Monthly Archives: November 2014

11/28/14

Help Me in My Unbelief!

“I believe; help my unbelief!”  Too many times it seems that just as in the biblical passage this cry was taken from, we approach God for some healing or restoration and nothing happens … at first.

In Mark 9:14-29 is the story of the “Healing of a Boy with an Unclean Spirit”, as the ESV referred to the passage. Parallels to the passage are in Matthew 17:14-21, and Luke 9:37-43. The story is essentially the same in all three accounts, but in Matthew, this boy is said to be an epileptic—he’s “moon struck,” a lunatic. In ancient times epilepsy was thought to be associated with the supernatural power of the moon. So the epileptic behavior was the result of the influence of demons or unclean spirits.

To set the scene, we find that Peter, John and James are returning with Jesus from His transfiguration. They see a crowd ahead gathered around some of the other disciples, who are arguing with the scribes, the ordained theologians of the Jews. Jesus asked his disciples what they were arguing about. A man in the crowd said he had brought his son for healing because he has “a spirit that makes he mute.” It convulses him and throws him to the ground; sometimes into the fire. “So I asked your disciples to cast it out and they were not able.”

Jesus immediately recognized the implications drawn by the crowd and the scribes: the disciple’s inability to heal the boy casts doubt on the message they preach; and ultimately the message Jesus himself preaches. We see this same issue occur repeatedly throughout the ministry of Jesus (Mark 2:1f; 8:11f; Matt. 12:38f; John 2:18f; 6:14; 6:30; 12:18). He condemned the crowd as “faithless,” and called for the boy to be brought to him. As the boy approached, the spirit seized him; the boy cried out and fell to the ground in a convulsion.

Jesus asked how long this has been happening to the boy, and his father said from childhood. The boy was often falling into the fire or water. The father then respectfully asked, “But if you can do anything, have compassion on us and help us.” Jesus then repeated his conditional statement—IF you can—declaring that everything is possible for him who believes.

The father immediately responded, “I believe. . . . Help my unbelief!” Jesus saw that a crowd was gathering around them, so he rebuked the spirit, commanding it to come out and never enter the boy again. The spirit shrieked, convulsed the boy violently, and came out. The boy seemed to be dead, but Jesus took him by the hand and the boy stood up. There are three reactions to the work of Christ here.

The crowd and the scribes represent individuals who may seek signs and wonders, but are deaf to the call to faith. They stand on the outskirts of the work of Christ, speculating and observing, but generally are unmoved by what they see. Like in the Parable of the Sower, the Word of God confronts their unbelief, but fails to penetrate the hardness of their hearts. They are the hard soil of the path. The unbelief in the lives of Christians is of the last two types: the father and the son.

The father represents those who hear the call to faith upon their life, yet recognize their inability to respond without the help of Christ. Overwhelmed by the continuing bondage of his son, the father’s attention to the world chokes his belief in Christ. He is (they are) the soil choked by weeds and the cares of the world.

Christians confess an intellectual assent of the power of Christ to heal, to move in their lives and the lives of others, yet they fall into unbelief like the father when their belief is not empirically validated. They pray; they read the Word of God; they stand on its promises; but nothing changes. So the cares of the world rise up like weeds and choke the Word of God. An encounter with the true Christ reveals to them, as to the father, they had a mere expectation of God, which they had called belief. In the presence of Christ, the father sees his confessed “belief” as unbelief, and cries out for help. Only the presence of Christ can reveal this unbelief; only the power of Christ can heal it.

The boy represents those who are fully aware of the hopelessness of their situation, and see no way out. He (or they) may even believe it is God’s will for his life. He (or they) may intellectually affirm that Jesus could heal or save him. But he doesn’t believe it will happen to him. He is (they are) the rocky soil.

Long ago they succumbed to the rocky soil of their lives that prevented the Word of God from taking root. With the approach of Christ, they fear their shallowness will be exposed. But they cannot hide their unbelief. It rises up and chokes out the cry of belief from their mouth even as it is spoken. But the Christ who comes is gracious. He took the boy by the hand and raised him up—healed of the demons that he had lost hope of ever being released from.

 
11/26/14

The Quest for the Holy Grail of Psychiatry

Our brain: the final frontier. This is the unending quest of research into biomarkers. Its continuing mission: to explore strange new theories, to seek out new mental illnesses and new diagnoses, to boldly go where no psychiatric research has gone before.

The quest for biomarkers (measurable indicators of a biological state or condition) of mental disorders has gone on for decades without success. The recently proposed research strategy of the National Institute of Mental Health (NIMH) know as Research Domain Criteria (RDoC), has proposed to set aside the DSM diagnoses used to frame past mental health research and utilize data from neuroscience, genomics and behavioral science to spell out the etiology of mental illness.

Psychiatrist Giovanni Fava views the RDoC model as “the reflection of an intellectual crisis in psychiatry.” While its “blanket” approach aims to see that all possible biological and behavioral measurements are utilized, Fava thinks it will result in conflicting results that may be difficult to interpret. He said it was “misguided” to assume that nothing will be missed with such a strategy and that “innovative classification systems will ensue automatically.” The complexity of the new approach and the potential for interpretive problems it is illustrated by this recently published article in World Psychiatry, “Biomarkers and clinical staging in psychiatry.”

He pointed out that major clinical challenges were left without independent research. Among these challenges was the problem of the loss of clinical effects during long-term antidepressant treatment. And despite a lack of any evidence to support their superiority, antidepressant drugs are increasingly used as a first-line treatment for anxiety disorders. Studies on psychological treatment were also “scandalously under-supported.”

A major problem in the development of the Research Domain Criteria project has been the fact that its strong ideological endorsement by leading figures of the National Institute of Mental Health has resulted in suppression of an adequate debate. How many investigators who are likely to submit funding applications to that agency may afford disclosing that the emperor has no clothes and that the strategy may be a road to nowhere?

Fava et. al thought the exclusive reliance upon diagnostic criteria had impoverished the clinical process and did not reflect “the complex thinking that underlies decisions in psychiatric practice.” Current diagnostic definitions of psychiatric disorders are based on collections of symptoms from very heterogeneous populations and are likely to yield “spurious results when exploring biological correlates of mental disturbances.”

The large studies of biomarkers across diagnostic categories proposed by RDoC are anticipated to yield improved clinical information. But “such a view is based on the concept of assessment as a collection of symptoms devoid of any clinical judgment and interpretation.” There is no evidence to support the research direction taken by RDoC. Fava et al. noted that although Kapur, Phillips and Insel proposed that new biomarker-defined subtypes be identified, they were not able to “provide exemplifications suggesting that this approach was likely to yield meaningful clinical results in psychiatry.” Incidentally, Thomas Insel is the current director of the NIMH.

Using meta-analyses of biomarkers commonly used in cardiovascular medicine as an example, Fava et al. noted the presence of publication bias and selective reporting. They said biomarkers could end up being the result of various mechanisms and not necessarily the result of a specific disease process.

The complexity of the brain and the spurious nature of measurements that can be recorded constitute a major difficulty for psychiatry. Specifically, the neuroplastic properties make the brain a unique organ that essentially has to be studied and understood in a longitudinal, lifetime and transgenerational perspective.

Biological reductionism was said to have resulted in an approach that is far from the “explanatory pluralism” required by clinical practice. The exclusion of the methodological triad of observation (outer viewing), introspection (inner viewing), and dialogue (inter-viewing) makes this approach unscientific. Either the human realm was excluded from scientific inquiry or the scientific approach was conformed to the reductionistic, mechanistic requirements of the biomedical paradigm.

This restrictive ideology characterizes the Research Domain Criteria. It is time to enrich such criteria with clinically relevant dimensions and add clinical validity to the reliability and reductionism-focused mainstream of psychiatry research.

Elsewhere (“We Are But Thinking Reeds”) I’ve spoken of the necessity to see human nature as a psychosomatic unity of body (soma) and soul (psyche). The human mind is more than just a manifestation of brain activity. Any approach to “mental” illness research that fails to acknowledge this will never entirely succeed in its quest to find the holy grail of psychiatry.

11/24/14

The Most Addictive and Harmful Drugs

image credit: iStock

image credit: iStock

Despite the press given lately to heroin, if you were to say that it was the most addictive or harmful drug there is, you would be wrong. It is the drug most likely to result in an overdose death when used, but there is a more harmful and more addictive drug than heroin.

In The Science of Addiction, Carlton Erickson reported on research done by Anthony, Warner & Kessler in 1994 on the “dependency liability” of various drugs and classes of drugs. A dependency liability is the likelihood that a person will become dependent (addicted) upon a drug if they use it. To get a “dependency liability” a drug has to have an effect on the mesolimbic dopamine system, the reward center or pleasure pathway, of the brain.

The research of Anthony et al. suggested that the percentage of users who became dependent upon a particular drug were as follows: nicotine, 32%; heroin, 23%; cocaine, 17%; alcohol, 15%; stimulants, 11%; cannabis, 9%; sedatives (includes tranquilizers), 9%; psychedelics, 5%; inhalants, 4%.  So according to their research, nicotine is the most addictive drug. But it wasn’t the most harmful drug.

There was an interesting British study done a few years ago on the harm caused by the misuse of various drugs. 12 Keys to Recovery recently put together an inforgraphic of data from the study, which can be found here. You can also read the original study in The Lancet, after a free registration. The goal of the study was to provide guidance when making policy decisions in health, policing and social care. However, it also provided some helpful information on the harm done by drugs to both drug users and to others.

The first stage of the process was to select the harm criteria that were to be assessed. These criteria were then organized by harms to users and harms to others; and then clustered under physical, psychological and social effects. See Figure 1 in the original study, which is a chart of the criteria and how they were organized. The second stage consisted of a meeting of drug experts who scored every drug on each harm criterion; “and then assessed the relative importance of the criteria within each cluster and across clusters.” The result was a common unit of harm across all the criteria. From that data, a new analysis of relative drug harms was done. The ratings were scaled from 0 to 100.

The following chart compiles the scores for the top ten drugs according to their overall score and that for harm to others and harm to users.

Drugs

Overall harm

Harm to users

Harm to others

Alcohol

72

26

46

Heroin

55

33

22

Crack cocaine

54

37

17

Cocaine

27

20

7

Tobacco 

26

17

9

Cannabis

20

12

8

Meth

33

31

2

Amphetamine

23

19

4

Ketamine

15

12

3

Ecstasy

9

8

1
  • The 5 most harmful drugs overall were: alcohol, heroin, crack cocaine, meth, and cocaine.
  • The top 5 harmful drugs to others were: alcohol, heroin, crack cocaine, tobacco, and cannabis.
  • And the 5 most harmful drugs to users were: crack cocaine, heroin, meth, alcohol, and cocaine.

Alcohol earned the highest overall rating by having over twice the rating of “harm to others” than heroin, its nearest competitor.  Interestingly, it was only rated at 26, 4th, for “harm to users.” Heroin and crack cocaine were always in the top three for each of the categories: overall, to users and to others.

There was also data on the types of harm and the drugs judged to be the most responsible for that type. Heroin was considered to be the drug most responsible for four types of harm. Alcohol was most responsible for seven types. Meth was most responsible for three types, most notably intoxication and psychosis, and loss of relationships. LSD was judged to be most responsible for mood disorders, which is an interesting finding as it is being researched as a treatment for alcoholism and other psychedelics are proposed to treat mood disorders. Look for a coming blog post: “Back to the Future with Psychedelics.” See the following chart for the information on which drugs were rated as being the most responsible for the types of harm.

Types of Harm

Drugs

Overdose

heroin

Accidents and suicide

alcohol

Related disease

alcohol

Self harm; unwanted sexual activity

heroin

Addiction

alcohol

Mood disorders

LSD

Intoxication and psychosis

meth

Loss of tangibles

heroin

Loss of relationships

meth

Injury

alcohol

Crime

heroin

Environmental damage

meth

Family adversities

alcohol

International damage

cocaine

Economic cost

alcohol

Community

alcohol

There were no real surprises here for me, except maybe the rating of LSD as the most responsible drug for mood disorders. Yet the study was useful in providing a systematic way to quantify the amount of harm done by drugs to their users and to others. I’ll close with a caveat from the discussion of the British study:

“Finally, we should note that a low score in our assessment does not mean the drug is not harmful, since all drugs can be harmful under specific circumstances.”

11/21/14

Make Me an Instrument of Your Peace

Back in the 1980s, Come to the Quiet by John Michael Talbot was one of my favorite cassette tapes. And his version of the “Peace Prayer of St. Francis” was one of my favorite songs on the tape. When I decided to write on the connection of the Peace Prayer to Alcoholics Anonymous, I discovered that John Michael Talbot is still around, making music and doing an evangelistic ministry. His look has changed. Now he sports a very long white and grey beard. Think ZZ Top and John the Baptist rolled into one.

The origins of the Peace Prayer of St. Francis are actually in 20th century France, not the writings of Francis of Assisi. In 1912 it appeared anonymously in a small French magazine, La Clochette (The Little Bell), published by a French priest, Father Esther Bouquerl. In 1915, it was sent to Pope Benedict XV and published the following year in the Vatican’s daily newspaper.  Around 1920, it was printed on the back of an image of St. Francis and titled “Prayer for Peace.” It was first attributed to St. Francis in 1927 by a French Protestant movement, The Knights of the Prince of Peace.

The first known English translation was in a 1936 book by Kirby Page titled: Living Courageously. Kirby was a Disciple of Christ minister and the editor of a pacifist magazine called “The World Tomorrow;” not to be confused with the long running radio and television program by Herbert W. Armstrong or the more recent 2012 political talk show hosted by Julian Assange.  Page clearly and specifically attributed the origins of the “Peace Prayer” to St. Francis of Assisi. During World War II and afterwards, it had a wide circulation as the “Prayer of St. Francis” especially through the books of Francis Spellman, who became the archbishop of New York City in 1939, the year the A.A. Big Book, Alcoholics Anonymous, was published. A.A.’s headquarters and Bill W., cofounder of A.A., were both in NYC.

In a December 1952 article for the AA Grapevine, Bill W. presented Francis of Assisi as an example of an individual who was able to practice “the spirit of Christmas” every day of the year. Bill thought that regardless of what an individual may call it, “the spirit of Christmas is in us all.” After describing the life of Francis and the vision Francis had after he “hit bottom” during a long illness, Bill presented the “Peace Prayer of St. Francis” as “the prayer he [Francis] so often spoke.” Bill then concluded his reflections stating that Francis left us a clear example of how to live our lives: “Freely ye have received; Freely give.”

When Bill W. wrote the essay for “Step Eleven” in the A.A. book, Twelve Steps and Twelve Traditions, he suggested it as a beginning for those trying to apply the meditation and prayer to recovery that the Eleventh Step encouraged. The Eleventh Step reads: “Sought through prayer and meditation to improve our conscious contact with God as we understood Him, praying only for knowledge of His will for us and the power to carry that out.” Within A.A., the Peace Prayer has become known as “the Eleventh Step Prayer.” In 1958, Bill wrote the “Prayer of St. Francis” in the AA Grapevine and described how he used Peace Prayer to overcome depression. He said:

Of course, I haven’t offered you a really new idea–only a gimmick [the Peace Prayer] that has started to unhook several of my own “hexes” at depth. Nowadays my brain no longer races compulsively in either elation, grandiosity or depression. I have been given a quiet place in bright sunshine.

A final indication of the importance of the Peace Prayer to Bill was that it was recited in a private memorial service when he died. And it was credited in Pass It On to be his favorite prayer. Here it is:

Lord make me an instrument of your peace

Where there is hatred,
Let me sow love;
Where there is injury, pardon;
Where there is error, truth;
Where there is doubt, faith;
Where there is despair, hope;
Where there is darkness, light;
And where there is sadness, Joy.

O Divine Master grant that I may not so much seek to be consoled
As to console;
To be understood, as to understand;
To be loved, as to love.
For it is in giving that we receive,
It is in pardoning that we are pardoned,
And it is in dying that we are born to eternal life.

 

Although Bill saw the Peace Prayer as applying to individuals of any faith background, to do so, the “Lord” and “Divine Master” of the prayer will have to be seen in the generic sense of God as we understood Him. Yet the Christian sense of who was “Lord” in the prayer was never in doubt. Even from its own anonymous beginnings it was referring to Jesus Christ. “If you confess with your mouth that Jesus is Lord and believe in your heart that God raised him from the dead, you will be saved. (Romans 10:9)”

Even if we look to the Peace Prayer as a blueprint to how all people should treat one another as Bill W. did, it elaborates the second greatest commandment of loving your neighbor as yourself (Mark 12:31). And when someone who does not confess Jesus as Lord still tries to live out the truth of the Peace Prayer in his or her life, we can say as Jesus did to the scribe in the Mark 12 passage, “You are not far from the kingdom of God. (Mark 12:34)”

11/19/14

Evidence-Based Treatment … Lacks Evidence

21828750_sEvidence-based medicine (EDM) began in the early 1990s and was seen as a revolutionary movement that would improve patient care. It grew to become the buzz-word for all medical and behavioral health care—make sure treatment is evidence-based! And yet, there is little evidence that EDM has achieved its aim. Health care costs have soared and there is a distinct lack of “high-quality evidence suggesting that EBM has resulted in substantial population-level health gains.”

Given that EBM firmly favours an empirical approach over expert opinion and mechanistic rationale, it is ironic that its widespread acceptance has been based on expert opinion and mechanistic reasoning, rather than EBM ‘evidence’ that it actually works.

The article from which the above critique was taken suggested that the lack of evidence for the overall benefit of EBM was a consequence of it not being implemented effectively. A cornerstone of EBM methodology—the randomized trial—has been corrupted by vested interests.  The authors, Every-Palmer and Howick, defined EBM as “the conscientious and judicious use of current best evidence in conjunction with clinical expertise and patient values to guide health care decisions.” They singled out the field of psychiatry for specific concern, where “the problems with corruption of randomized trials are dramatic.”

Most of the medical psychiatric evidence base has been funded by the pharmaceutical industry, often without the relationships being disclosed. “Between two-thirds and three-quarters of all randomized trials in major journals have been shown to be industry funded.” One of the consequences of this has been publication bias: positive results are published; negative results are not. The best current estimate is that half of all completed clinical trials have never been published in academic journals. Some trials are never registered.

There is also evidence that industry-funded studies exaggerate the treatment effects in favor of the product preferred by their sponsor. One study reviewed industry-funded studies of atypical antipsychotics and found that 90% of the trials showed superiority of the sponsor’s drug. The studies had been designed “in a way that would virtually guarantee the favoured drug would ‘win.’”

Among their recommendations, Every-Palmer and Howick suggested that all clinical trials should be registered and reported. There needs to be more investment in independent research. Evidence-ranking schemes also need to be modified to account for industry bias. These suggestions would be helpful corrections for the corruption of the randomized trial methodology, but what if there are additional problems? For example, merely correcting problems with the misuse of randomized trials would not address concerns related to clinical expertise or patient values.

If current medical science is reaching its limits with some complex illnesses, as Every-Palmer and Howick said was one possibility for the lack of progress with EBM, then further gains will be hard to come by. This would seem to be true with mental illness and addiction, which are diagnosed with the Diagnostic and Statistical Manual (DSM), 5th edition. DSM diagnoses are consensus-based decisions about clusters of symptoms and do not have any objective laboratory measure. Thomas Insel, the Director of the National Institute of Mental Health (NIMH), said that diagnosis with the DSM was equivalent to “creating diagnostic systems based on the nature of chest pain or the quality of fever.”

A further compounding error could be when the role of clinical judgment is neutralized as a result of an overreliance upon the trump of scientific—real or imagined—evidence. Kiene and Kiene noted how the reputation of clinical judgment in medicine has undergone a “substantial transformation” over the last century with the rise of modern research methodology.  “A primary mission [in medical progress] therefore became ‘to guard against any use of judgement’, and it was executed through clinical trials.”

Giovanni Fava pointed to the increasing crisis in psychiatric research and practice because “Psychopathology and clinical judgment are often discarded as non-scientific and obsolete methods.” He noted how the concept of evidence-based medicine has achieved widespread endorsement in all areas of clinical medicine, including psychiatry. But randomized trials were not intended to answer questions about the treatment of individual patients. “The results may show comparative efficacy of treatment for an average randomized patient, but not for pertinent subgroups formed by characteristics such as severity of symptoms, comorbidity and other clinical nuances.”

An aura of authority is given to collections of “best available evidence”, which can in turn lead to major abuses that produce “inappropriate guidelines” for clinical practice. The risk is especially serious as a result of the substantial financial conflicts of interest in medical societies and with the authors of the medical guidelines for clinical practice within those societies.

Special interest groups are thus using evidence-based medicine to enforce treatment through guidelines, advocating what can be subsumed under the German language term of “ Leitkultur ”, which connotes the cultural superiority of a culture, with policies of compulsory cultural assimilation. In psychiatry, such process has achieved strong prescribing connotations, with a resulting neglect of psychosocial treatments.

Given the existing crisis within psychiatry, especially with the questionable validity and reliability of diagnosis within the DSM, evidence-based treatment guidelines that were developed and disseminated within such a culture require radical revision or should be used with extreme caution. The evidence for their efficacy is lacking.

11/17/14

The Improbable Truth of Sudden Death with Marijuana

iStock image

iStock image

A study by German researchers, “Sudden Unexpected Death Under Acute Influence of Cannabis,” has stirred up a firestorm of controversy as a result of their conclusion that two unexplained deaths were the result of marijuana use. High Times ridiculed the study as another round of “Pot Kills” propaganda. They claimed that news sources like Mail Online were “bastardizing” the story and spreading a certain level of fear. High Times and other news sources then quoted the head of the German Association for Drugs and Addiction (FDR) as saying that cannabis does not paralyze the breathing of the heart. “Deaths due to cannabis use are usually accidents that are not caused by the substance, but to the circumstances of the use.” But let’s take a look at what the study and the researchers actually said.

The case report (here and here) described two young, healthy men who died unexpectedly under the acute influence of cannabinoids (THC). “To our knowledge, these are the first cases of suspected fatal cannabis intoxication where full postmortem investigations, including autopsy, toxicological, histological, immunohistochemical, and genetical examinations, were carried out.” After excluding other possible causes of death, they assumed the men died from “arrhythmias evoked by smoking cannabis.” HOWEVER, “this assumption does not rule out the presence of predisposing cardiovascular factors.”

They noted the absolute risk of cannabis-related cardiovascular effects was low and that the cannabis-induced changes were transient. Yet they cited two studies indicating that the risk of myocardial infarction was elevated almost 5 times in the first hour after smoking marijuana; then it declined rapidly afterwards. “Consequently, the relative risk of cardiovascular effects is most probably increased within this period.”

The Mail Online article cited the research claims of the German study, namely that cannabis can kill, but also stated that: “it remains unclear how it can trigger heart problems.”  They pointed to more significant risks associated with marijuana use and quoted David Raynes of the UK National Drug Prevention Alliance as saying about the study’s findings: “These deaths are rare and will remain rare. The real risks are from long-term effects on the young brain.”

There was another alleged case of unexplained death from THC, a young woman named Gemma Moss. A Colorado doctor who works with medical marijuana patients in that state said: “There’s no history of any reports of a death from cannabis ever.” He admitted that it could cause an increased heart rate, so there was a potential problem with someone with a pre-existing heart disease. “But there’s no known dose of cannabis that could kill a human.”

Well, there does seem to be a known dose of THC that would kill a human. The above noted report cited a 2009 study in American Scientist on the toxicity of recreational drugs suggested that using more than 1,000 times the effective dose of THC in marijuana would have to occur for possible fatalities. This fact—that typical doses of THC are well below the supposed lethal dose—was also noted by the German researchers. But they suggested further study of the potential issue and cautioned against individuals who are at high risk of cardiovascular disease to avoid the use of cannabis.

It is impossible to predict how certain individuals respond to cannabis smoke, as underlying illnesses and complicating factors may be unknown. The presented case highlights the potentially hazardous cardiovascular effects of cannabis in putative healthy young persons.

The researchers had an approach that Sherlock Holmes would have been proud of. They said: “After exclusion of other causes of death we assume that the young men died from cardiovascular complications evoked by smoking cannabis.” Holmes famously said: “When you have eliminated the impossible, whatever remains, however improbable, must be the truth.” It seems to me that pro-marijuana individuals and organizations are dismissing the results of the study out-of-hand for their own propaganda purposes.

 

 

11/14/14

Where Stephen Hawking and Augustine Agree

What, then, is time? If no one [asks] me, I know; if I wish to explain to him who asks, I know not. Yet I say with confidence, that I know that if nothing passed away, there would not be past time; and if nothing were coming, there would not be future time; and if nothing were, there would not be present time. (Augustine, Confessions, 11.14.17)

Citing the above passage from the Confessions of Augustine, Huw Price commented in Time’s Arrow and Archimedes’ Point that despite some notable advances in science and philosophy since the time of Augustine, “Time has retained this unusual dual nature.” It is simultaneously familiar and profoundly mysterious.

We live and move and have our being within the space and time of the creation. So when Scripture says in Genesis 1:1 that: “In the beginning God created the heavens and the earth,” it makes a statement of eternal truth that we have difficulty comprehending. How could there be a beginning to all things, including time? What did God do before the beginning?

These and other questions were put to early Christians in response to their insistence, from Genesis 1, that the world had a temporal beginning, that matter was created out of nothing, and that God created freely and not out of necessity. Widely accepted philosophical and religious ideas of the time believed in an eternal world that God shaped—but did not create—out of pre-existent matter. So opponents of Christianity often ridiculed elements of biblical creation that seemed questionable to them. Particularly that there was a beginning to all things, including time and matter. There were also similar “heretical currents” within the church. “Gnosticism, Marcionism, Manichiesm, and Priscillianism called for a theological explanation that would oppose any form of dualism” (Edmund Hill, On Genesis, John Rotelle, ed., p. 18).

Augustine, whose quote on time was given above, left the Manichee sect, and converted to Christianity in 386 AD. Over a period of thirty years, he wrote five commentaries on the biblical creation stories. His first Genesis work was to refute the teachings of the Manichees. In his later classic work, the Confessions, Augustine devoted the last three books to a commentary on Genesis 1. In yet another one of his Genesis commentaries, The Literal Meaning of Genesis, Augustine said that not only had he written against the Manichees to refute their ravings, but “also to prod them into looking for the Christian and evangelical faith in the writings which they hate.”

Just before the above opening quote from the Confessions, Augustine said: “Thou hast made all time; and before all times Thou art, nor in any time was there not time” (11.13.16). God created time, so the question of what God did before He made the heavens and the earth is nonsensical—because before the heavens and earth were created, there was no time. In On Genesis: A Refutation of the Manicheees (1.2.3), Augustine said: “God, after all, also made times, and that is why there were no times before he made any.” We cannot say there was a time when God had not yet made anything, because how could there be a time which God had not made, “seeing that he is the one who forges all times.”

Stephen Hawking disagrees with Augustine on the necessary existence of God. He said in an ABC interview about his book The Grand Design, you cannot prove that God does not exist. “But science makes God unnecessary. The laws of physics can explain the universe without the need for a creator.” Hawking suggested in his essay, “The Beginning of Time,” that despite the Big Bang, we don’t have to appeal “to something outside of the universe, to determine how the universe began.” Yet Hawking does agree that there was a beginning for both time and the universe: “The universe, and time itself, had a beginning in the Big Bang.”

In Hawking’s recent autobiography, “The Reason We Are Here,” he said: “To ask what happened before the beginning of the universe would thus become a meaningless question.” He also agreed that the universe was made out of nothing. Using the concept of imaginary time, a real scientific idea, he asserted that the beginning of the universe was governed by the laws of science and removed the age-old objection that the universe had a beginning, where the normal laws of physics broke down. “We had side-stepped the scientific and philosophical difficulty of time having a beginning by turning it into a direction in space. The no-boundary condition implies, that the universe will be spontaneously created out of nothing.”

So then for a beginning to time and creation ex nihilo, out of nothing, Hawking seems to agree with modern Christians and Augustine. But since the laws of physics can explain the universe without a creator, “science makes God unnecessary.”  Nevertheless, I think I’ll agree with Augustine on this last assertion, since even Stephen Hawking admits that you can’t prove that God doesn’t exist: “Thou, our God art the Creator of every creature.”

11/12/14

What a Drag It is Getting Old

Things are different today. Grandmother needs something to calm down. Although she’s not really ill, they’ll give her a little yellow pill. And it helps her on her way, and gets her through the day. So she goes running for the shelter of a mother’s little helper. Four will help her sleep right through the night; and might even help to minimize her plight.

“Doctor please, some more of these
Outside the door, she took four more
What a drag it is getting old.”

Above and below are the chorus and two paraphrases taken from the lyrics of the Rolling Stones 1966 song, “Mother’s Little Helper.” Following the runaway success of the first modern tranquilizer, Miltown, Hoffman-La Roche brought the newest benzodiazepine—Valium to market in 1963 and then targeted women in its advertising. “From 1968 to 1981, it was the best selling drug in the Western world.”

Recently there has been a good bit of press (Science Daily and Web MD and others) on a study published in the British Medical Journal that indicated benzodiazepine (benzo) use was associated with the risk of developing Alzheimer’s disease. A BBC report about the study quoted some Alzheimer’s experts who minimized the study’s findings by saying that it was hard to know the underlying reason for the link.  Other reports, such as that by Paula Span, on her New York Times blog, The New Old Age, noted how the study was designed to reduce the possibility of reverse causation. That is, reverse causation claims the correlation existed because individuals first diagnosed with Alzheimer’s were given benzos afterwards as part of their medical treatment.

Mad in America quoted from the study’s abstract, where the researchers said: “the stronger association [between Alzheimer’s and the use of benzos] observed for long term exposures reinforces the suspicion of a possible association.” The study’s authors further said:

Risk increased with density of exposure and when long acting benzodiazepines were used. Further adjustment on symptoms thought to be potential prodromes [precursors] for dementia—such as depression, anxiety, or sleep disorders—did not meaningfully alter the results.

The results of the study were consistent with five previous studies. It reinforced the suspicion of an increased risk of Alzheimer-like dementia among benzo users, particularly those who are long-term users. Their findings are particularly important when considering the wide spread use of benzos with older people, and the concurrent rise of dementia in developed countries. “Unwarranted long term use of these drugs should be considered as a public health concern.”

A JAMA Internal Medicine article noted that: “The American Board of Internal Medicine Foundation Choosing Wisely Campaign recommends against the use of benzodiazepine drugs for adults 65 years and older.” Paula Span reported in another article that a particular concern with older adults is falls, which are a leading cause of death and disability. The CDC estimated that one out of three older adults over the age of 65 falls each year. “In 2012, 2.4 million falls among older adults were treated in emergency departments and more than 722,000 of these were hospitalized.” Advice for tapering older adults off of benzos and other sleep aids like Ambien is available.  See the Paula Span article, “More on Sleeping Pills and Older Adults,” linked in this paragraph.

Not only are benzos problematic when given to older adults long-term, there is a well-documented concern with any long-term use of this class of drugs. Quoting Dr. Stevan Gressitt, Robert Whitaker indicated in Anatomy of an Epidemic that there was no evidence supporting the long-term use of benzos. Additionally, they could aggravate medical and mental health problems like anxiety, depression, cognitive impairment and functional decline.

Whitaker described a 2004 Australian study that looked at the potential deficits in cognitive functioning after long-term benzo use. The duration of benzo use by the patients in the research studies they looked at ranged from 1 to 34 years. The mean was 9.9 years. They found that long-term benzo users were consistently more impaired across all the cognitive categories examined. “The observation that long-term benzodiazepine use leads to a generalised effect on cognition has numerous implications for the informed and responsible prescription of these drugs.”

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, with dozens of studies subsequently confirming the wisdom of that advice, the prescribing of benzodiazepines for continual use goes on. Indeed, a 2005 study of anxious patients in the New England area found that more than half regularly took a benzodiazepine, and many bipolar patients now take a benzodiazepine as part of a drug cocktail. The scientific evidence just doesn’t seem to affect the prescribing habits of many doctors.” (Robert Whitaker, Anatomy of an Epidemic, p. 147)

“Life’s just much too hard today,”
I hear every grandmother say.
The pursuit of happiness just seems a bore
And if you take more of those, you will get an overdose.
No more running for the shelter of a grandmother’s little helper.
They just helped you on your way, towards your busy dying day.

11/10/14

A “Cure” for Alcoholism

Stockfresh image by stevanovicigor

Stockfresh image by stevanovicigor

There is an alleged “cure” for alcoholism. Yes, “cure.” It’s called “The Sinclair Method.” It actually encourages individuals to drink, but only after taking naltrexone or nalmefene before they start drinking. Naltrexone and nalmefene are opiate agonists (drugs that blocks opioid receptors in the brain). The theory is their use before drinking will reduce the neurological “reward” after drinking. The “cure” claim is that this reduction eventually leads to the extinction of the person’s desire to drink because they no longer catch the same buzz when they drink.

This is not a joke. The Sinclair Method has its own facebook page; it is promoted in a new documentary, “One Little Pill,” which also has its own facebook page. The original research was done by David Sinclair, and published in the journal, Alcohol & Alcoholism in 2001. You can see the original article here or here. Sinclair believes that drinking alcohol is a learned behavior. Some individuals (partly for genetic reasons) get so much positive reinforcement from drinking, that the behavior becomes too strong for them to control. “They cannot always control their drinking; they cannot ‘just say “no”.’  And society calls them alcoholics.”

The use of the Sinclair Method is said to remove “the neural changes that have caused alcoholism—the over-strengthened pathways of neurons that have developed in the brain, causing alcohol craving and excessive drinking.” The basic premise of the treatment method is that addiction is a learned behavior that has become so entrenched that the addict can no longer control it. “Alcohol drinking produces reinforcement and is learned through that reinforcement.”

Sinclair’s method is the subject of a book by Roy Eskapa, The Cure for Alcoholism. Eskapa said the book’s title means what it says: “Addiction to alcohol can now be cured—not through abstinence, but by always taking a medication an hour before drinking alcohol.” The reduction in cravings is progressive, with the strongest effects in evidence three to four months after beginning to use the Sinclair Method. “The benefits continue increasing indefinitely so long as you take naltrexone if and when you drink.”

Eskapa claimed that the Sinclair Method does not need to be done in conjunction with “extensive counseling.” He based this on his understanding of a study called Project COMBINE. “As a result of this study, naltrexone is no longer just for large clinics specializing in alcohol problems; now, any licensed doctor can ethically and safely prescribe naltrexone for problem drinking.” Citing clinical trials in Finland and the U.S., he said that naltrexone treatment was only effective when it was taken at the same time that alcohol was being drunk. “Until now, most doctors and addiction experts were unaware that to cure alcoholism, one has to drink alcohol while naltrexone is in the bloodstream.”

What the COMBINE study actually found was that all treatment groups experienced a large increase in the percentage of abstinent days, a factor of three times greater. The treatment groups for naltrexone alone, treatment alone and the combination of treatment and naltrexone had comparable outcomes. It did not conclude that treatment wasn’t needed.  What it said was: “Medical management of alcohol dependence with naltrexone appears to be feasible and, if implemented in primary, and other, health care settings, could greatly extend patient access to effective treatment.”

Before you seek out a doctor to prescribe naltrexone (nalmefene is not approved by the FDA for use in the U. S. at this time), let’s look at this alleged “cure.” First, alcoholism is reductionistically conceived as a learned behavior. And the treatment or “cure” is the systematic application of a behavior modification technique known as extinction. Now, the science behind extinction, and the reduction in drinking by using the Sinclair Method is clear. When you positively reinforce a behavioral stimulus, the individual person (or hamster) will do the behavior more. When you stop positively reinforcing the behavior, it will decrease in frequency. This systematic decrease is extinction. Here is a short YouTube primer on the four basic elements of classical conditioning, if you’re interested.

So here’s the kicker. The “cure” is contingent upon continuing the extinction process. In other words, you need to continue taking the medication an hour before you plan to drink . . . forever. But you can resume drinking for the positive reinforcement of the high simply by not taking your pill. So the “cure” is also contingent upon the motivation level of the potential drinker to take the drug before drinking. This is not a “cure” for alcoholism in my way of thinking.

Alcohol in high enough concentrations in the blood stream can cause unconsciousness, stop your breathing leading to cardiac arrest and other physical problems. The physiological effects from alcohol in your blood stream continue to occur even if the neurological reward for drinking is neutralized. The Sinclair Method does not stop these other effects from occurring. It simply neutralizes the reward from drinking and gradually extinguishes the cravings to drink. It does not metabolize the alcohol in your system.

Understanding what is actually treated by the Sinclair Method is slippery. Eskapa’s book title says it’s a “cure” for alcoholism. But he speaks about “alcohol drinking” being positively reinforced to the point that some individuals (excluding those with a genetic predisposition) cannot control their drinking and are called alcoholics.  Alcoholism is more than just a learned behavior or an out-of-control behavioral reinforcement strategy. It’s not something that pharmacological extinction can remove or cure. “It’s like a switch, clickin’ off in my head. Turns the hot light off and the cool one on, and all of a sudden there’s peace”  (“Brick” from: Cat on a Hot Tin Roof).

 

11/7/14

Abandon Yourself to God

© Bonciutoma | Dreamstime.com - Walk To The Cross Photo

© Bonciutoma | Dreamstime.com – Walk To The Cross Photo

I remember hearing a sermon once on Romans 12:1, “I appeal to you therefore, brothers, by the mercies of God, to present your bodies as a living sacrifice, holy and acceptable to God, which is your spiritual worship.” The minister, George Stockhowe, said the problem with living sacrifices was that they are always trying to crawl off of the altar.

Several commentators have noted that the phrase, “the mercies of God,” in verse 12:1 is a succinct summary of what Paul has said up to this point in the epistle to the Romans. C. K. Barrett said that the proper response “is not to speculate upon the eternal decrees, or one’s own place in the scheme of salvation, but to be obedient.”  And the sacrifice is to be a living one. F. F. Bruce commented that the sacrifices of the New Testament did not consist of taking the life of others, “but in giving one’s own.”

The phrase “spiritual worship” can get scholars going because the Greek word used here for spiritual, logikos, only appears one other time in the New Testament (1 Pet. 2:2). Sifting through the various perspectives, I’d suggest we see Paul as saying that our living sacrifice is “your [true] spiritual worship.” So while there can be a variety of things that we do as “spiritual worship,” being a living sacrifice is real, true spiritual worship.

Oswald Chambers regularly addressed the topic of surrender and being a living sacrifice in his devotional classic, My Utmost for His Highest. Here are a few selections:

“It is of no value to God to give Him your life for death. He wants you to be a ‘living sacrifice,’ to let Him have all your powers that have been saved and sanctified through Jesus. This is the thing that is acceptable to God. . . . In sanctification, the regenerated soul deliberately gives up his right to himself to Jesus Christ. . . . If we do not sacrifice the natural to the spiritual, the natural life will mock at the life of the Son of God in us and produce a continual swither. . . . The only way we can offer a spiritual sacrifice to God is by presenting our bodies a living sacrifice. . . . This is always the result of an undisciplined spiritual nature. We go wrong because we stubbornly refuse to discipline ourselves, physically, morally or mentally.  .  . . Surrender is not the surrender of the external life, but of the Will; when that is done, all is done. There are very few crises in life; the great crisis is the surrender of the will. God never crushes a man’s will into surrender, He never beseeches him, He waits until the man yields up his will to Him. That battle never needs to be re-fought. . . . After surrender—what? The whole of life after surrender is an aspiration for unbroken communion with God. ” (My Utmost for His Highest, January 8, January 10; December 10; September 13)

There is a clear parallel here to the surrender thinking in recovery, as in these slogans: “I can’t, God can, I think I’ll let Him;” or: “I can’t handle this one God; please take over.” It’s also present in the Third Step: “Made a decision to turn our will and our lives over to the care of God as we understood Him.”

Although you won’t see this mentioned in A.A. literature, early AAs and its founders read My Utmost for His Highest in the early pre-Big Book years. Dick B., an historian on A.A., reported that early Akron A.A. meetings opened with prayer and a reading from the Bible or a devotional such as My Utmost for His Highest. Dr. Bob, his wife Anne, Bill W. and his wife Lois used the devotional. Dr. Bob and Anne used it on a daily basis. Lois mentioned in a notebook she kept between December 1934 and August 1937 that she really saw herself in the reading for July 22nd.

In his July 22nd reflection on Sanctification, Oswald Chambers commented there was a battle royal before sanctification; there was always something that resented the demands of Jesus Christ. Quoting Luke 14:26 on the cost of discipleship, Chambers noted that the struggle began as soon as the Spirit of God began to show us what sanctification meant–to hand our “simple naked self over to God”:

Am I willing to reduce myself simply to ‘me,’ determinedly to strip myself of all my friends think of me, of all I think of myself, and to hand that simple naked self over to God? Immediately I am, He will sanctify me wholly, and my life will be free from earnestness in connection with everything but God. (My Utmost for His Highest, July 22nd)

Finally, in the closing exhortation of the chapter, “A Vision for You,” from the Big Book, Alcoholics Anonymous, Bill W. said: “Abandon yourself to God as You understand God. Admit your faults to Him and to your fellows. Clear away the wreckage of your past. Give freely of what you find and join us.” And remember: living sacrifices will try to crawl off of the altar.