellbutrin XL (bupropion)

16,053,000

Depression

Effexor (venafaxine)

15,796,000

Depression, anxiety, panic disorder

Valium (diazepam)

14,754,000

Anxiety, panic disorder

Paxil (paroxetine)

14,335,000

Depression, anxiety, panic disorder

Seroquel (quetiapine)

14,326,000

Bipolar disorder, depression

1,183,989,000

Amphetamine salts (Adderall)

12,785,000

ADHD

727,892,000

Risperdal (pisperidone)

12,320,000

Bipolar disorder, schizophrenia, iirritability in autism

Vyvanse (lixdexamfetamine)

9,842,000

ADHD

1,689,091,000

Concerta ER (methylphenidate)

8,803,000

ADHD

Abilify (aripiprazole)

8,747,000

Bipolar disorder, schizophrenia, depression

6,293,801,000

Wellbutrin SR-W (bupropion)

8,238,000

Depression

Buspar (buspirone)

8,065,000

Sleep, anxiety

Vistaril (hydroxyzine)

8,052,000

Anxiety

Amphetamine salts ER (Adderall)

7,925,000

ADHD

Zyprexa (olanzapine)

5,101,000

Bipolar disorder, schizophrenia

Concerta/Ritalin (methylphenidate)

5,335,000

ADHD

1,383,814,000

Pristiq (desvenlafaxine)

3,217,000

Depression

Of the top 25 prescribed psychiatric drugs in 2013, 13 were to “treat” anxiety; 13 were to “treat” depression; 4 were to “treat” panic disorder; 4 were to “treat” bipolar disorder; and five were to “treat” ADHD. As the chart indicates, some of the medications are used for two or more disorders. In fact, 11 of the top 13 prescribed medications in 2013 could be used for anxiety; 10 of the top 13 could be used for depression.  Three of those were benzodiazepines (Xanax, Ativan and Valium); nine were antidepressants of some type (Zoloft, Celexa, Prozac, Desvrel, Lexapro, Cymbalta, Wellbutrin, Effexor and Paxil); and one, Seroquel, was an antipsychotic.

In addition to causing emotional distress, long-term benzodiazepines usage also leads to cognitive impairment (137). Although it was thirty years ago that governmental review panels in the United States and the United Kingdom concluded that the benzodiazepines shouldn’t be prescribed long-term … the prescribing of benzodiazepines for continual use goes on (147). Antidepressant drugs in depression might be beneficial in the short term, but worsen the progression of the disease in the long term, by increasing the biochemical vulnerability to depression. . . . Use of antidepressant drugs may propel the illness to a more malignant and treatment unresponsive course (160). In a recent survey of members of the Depressive and Manic-Depressive Association, 60 percent of those with a bipolar diagnosis said they had initially fallen ill with major depression and had turned bipolar after exposure to an antidepressant (181). Given that the biology of ADHD remains unknown, it is fair to say that Ritalin and other ADHD drugs ‘work’ by perturbing neurotransmitter systems. . . . Cocaine acts on the brain in the same way (227).

Disturbing, huh?

Only six of the most widely prescribed medications were among the 100 best sellers. The six best selling psychiatric medications in the order of their sales were: 1) Abilify ($6.294 billion); 2) Cymbalta ($5.083 billion); 3) Vyvanse ($1.689 billion); 4) Concerta/Ritalin ($ 1.384 billion); 5) Seroquel ($1.184 billion); 6) Amphetamine salts (found in Adderall, $727.9 million). Part of the explanation for the difference is that the majority of the prescribed psychiatric medications are now off patent and available as generic drugs. So they typically don’t make as much money for pharmaceutical companies. An example would be how Abilify was the top grossing prescription for all medications in 2013, but only the 18th most prescribed medication.

With the exception of VyVanse, I’d expect most of the six to also drop out of the top 100 selling drugs of the next few years. Abilify’s patent expires in October of 2014. Cymbalta’s patent expired in December of 2013. Vyvanse’s patent will expire in 2023. Concerta’s patent expired in 2011. Seroquel’s patent expired in 2012.

If you expand the boundaries of mental illness, which is clearly what has happened in this country during the past twenty-five years, and you treat the people so diagnosed with psychiatric medications, do you run the risk of turning an anger-ridden teenager into a lifelong mental patient? (p. 30) We have been focusing on the role that psychiatry and its medications may be playing in this epidemic, and the evidence is quite clear. First, by greatly expanding diagnostic boundaries, psychiatry is inviting and ever-greater number of children and adults into the mental illness camp. Second, those so diagnosed are then treated with psychiatric medications that increase the likelihood they will become chronically ill. Many treated with psychotropics end up with new and more severe psychiatric symptoms, physically unwell, and cognitively impaired. This is the tragic story writ large in five decades of scientific literature (209). Twenty years ago, our society began regularly prescribing psychiatric drugs to children and adolescents, and now one out of every fifteen Americans enters adulthood with a “serious mental illness.” That is proof of the most tragic sort that our drug-based paradigm of care is doing a great deal more harm than good. The medicating of children and youth became commonplace only a short time ago, and already it has put millions onto a path of lifelong illness (246). For the past twenty-five years, the psychiatric establishment has told us false story. It told us that schizophrenia, depression, and bipolar illness are known to be brain diseases, even though … it can’t direct us to any scientific studies that document this claim. . . . Most important of all, the psychiatric establishment failed to tell us that the drugs worsen long-term outcomes (358).

 

10/27/14

Conscientious Objectors to AA

image credit: iStock

Not all the drunk driving stories I’ve heard were tragic. One individual driving back from an out-of-state visit became lost on a rural road in the middle of the night. He saw a local police officer in the process of having another vehicle towed, so he stopped to ask directions. As it turned out, the officer was finishing up with a DUI arrest he had made earlier that night. Soon after the lost man lowered his window to ask for directions, he became the officer’s second DUI arrest of the night.

Another person returned to her downtown apartment after a long workday and was relaxing with a few glasses of wine. She answered an insistent knocking on her door from her landlord, who informed her the city would tow her car in the morning if she didn’t move it. The officer who arrested her for DUI was not sympathetic. The woman was particularly incensed because she previously thought she was doing the right thing by sleeping it off in her car instead of driving home from a restaurant. But she was still charged with a DUI when a police officer woke her in her car a few hours later.

In many states, multiple offenders have the opportunity to receive alternate sentencing to DUI courts or treatment programs in lieu of jail time. The American Automobile Association (AAA) reported that there are currently more then 1900 DUI/Drug Courts across the country.  And there is evidence that these programs reduce recidivism. The vast majority of DUI episodes are caused by a small group of repeat offenders. Estimates suggest that 3-5 percent of drivers account for around 80 percent of the DUI episodes.

These courts are mostly post-conviction, meaning that the accused must plead guilty or be convicted to participate in them. . . . Compliance with treatment and other court-mandated requirements is verified by frequent testing, close community supervision and interaction with the judge in non-adversarial court review hearings.

A frequent requirement of DUI courts and other legal-based substance-abuse intervention programs is for the individual to attend some sort of a treatment program and Alcoholics Anonymous meetings. And some individuals raise strong objections to the court-ordered AA attendance.

One former court mandated attendee of AA meetings viewed her attendance as the government prescribing “prayer under the threat of imprisonment.” As an atheist, she found it difficult to believe she had an imaginary friend. A court ordered treatment program she was in structured its group therapy sessions with opening and closing prayers (the Lord’s Prayer and the Serenity Prayer). She reported that when she took a bathroom break during the “Our Father,” she was told she couldn’t leave during the prayer.

Another individual is suing the state of Nebraska, alleging his constitutional rights were violated because he was required to attend AA meetings even though he objected to its religious foundation: “I do not believe the state should be telling anybody to go to them, and it cost me a career as a massage therapist because I didn’t go.” Somehow I think there is a little bit more to the loss of his masseuse license.

When I hear of experiences like these, I wonder what’s missing. Was the woman really reprimanded for not participating in a prayer or for leaving the group without permission? Did the Nebraska man lose his career because he refused to attend AA meetings, or because an alcohol-related arrest violated a professional code of ethics?  I think many of the conscientious objectors to AA attendance on nonreligious grounds are erecting straw man arguments to knock down because they are angry about the legal consequences of their drinking—and not simply their forced attendance at “religious” gatherings.

AA meetings have been legally designated as “religious” within the U.S. The court cases that successfully challenged mandated meeting attendance were all brought by parolees, probationers and inmates. They argued that mandated attendance was a violation of the Establishment Clause, which requires “governmental neutrality with respect to religion and a wall of separation between Church and State.” So it seems there will have to be an ongoing adjustment to how governmental agencies address this perceived violation of Church and State through mandated AA attendance. This is a state-by-state battle for now.

However, I don’t think it is a forgone conclusion that A.A. is “religious” because the courts have said its literature reflects elements common to most theistic religions. Yes, there are clear elements of religious dogma if the “Our Father” or “The Lord’s Prayer” is recited at meetings. But that does not occur at all A.A. meetings and I’ve not known where it is expected of anyone to recite the prayer.

There are conceptions of what constitutes a “religion” and a “church” that do not equate any and all belief in God or a Higher Power as religious dogma. If these views were to be legally recognized, then mandated A.A. attendance would not necessarily be a violation of the Establishment Clause. I’ll look at this in some future posts. But back to the conscientious objectors to AA attendance.

Erica Larsen on AfterPartyChat is more sympathetic to these individuals than I am. She empathizes with their “feelings of alienation from AA’s more Christian elements. The whole Higher Power thing kept me out of any 12-Step programs for years, so I get it. I totally get it.” But now that she is actually involved in 12-Step fellowships, she believes it was one of the best personal decisions she ever made. “Getting over the God thing was surprisingly easy once I decided to actually give meetings and sponsorship a try.” But she still wanted to just shake the guy in Nebraska and tell him to just go to the meetings.

 

10/24/14

How to Handle Hypocrisy

I don’t know the man; not even his name. But if I ever did, I’d tell him what a jerk he is. No, that’s not true. My thought language as I read about what he did was much stronger. I can get really angry at the blatant duplicity of some of the supposedly “Christian” men I hear about. This unknown man had multiple affairs, which he denied and lied to his wife about. He even went on vacations with his women “friends;” sent them money; and more.

Yet when his wife had enough, and legally separated herself and their children from his emotional abuse and manipulations, he called foul. He also argued that garnishing his wages to ensure that child support was paid would bankrupt them. He said she was ruining him and out for revenge. Then he pulled out the big guns. He claimed that her actions in going to court over child support was “unbiblical” because the ungodly shouldn’t determine what they do within their family. What a hypocrite!

In Matthew 15 is an example of how Jesus handled a bunch of hypocrites. Jesus was approached by a group of Pharisees and scribes who had traveled all the way from Jerusalem to Galilee to see him. They came all that way to ask why his disciples broke the traditions of the elders by not washing their hands before they ate.

In this particular case, the tradition was an extension of the ceremonial washing required of the priests (Exodus 30:17-21). Contact with unclean things made your hands unclean. And if unclean hands touched food, that too became unclean. The tradition of hand washing before meals to remove ceremonial defilement can be traced back to the teachings of Hillel and Shammai, two of the greatest rabbis in Jewish tradition. Both were Pharisees. So these Pharisees weren’t seeking to be enlightened by Jesus. They were trying to pick a fight.

Using a typical rabbinic technique, Jesus answered their question with another question, “Why do you break God’s commandments for the sake of your tradition?” Quoting the 5th commandment in Exodus 20:12, and then citing Exodus 21:17, Jesus pointed to how the tradition of Corban could be used to justify not helping others in need; even someone’s parents. Corban meant that money or other material resources that were pledged to the temple could not be transferred or given to anyone else. When the individual died the funds or resources would be turned over to the temple, BUT the materials could still be used by the giver while they were still alive! In this way, the Corban tradition of men nullified the word of God.

So these upright, religious Pharisees were really just hypocrites; they said one thing but did another. Jesus again turned to Scripture, quoting Isaiah 29:13 to show how they honored God with their lips, but their heart was far from Him. Their “spirituality” was in vain, for they presented their own wisdom as being on par with the word of God.

Verse 14 of Isaiah 29 adds to their condemnation, and would likely have been understood by the Pharisees as being implied, but left unsaid by Jesus. In Isaiah 29:14 God said: “I will again do wonderful things with this people.” BUT “The wisdom of their wise men shall perish, and the discernment of their discerning men shall be hidden.” In other words, the traditions taught to you by the Pharisees will wither and die. Turning from the Pharisees and calling the people to him, Jesus prophetically acts out the application of Isaiah 29:14 in his situation.

Jesus turned away from these religious leaders who had come from Jerusalem to see him and started to teach the ordinary people who had gathered to hear him. And he has the audacity to negate the very tradition they had come to confront him about. He said that it wasn’t what went into a person that defiled them. Rather, it was what came out of them that defiled the person.

The disciples apparently missed what Jesus said at this moment. Seemingly overcome with jaw dropping amazement at what he had just said, they watched the Pharisees walk away in a huff. The elite spiritual, religious group of that time and Jesus had just insulted and humiliated them—intentionally!

The disciples essentially asked him if he realized that he had just offended the Pharisees. Jesus responded by saying that the Pharisees were blind guides; let them alone—don’t chase after them. Peter then asked Jesus to explain what he meant when he said: “It’s not what goes into a person’s mouth that defiles them, but rather what comes out of their mouth.”

Seemingly frustrated that they still didn’t get it, Jesus said that whatever a person puts into the mouth passes into the stomach and is eventually “expelled.” Rather, what comes out of the mouth, what proceeds from the heart, is what defiles a person. Things such as evil thoughts, murder, adultery, sexual immorality, theft, false witness, slander all come from the heart. These are the things that defile a person. “But to eat with unwashed hands does not defile anyone.”

So how did Jesus handle the hypocrites? First, he confronted and exposed their hypocrisy. Second, he didn’t chase after them to smooth over the perceived offense. Third, he neutralized the hypocrisy and taught that true defilement begins in the heart of the individual.

So how do you handle your own hypocrisy? Confront it. Don’t rationalize or justify it; don’t coddle it. And walk your talk—be sure that not only do you say what’s true, but that you do what’s true.

 
10/22/14

This is Your Brain on Porn

image credit: iStock

image credit: iStock

I found myself unable to stop looking at porn for long periods of time. My lust became harder to satisfy, and I looked for something different, frequently searching for porn featuring same-sex actors, nonconsensual sex or occasionally even pedophilia. At its worst, I would look at porn every day. (quoted from Closing the Window, by Tim Chester)

A 1997 study of compulsive sexual behavior (CSB) suggested that the extent of CSB was both under-recognized and underappreciated. Previous estimates cited in that study indicated that 5 or 6% of adults were affected by CSB. That, however, is likely an underestimate at this time, given the easy access to porn on the web, and its resultant anonymity. The sexual behaviors engaged by the study’s subjects did not even mention online porn, which was just beginning to emerge as a problem.

This early study’s research data were responses to “The Compulsive Sexual Disorders Interview.” Fifty-four percent of the 36 individuals reported a history of childhood physical or sexual abuse. Seventy-five percent reported that their sexual behavior sometimes occurred when under the influence of alcohol or drugs. The researchers suggested that the lack of a universally accepted definition of CSB was a major stumbling block to future work. They also said more work needed to be done to establish the frequency of CSB and clarify if it was indeed an addiction.

A 2006 article reviewed CSB (called impulsive-compulsive sexual behavior, ICSB) and assessed the merit of classifying it as an addiction. It concluded that there was still only limited evidence to classify ICSB along with the chemical addictions. “It is hoped, that as more research is done on this disorder, it will become clearer if this disorder should be classified in that manner or in some other manner.” Recent studies with neuroimaging technology seem to be providing evidence that CSB is a form of addiction.

A July 2014 article published in the PLOS One journal noted that while the DSM-5 classified pathological gambling as a behavioral addiction, video-gaming, internet use and sex (Hypersexual Disorder) were not included in the main part of the DSM. CSB was described in a University of Cambridge report on this research as an obsession with sexual thoughts, feelings or behavior that they are unable to control; which negatively influence personal or work life. CSB sufferers also have high levels of distress from feelings of shame. The study compared 19 heterosexual males with CSB to 19 age-matched heterosexual males without CSB. All CSB subjects met the proposed criteria for Hypersexual Disorder.

The participants were shown a series of short videos featuring either sexually explicit content or sports while their brain activity was monitored by functional magnetic resonance imaging (fMRI).  The research found that three regions in the brain were more active in the brains of individuals with CSB than the control group. “Significantly, these regions – the ventral striatum, dorsal anterior cingulate and amygdala – were regions that are also particularly activated in drug addicts when shown drug stimuli.”

The researchers also asked participants to rate the level of sexual desire they felt while watching the videos. “As anticipated, patients with compulsive sexual behaviour showed higher levels of desire towards the sexually explicit videos.” A correlation was also found between brain activity and age. The younger the person was, the greater the level of activity in the ventral striatum in response to pornography. This association was strongest in subjects with CSB.

The study’s lead author said that while there are clear differences in brain activity that mirror those with drug addicts, these differences cannot be used to diagnose CSB; nor can they suggest that porn is inherently addictive. Dr John Williams, Head of Neuroscience and Mental Health at the Wellcome Trust, said:

This study takes us a step further to finding out why we carry on repeating behaviours that we know are potentially damaging to us. Whether we are tackling sex addiction, substance abuse or eating disorders, knowing how best, and when, to intervene in order to break the cycle is an important goal of this research.

A study published in the July 2014 edition of JAMA Psychiatry found a significant negative association between the hours of porn viewed per week and the grey matter volume in the parts of the brain related to porn consumption. The researchers speculated that this loss of brain function “could reflect change in neuroplasticity as a consequence of an intense stimulation of the reward system [one of the areas of the brain associated with addiction].” It also could be a precondition that makes porn consumption more attractive. The authors said:

Since pornography appeared on the Internet, the accessibility, affordability, and anonymity of consuming visual sexual stimuli have increased and attracted millions of users. . . . Based on the assumption that pornography consumption bears resemblance with reward-seeking behavior, novelty-seeking behavior, and addictive behavior, we hypothesized alterations of the frontostriatal network in frequent users.

Frontostriatal circuits are neural pathways that connect frontal lobe regions of the brain with the basal ganglia (striatum). They mediate motor, cognitive, and behavioral functions within the brain.

You can read popular reflections on the above-discussed brain scan studies here, here and here.

Do you think there is enough evidence to say that porn is truly addictive?

10/20/14

Pandora’s Box is Now Open

image credit: iStock

image credit: iStock

A drinkable form of marijuana called Legal is now available at eight of Washington State’s recreational marijuana stores. The drink comes in five different flavors and is infused with 22 milligrams of THC: “enough to know you’re high, but not so much as to overwhelm.” Each flavor is supposed to give you a slightly different high. The Company’s founder, Adam Stites said that “drinakables” don’t carry as much of a taboo as other forms of marijuana, “It’s more approachable” to ask your parents if they want a Legal instead of a joint. Stites sees “green” beverages as an amazing, untapped new market:

It’s an opportunity to make an amazing, unique, unusual, and delicious product while also making history. . . . I think my grand-kids will be amazed to know that people used to go to jail for having a plant.

At the same time that Denver and Seattle city officials are denying that legal marijuana is bringing in pot tourists (here and here), travel websites have reported an increase in searches for both destinations. Taylor Cole, who handles public relations for Hotels.com said: “We’ve seen that searches for both destinations have spiked dramatically.”

Year-after-year, there has been a 73 percent increase in traffic at Hotels.com for Denver rooms during its 4/20 festivities. And there was a 68 percent increase among travelers looking for Seattle rooms during July, the first month of legal marijuana sales in that state.

My 420 Tours of Denver Colorado offers a variety of pot-based tour packages. You can take a cannabis cooking class; a Dispensary & Grow Tour, a Sampler Vacation package. You can book a 420 friendly luxury hotel room in the heart of downtown Denver. “Enjoy vaping in your room or smoking freely on 420 smoking deck overlooking downtown Denver.”

You can take a six-hour ride on the My 420 Tours Cannabus, stopping at some of Denver’s top retail marijuana stores. A tour of a professional grow facility, a cannabis friendly lunch, and a 4:20 pm smoke out are all included. There is also free sampling of cannabis edibles on the bus throughout the tour.  In a 2½ hour cooking class you will learn “how to make and use various cannabis oils and a variety of organic cannabis-infused treats.” Oh, and you get free samples during class and to take home.

Along with the new edible products and tourism destinations, marijuana legalization is having some potentially harmful and far-reaching consequences. On March 10th, a college student from Wyoming bought four marijuana cookies for herself and her three friends and returned to their Denver hotel. A few hours later, her 19-year old friend leapt over the fourth-floor railing into the lobby.

The woman who bought the cookies said she believed it was the first time her friend had ingested marijuana. They began eating their cookies around midnight. Levy Thamba said he wasn’t feeling anything, so he ate the rest of his cookie. Later that night Levy was “screaming, speaking in French, apologizing for criminal behavior that he had not committed, smashing fixtures and finally jumping off the balcony.” They had been advised to split the cookie into six pieces and eat one piece at a time.

In May of 2014, the governor of Colorado signed legislation to tighten controls on edible and concentrated forms of marijuana. The first law created a task force to devise packaging for cannabis-infused edibles to make those products readily distinguishable from regular foods. Why? Because Colorado Children’s Hospital reported they had treated 13 children, six who became critically ill from edible marijuana.

The hospital’s medical director of the emergency room reported that a number of children had been admitted for “for sedation or agitation and one child suffered breathing problems that required a respirator.” A Colorado study reported in JAMA Pediatrics found there has been an increase of unintentional ingestion of marijuana by children since the modification of drug enforcement laws for marijuana possession in 2009. State Senator Mike Johnston said: “By improving labeling and giving kids a way to tell the difference between a snack and a harmful substance, we can keep kids … out of the emergency room.”

The second law regulates the amount of concentrated marijuana that can be sold to an individual. Marijuana edible companies were encouraged to make products containing no more than 10 mg of THC. If they do, these products will be tested less often for potency than other edibles.

Another incident of suspected marijuana intoxication involved a Denver man shooting his wife to death as she was on the phone with an emergency dispatcher. She told the dispatcher her husband had use pot and was hallucinating and frightening her and their three children.

Under emergency rules that were adopted on August 1, if a marijuana edible is more than 10 mg and up to 100 mg, “you have to score it or demark it in such a way that it is intuitively obvious to the consumer how to break off a serving size of that edible.”

Like opening Pandora’s box, the increased availability of marijuana as a medicinal and recreational drug is having some unanticipated detrimental consequences. Children are being poisoned and people are dying after unintentional ingestions and overdoses of THC. And we are only at the beginning of the medicalization and legalization movement. Where will we be in five or ten years from now? Hopefully the corrections mentioned here will minimize what we’ve seen so far. But like Pandora, I’m afraid that it is already too late to close the container. The genie is already out of the bottle.

10/17/14

Ancient Star Wars Philosophy

© Waldemarblut | Dreamstime.com - Star Wars Photo

© Waldemarblut | Dreamstime.com – Star Wars Photo

Christians are familiar with how the body metaphor communicates the unity in diversity that believers have in Christ. The apostle Paul used it repeatedly in his writings to communicate the unity in diversity within the body of Christ, as in Romans 12:4–5: “For as in one body we have many members, and the members do not all have the same function,so we, though many, are one body in Christ, and individually members one of another.” It seems that Paul used an idea that already existed within ancient Greek and Roman philosophy to communicate the Christian gospel to them. In his work Coriolanus, the historian Plutarch attributed the origin of the body metaphor to a Roman aristocrat, Menenius Agrippa.

In the 5th century BC, the plebian lower class of Rome was on the verge of a revolt because of the callous treatment they received from upper class Roman money-lenders. In a mass protest, the plebes left Rome and encamped on the Sacred Mount. The Roman Senate sent a diplomatic team, led by Menenius Agrippa. He concluded his gentle requests and persuasions with the following tale.

All the members of man’s body rebelled against the stomach. They complained that it did nothing for the maintenance of the rest of the body. But “all other parts and members did labour painfully, and were very careful, to satisfy the appetites and desires of the body.” The stomach laughed at their folly and said: “It is true, I first receive all meats that nourish man’s body: but afterwards I send it again to the nourishment of other parts of the same.” So it was with the Senate: “The Senators are cause of the common commodity that cometh unto every one of you.”

These words and the promise of political changes pacified the plebes, who returned to the city. And so the revolt was averted. The Plebes returned to fight in the Roman armies; and the rest is, as they say, “history.”

Stoic philosophy, which was popular during the time of Paul’s preaching, also applied the imagery of head and body to God and the universe. John Thom in The Dictionary of New Testament Background described Stoic theology “as a monistic and materialistic pantheism, in which God permeates all of nature, from the cosmos as a whole down to the most lowly physical object.” Nothing existed outside of the world and its material principles.

God is an immanent ordering and creative principle that is present in all things as fine, fiery substance or pneuma, which gives everything its form and internal cohesion. God is also an active principle or reason (logos) that acts upon matter. “Since all of nature is imbued with the universal reason (logos), all events form part of a goal-directed rational process  … nothing is left to chance.” Everything is providentially arranged. There is a season and a time for everything.

Happiness was found in attaining one’s goal as a human being, which Diogenes Laertius said was: “to live in agreement with nature.” This meant people were to live in agreement with their rational nature as well as the nature of the universe. Stoic happiness did not depend upon attaining positive things like health and wealth, but on making the right choices to attain them. “Happiness therefore depends on what is in our power (i.e., making rational choices) and not on things beyond our power (i.e., attaining wealth or being healthy).”

A choice was right only if it was made consciously and for the right reasons. There was only a right or a wrong judgment; there are no intermediate possibilities. So two identical actions could be valued differently, depending upon the person’s motivation in performing the action. “Only the truly wise person is able to make the right judgments and thus perform correct and virtuous actions, but Stoics admitted that there are very few, if any, truly wise people.”

Everything in nature was rationally and providentially arranged. “The wise person therefore accepts his or her fate willingly without trying to resist, because it is at the same time the divine will and providence.” The Stoics denied that this was determinism. Even if the individual could not change what was fated, they still had the freedom to accept their fate voluntarily or be forced to submit to it.

The Force in the Star Wars movies seems to be a modernized version of the Stoic Logos. There was also a Dark Side to the Stoic universe. Universal purpose and design was offset with chaos. Destruction and devastation seems to frequently overrun purpose and design. The universe could often be a dangerous place. Thus the Stoic’s call to align with the natural order, the Logos. We might say that Stoics were exhorted to “use the force” of the Logos to overcome the darkness of uncertainty.

The major distinction between Stoicism and Christianity is the pantheism of Stoic thought, where the universe was God: “For there is one Universe out of all, one God through all, one substance and one law, one common Reason of all intelligent creatures and one Truth.” (Marcus Aurelius, Meditations)

In Christianity, the transcendent God created the universe: “In the beginning was the Word [logos], and the Word was with God, and the Word was God. He was in the beginning with God. All things were made through him, and without him was not any thing made that was made.” (John 1:1-13)

10/15/14

Psychiatry’s Mythical Phoenix

Prominent research psychiatrists are beginning to sound like their “antipsychiatric” critics. They are saying the current DSM diagnostic system isn’t valid; that something new, something scientifically sound and useful for treating patients is needed. One of these research psychiatrists is Thomas Insel, the Director of the Director of the National Institute of Mental Health (NIMH). He dropped a bombshell last year when he announced that the NIMH would be “re-orienting its research away from DSM categories.” The New York Times quoted Insel as saying: “As long as the research community takes the D.S.M. to be a bible, we’ll never make progress. . . . People think that everything has to match D.S.M. criteria, but you know what? Biology never read that book.”

So the NIMH has developed a new research strategy to classify mental disorders based upon “dimensions of observable behavior and neurobiological measures.” This strategic plan is known as: Research Domain Criteria (RDoC), a framework for collecting data needed for a new nosology. The goal is for RDoC to “transform diagnosis by incorporating genetics, imaging, cognitive science, and other levels of information to lay the foundation for a new classification system.” It was not meant to be a useful clinical tool.

RDoC is in search of the holy grail of psychiatry: reliable biomarkers (measurable indicators of a biological state or condition) for mental disorders. This search for biomarkers has been going on for decades. David Kupfer, the chair of the DSM-5 Task Force said: “We’ve been telling patients for several decades that we are waiting for biomarkers. We’re still waiting.” Susan Kamens suggested that the imminent discovery of biomarkers has been “the driving expectation of psychiatry since its birth in the 18th century.” But there are some problems with the RDoC quest.

What RDoC proposes is to replace the DSM diagnoses used currently to frame mental health research with broad categories based upon cognitive, behavioral and neural mechanisms. This means that the NIMH will be supporting research projects that look across or sub-divide existing DSM categories. But this very same DSM is what is used to assess the potential of future NIMH-funded research under RDoC.

In an article found in Nature, “Psychiatry Framework Seeks to Reform Diagnostic Doctrine,” Nassir Ghaemi said: “It is very hard for people who have been following the DSM their entire professional lives to suddenly give it up.” Ghaemi has felt shackled by the DSM. He wanted to do some research that cut across DSM categories. But his colleagues warned him against straying too far from the DSM structure when he applied for funding from the NIMH, because peer reviewers tended to insist on research structured by the DSM. So he held off from applying.

Steven Hyman, a former NIMH director, blames the DSM for hampering research into the biological or genetic basis of psychiatric illness. He said it was “a fool’s errand” to use symptom-based DSM diagnosis with little basis in nature to try and find a biomarker. Hyman urged the NIMH to think about how biomarkers identified by RDoC would be incorporated into mental health practice with the DSM. “It would be very problematic for the research and clinical enterprises to wake up in a decade to a yawning gulf.”

But Susan Kamens sees a deeper problem with blaming the DSM for hampering the search for biomarkers—it takes for granted that the biomarkers exist. In other words, it presumes what it seeks to find. According to Kamens:

“The main difference is belief versus doubt in the hypothesis that what we call mental disorder is primarily a disorder of biology. We treat that hypothesis as unfalsifiable, as if the proof [that mental disorder is biological] arrived before the evidence. We don’t test whether the hypothesis holds; we test whether and how to make the data fit it. When critics raise doubts, they’re often accused of ignoring the very same evidence that psychiatric researchers have recently declared to be utterly insufficient.”

Kamens noted that the RDoC “blueprint” is no less theoretical that the DSM-5. While the RDoC constructs are more measurable than the categories listed in the DSM, they are “essentially no more than basic human emotions and behaviors.”  She asked how RDoC would make clinically meaningful determinations into its “domains” and “constructs”? How would the research reveal anything beyond the coordinates of normal psychological processes? “In other words, how is RDoC anything beyond basic (nonclinical) neuroscience?”

RDoC is developing a new research model that will undoubtedly yield unprecedented data, but it focuses on the biogenetic correlates and normative mapping of basic psychological processes like visual perception, language, fear responses, and circadian rhythms. The idea is to create interventions for psychological and physiological processes that deviate from the norm. For this reason, RDoC is less likely to save psychiatry than it is to resurrect eugenics.

The quest for biomarkers in psychiatry can be likened to the legend of the phoenix, a mythological bird that repeatedly rises out of the ashes of its predecessor. The DSM seems to be near end of its life-cycle. Now psychiatry is building an RDoC “nest” that it will eventually ignite, reducing both the DSM and RDoC to ashes. And from these ashes, it is hoped, a new diagnostic system—a new phoenix—will arise.

Also see my blog post, “Psychiatry Has No Clothes.”

10/13/14

Russian Roulette with Heroin?

Some of the most intriguing research into addiction treatment being done today is with vaccines. The idea is rather simple. Drugs of abuse pass through the blood-brain barrier because they are too small, too simple to be targeted by the immune system. So researchers have designed vaccines that take key fragments of the drug molecules and attach them to larger, more immune-provoking carriers (such as a cholera toxin or a tetanus toxin). The antibodies produced by this work-around will attack the drug and prevent it from passing through the blood-brain barrier and reaching the reward pathway in the brain. In other words, you can ingest the drug BUT WON’T GET HIGH!

Vaccines are being developed for drugs of abuse like alcohol, marijuana, heroin, methamphetamine, nicotine, and cocaine. A previous blog post, “Raising the Stakes in the War on Cocaine Addiction,” looked at the attempts to develop a cocaine vaccine by Thomas Kosten. His research has developed to the stage of clinical trials with humans, but a concern was discovered. Some of the human participants used ten times as much cocaine while attempting to override the blocking action of the cocaine vaccine. That trick could kill an individual who tried it with heroin.

Heroin has been a moving target for vaccine research because it quickly degrades into 6-acetylmorphine (6AM) and morphine. Kim Janda and his team of researchers associated with The Scripps Research Institute have developed a “dynamic vaccine” that creates antibodies against heroin and its psychoactive metabolites. You can read the academic journal article on their work found in the Proceedings of the National Academy of Sciences here or a summary of their research on The Scripps Research Institute website here or here.

There are positives and negatives to Janda’s dynamic heroin vaccine. First, while it will attach to heroin and its metabolites, it won’t work with oxycodone (OxyContin) or hydrocodone (Vicodin, Zohydro); or any other opioid. This is a trade-off because of the above-mentioned rapid degradation of heroin into its psychoactive metabolites. Second, this means the dynamic vaccine also won’t work with methadone or buprenorphine (Suboxone, Subutex), which are both opioids. So it can be used in conjunction with opioid maintenance therapy.

Although Janda’s research suggested that his vaccine helped limit heroin seeking behavior and halted the progression of compulsive heroin taking with rats, there are easy work-arounds for human beings. A human addict could ingest oxycodone or hydrocodone while taking the heroin vaccine to get high. They could even take a benzodiazepine along with their methadone or Suboxone for a nice, heroin-like buzz while taking the Janda vaccine. These limitations were acknowledged by Janda’s research team: “Although the dynamic heroin vaccine is not targeted to treat the ‘addicted’ brain, it represents a robust tool in the continuous blockade of all heroin activity.” In the concluding paragraph of the journal article, the research team said:

The prospect of heroin vaccine use in the treatment of addiction presents a high-payoff, low-risk opportunity. Drug vaccination requires minimal medical monitoring and compliance to maintain opiate resistance, allowing for greater potential worldwide accessibility. Furthermore … drug vaccines represent a low risk for long-term side effects. . . . Although it may not be a “magic bullet” against all aspects of drug addiction, the dynamic nature of our heroin vaccine represents a promising and innovative adjunct therapy in the treatment of heroin addiction.

But Janda’s research is stalled because it ran out of funding. In an interview with The Fix, he said: “We are not anywhere near human trials because nobody wants to pay for them.” Earlier funding was obtained by the Scripps Research Institute, the Pearson Center for Alcoholism and Addiction Research and the National Institute of Health (NIH). Janda and others have approached the NIH for additional funding, but so far have been unsuccessful.

Pharmaceutical companies aren’t interested either. Janda commented: “I have talked to many different companies and not one has shown any interest whatsoever. They don’t feel there is value for their company.” He doesn’t understand this from the standpoint of the greater good of society, but will attempt the route of applying for more research grants from the government. “I think we’ll probably just have to keep going it alone.”

I have mixed feelings about this vaccine, not because of the research, but because of what I know about how some addicts think. The research from the cocaine vaccine clinical trails discussed above noted how some addicts tried to test the vaccine with ten times as much cocaine as they usually ingested to get high. If heroin addicts test Janda’s heroin vaccine in a similar way, they will be risking their lives. It will be like playing Russian roulette with heroin.

There is also an “addiction” to the ritual of getting high (tying off, cooking the heroin, etc) for some addicts that the vaccine will not touch. I’ve known heroin addicts under the influence of this kind of obsession who compulsively “shoot up” water attempting to satisfy this urge. As Janda himself said, while it will blockade all heroin activity, it is not targeted to treat the “addicted brain.”

 

10/10/14

Walking in Beauty

© Guoqiangxue | Dreamstime.com - Monument Valley Navajo Tribal Park At Sunrise Photo

© Guoqiangxue | Dreamstime.com – Monument Valley Navajo Tribal Park At Sunrise Photo

Aligning your will with the Logos of nature, discovering your place in the natural order, is a common theme in many philosophies and religions. One such example is the Navajo sense of hózhó. I first became aware of this Navajo concept when I read a mystery novel by Tony Hillerman, The Blessing Way. I’ve read through the series twice and think I may do it a third time. The stories were always told within the context of some aspect of Navajo culture, which I’ve come to deeply respect.

In the Navajo language there is no word for religion, but hózhó comes closest. Hózhó defines the essence of Navajo thought and is their basic value concept. The term is often translated as: “it is pleasant, beautiful or blessed.” It expresses a combination of concepts in English such as: beauty, perfection, harmony, goodness, normality, success, well-being, blessedness, order, and ideal. Every aspect of traditional Navajo life, secular and spiritual, is related to hózhó.

The Navajo believe the universe is “an orderly, all-inclusive, unitary system of inter-related elements.” A universal continuum ranges from the tiniest insect, being or power; to the largest and most powerful, such as the great mountains that set the boundaries for the Navajo country or the thunder and lightening that crash above them. This all-inclusive universe contains evil as well as good. This is not an abstract sense of evil, but the complement to what is hózhó in all things—controlled, harmonious, orderly. Evil is then what is uncontrolled, unharmonious, disorderly in all things. “Every human being, no matter how good in life, has an evil component.”  Evil and danger come from disturbances in the natural order or balance in the universe.

Similar to the principle of reciprocity, hózhó governs Navajo relations with many elements of the universe, including other humans. So injury for injury, sickness for misbehavior, and favor for favor will set things right. this sense of reciprocity echoes the teaching of “an eye for an eye” in Leviticus 24:17. In the Sermon on the Mount, Jesus noted how reciprocity was used to justify returning evil for evil, but then restated it in a way similar to the concept of hózhó: “You have heard that it was said, ‘An eye for an eye and a tooth for a tooth.’ But I say to you, Do not resist the one who is evil. But if anyone slaps you on the right cheek, turn to him the other also.” (Matthew 5:38-39)

The Navajo ceremonial system, which is aimed at the restoration of universal harmony, ritualizes this principle of reciprocity. A ceremony or “sing” is conducted by a hataalii or “singer.” Singers often apprentice with older experts for long time periods. The following is the closing prayer from the “Navajo Way” Blessing Ceremony:

In beauty I walk

With beauty before me I walk

With beauty behind me I walk

With beauty above me I walk

With beauty around me I walk

It has become beauty again

It has become beauty again

It has become beauty again

It has become beauty again

Navajos believe in a Creator, a formless spiritual force that is the source of all life. When Navajos pray to this almighty Force, they address the evidence of its powers: the sun, the wind, etc. The traditional Navajo way can be described as “life itself, the land, and well–being.” All living things—people, plants, animals, mountains, and even the Earth itself—are relatives. Each has its own spirit or inner form, which gives it life and purpose within the orderly, interconnected universe. Like the ancient Stoics, the purpose of Navajo life is to maintain balance between the individual and the universe; to live in harmony with nature and the Creator.

Regrettably, the union extolled here seems to be a pantheistic one, where everything in existence merges into God. As Charles Hodge noted in his Systematic Theology, God exists as the universe in pantheism: “All is God.” All reason is his reason; all activity is his activity. Good and evil, pain and pleasure, are equally phenomena of God; “modes in which God reveals himself, the way in which He passes from Being into Existence.” He is not then a person; someone we can trust. God is merely the substance by which the universe and all it contains manifests its eternal transformation. Finding your place within the natural order, striving to walk in beauty, does recognize a beauty and purpose within the creation, but ultimately that is lost in the pantheistic union with God.

The wisdom teaching of Ecclesiastes seems to be a point of contact in Christianity with hózhó. We see this in Ecclesiastes 3:11: “He [God] has made everything beautiful in its time.” And again in Ecclesiastes 3:1ff: “For everything there is a season, and a time for every matter under heaven.”  Yet in the end, the path walked in beauty by the Navajo will diverge from that of the Christian. For the hózhó of the followers of Christ is to “Fear God and keep his commandments, for this is the whole duty of man.” (Ecc. 12:13)