Unknown's avatar

About FmH

70-something psychiatrist, counterculturalist, autodidact, and unrepentent contrarian.

Love = Addiction?

“The reward mechanism involved in addiction appears to regulate lifelong social or pair bonds between monogamous mating animals, according to a Center for Behavioral Neuroscience (CBN) study of prairie voles published in the January 19 edition of the Journal of Comparative Neurology. The finding could have implications for understanding the basis of romantic love and disorders of the ability to form social attachments, such as autism and schizophrenia.” EurekAlerts!

The Grief Industry

The ‘skeptical inquirer’ of modern medicine, Dr. Jerome Groopman, investigates how much crisis counseling after a trauma helps… or hurts in The New Yorker. (As usual, I advise anyone interested in this article to read it soon, as it is my experience that New Yorker articles go into the bit bucket in relatively short order…) He gives a good overview and history of the prevailing paradigm, ‘critical incident stress debriefing (CISD),’ in which I am trained and have practiced. He rightly points out the ways in which the process was misused in the aftermath of the Sept. 11, 2001 attacks — among them mandatory rather than voluntary debriefing, the inclusion of people with little or no direct traumatization, and corporate (public relations, do-goodism, preventing absenteeism and avoiding liability) rather than compassionate motives. Recently, the first systematic research has shown that rapid crisis interventions are ‘inert’ in terms of preventing the development of PTSD in those exposed to massive traumas. Indeed, by encouraging sufferers to open up instead of seal over, it may promote PTSD sxs. The question is whether, as the paramedic-turned–psychologist developer of CISD suggests, these botched results arise only from misapplication of his paradigm.

I personally think, and the data supports this notion, that most people exposed to trauma are resilient and recover over time with their own strengths, and that misguided attempts to keep their wounds open and raw can indeed do harm rather than good. A smaller percentage of people do not recover and will eventually need extended psychological support because they develop the post-traumatic stress syndrome. It is doubtful whether these people can be identified in advance and singled out for early intervention, and even more doubtful whether preemptive intervention works.

To understand this issue, one has to understand the current concept of ‘trauma’ and the psychiatric politics behind it. (Groopman does not, or chooses not to discuss any insights he may have in this area, perhaps because of their ‘political incorrectness’. Groopman is a hematologist/oncologist; I have considered writing to him suggesting that he collaborate with a well-versed psychiatrist if his medical musings turn to issues in mental health treatment in the future…) The modern notion of trauma is much obliged to the historical coalescence of the women’s movement and the exposure of the ugly secret of rampant sexual abuse with the interests of a small number of psychiatrists working with the mental health issues of returning Vietnam veterans. Because treatment and study of these two populations is of necessity retrospective (the trauma has long since passed by the time the suffer annoounces her/himself), a third stream of data was fused into this notion of trauma, the prospective study of the course of post-traumatic reactions in those exposed to overwhelming solitary traumatic events such as natural disasters, plane crashes and crimes ranging from rapes to genocide. (One of the most famous trauma researchers made her name by getting in only months after they were freed to study a group of 23 schoolchildren in Chowchilla, California, who had been the victims of a 1976 hijacking, kidnapping and imprisonment.) Although, by and large, the research has supported the notion that trauma symptoms and resiliency depend on one’s prior constitution and resources, this has been obscured by lumping so many heterogeneous types of experience together as trauma. It has further been obscured by the feminist-inspired political correctness of insisting that all inappropriate sexual contact is victimization and that victimization explains mental health symptoms in many women. The idea that sexual victimization is not the fault of the victim turns inexorably (and wrongly) into the notion that the sufferer’s personal characteristics are irrelevant to the development of the post-traumatic symptoms.

Thus, in some clinical circles, patients are diagnosed as trauma victims (or ‘survivors’) at the drop of a hat, all trauma victims are said to have PTSD (regardless of whether they demonstrate the symptoms which define the syndrome or not), and careers of victimhood and chronicity are rationalized and excused zealously. And this is without even even talking about the induction of ‘false memories’, in which so-called ‘suppressed memories of trauma’ which may never have happened are ‘uncovered’ enthusiastically by mental health practitioners on the trauma bandwagon, shaping and explaining everything.

So two of the covert, probably erroneous foundations on which the CISD gospel has rested is are a vague, imprecise notion of what constitutes traumatic exposure and the politically correct notion that all those exposed to trauma will go on to develop symptoms. Thus relatively little attention has been paid until very recently to the notion that it may only be the particularly vulnerable who will succumb to their traumatic stress.

The wastebasket notion of trauma is so maddeningly imprecise that it obscures many clinically crucial distinctions among ‘trauma sufferers’. Let me highlight just a few:

  • There are probably profound physiological as well as cognitive differences between the reactions to sudden, acute trauma and chronic or repetitive traumatization; think of a single rape by a stranger vs. being kept imprisoned and regularly sexually abused. This is related as well to whether it is expectable or unexpected.
  • Human-perpetrated abuses cause a disturbance in ability for basic trust in others that exposure to an accident or natural disaster does not.
  • Different ‘traumas’ are perceived as more or less avoidable or inevitable. How escapable a trauma seems in retrospect has effects on one’s sense of responsibility for one’s victimhood and sense of efficacy for the future.
  • Socially-shaped expectations of what is within the realm of expectable human experience vs. outside cultural norms of human experience have an effect. Think about the impact different attitudes about the acceptability of warfare and combat will have on shaping combat trauma or ‘shellshock’.
  • Sexual abuse, physical brutality, and psychological/emotional abuse cause different reactions. Likewise undergoing victimization as opposed to merely observing it, even at close range.

Despite the influx of counselors into New York after Sept. 11th (from personal experience, I know that many of them were employed ministering to so-called “secondary victimization” suffered by the first wave of helping professionals!), most New Yorkers received no psychological attention. And, contrary to predictions, there really was no phenomenon of massive psychological distress, Groopman observes and, as I have above, concludes “that the debriefing industry is predicated on a false notion: that we are all at high risk for P.T.S.D. after exposure to a traumatic event.” More useful is immediate “psychological first aid”, Groopman says. A number of my CISD-trained colleagues, in fact, went to New York as part of the ‘post-trauma industry’. Those who found themselves most useful, according to discussions I have had with them, did not however do CISD, but rather other kinds of mental health intervention such as grief counseling for those who had lost family members, and assisting and empowering those entitled to relief benefits to navigate through the red tape of securing these entitlements. Similarly, Groopman cites examples of proponents of CISD who, in the wake of their experiences after Sept. 11th, have turned away from that paradigm.

The psychotherapy of those who have complicated PTSD in earnest (with a legitimate traumatic antecedent, usually a protracted period of exposure to inescapable brutalization by others; and the scientifically described symptom complex) is painstaking, complicated and protracted. An early stage is giving the sufferer a name and a description for what they are undergoing. I do believe that counseling those exposed, truly exposed (and participating of their own accord), to traumatic events to recognize the symptoms of PTSD they might develop or may already have developed — by which time they would have declared their vulnerability, and it would be too late to depend on preemption — is a more useful model for early intervention, predicated neither on the notion that we are all vulnerable nor on the mistaken belief in its preventive efficacy.

Groopman turns later in the article to the very important and often-neglected topic of the neuroscience of the trauma reaction. In vulnerable individuals, evidence suggests that the physiology of their stress causes the memories of the trauma to actually be encoded differently in the brain, so that they are both less accessible and cause more enduring distress. Classical ‘talking therapy’, especially long after the fact, is not very useful in undoing these neurally encoded trauma residues. Groopman describes work being done in very different, promising, neuroscientifically informed trauma treatment.

Part of Patriot Act Ruled Unconstitutional

A very small part, to be sure, but an encouraging step: “A federal judge has declared unconstitutional a portion of the USA Patriot Act that bars giving expert advice or assistance to groups designated foreign terrorist organizations.

The ruling marks the first court decision to declare a part of the post-Sept. 11 anti-terrorism statute unconstitutional, said David Cole, a Georgetown University law professor who argued the case on behalf of the Humanitarian Law Project.” —My Way News

Kerry vs. Kerry

“John Kerry has surged into first place here, proving his oft-repeated contention that he is a “good closer.” Kerry has long said that he is a great fighter. If he completes his miraculous comeback to win the Democratic nomination, he will indeed have the fight of his life on his hands — against his own legislative record.” Everyone talks about his flip-flop on the invasion of Iraq but it goes much deeper than that.

Today’s Kerry excoriates Attorney General John Ashcroft for violating American civil liberties with his evil tool, the Patriot Act. “We are a nation of laws and liberties, not of a knock in the night,” Kerry huffs. “So it is time to end the era of John Ashcroft. That starts with replacing the Patriot Act with a new law that protects our people and our liberties at the same time.” Maybe Kerry should have thought about that before voting for the Patriot Act in 2001 — since laws and liberties are pretty important and all.

Back before he had to worry about competing with one Howard Brush Dean, Kerry was positively delighted by the Patriot Act. “It reflects,” he said on the Senate floor, “an enormous amount of hard work by the members of the Senate Banking Committee and the Senate Judiciary Committee. I congratulate them and thank them for that work.” While supportive of “sunset” provisions in the bill, Kerry pronounced himself “pleased at the compromise we have reached on the anti-terrorism legislation.” These are not the words of a man about to help inaugurate an era of brown-shirt law enforcement. —Rich Lowry, National Review

Since we are so obsessed with “electability”, let us recall that Kerry as Democratic Presidential candidate would be going up against the most ruthless and deep-pocketed Republican election machine (otherwise know as “the administration”) of the last century. Bush, at least, is a consistent liar.

Wikipedia Shows Power of Cooperation

“Sometime in the next few days or weeks, one of the world’s most comprehensive online reference sites will publish its 200,000th article. More accurately, one of the site’s contributors will publish the article.

Wikipedia, an encyclopedia created and operated by volunteers, is one of the most fascinating developments of the Digital Age. In just over three years of existence, it has become a valuable resource and an example of how the grass roots in today’s interconnected world can do extraordinary things.” —Dan Gillmor

Sp@m ShEn@nig@nS!!:

That Gibberish in Your In-Box May Be Good News: “If you could sit back with Zen-like detachment and observe the dross piling up in your electronic mailbox, the spam wars might come to seem like a fascinating electronic game. Like creatures running through a maze with constantly shifting walls, spammers dart and weave to sneak their solicitations past ever wilier junk mail filters. They are organisms, or maybe genomes, grinding out one random mutation after another, desperately trying to elude the Grim Reaper…

Dispiriting as it is to start the morning with a hundred of these orthographic monsters crouching in your in-box, there is reason to take heart. Measured in bits and bytes, the sheer volume of spam may not have diminished. But advanced filtering software, which learns to recognize the mercurial traits of junk e-mail, is having an effect. The spammers’ messages are becoming harder and harder to decipher. Sense is inevitably degenerating into nonsense, like a pileup of random mutations in an endangered species gasping its last breaths.

Earlier this month, when Internet experts met in Cambridge, Mass., for the 2004 Spam Conference (available as a Web broadcast at spamconference.org), they showed just how far the science of spam fighting has come. For all the recent talk of suing spammers and compiling a national do-not-spam list, most speakers were putting their hopes in technological, not legal solutions. The federal government’s new junk e-mail law, the Can Spam Act, barely rated a mention.” —New York Times

Science, Trying to Pick Our Brains About Art

“Does a Rembrandt portrait or a van Gogh still life press some special buttons in every human being’s brain? Will a red painting speak to us in ways a blue one never could? Are we wired in ways that make every one of us enjoy a smiling bust and shiver at a frowning one?


And if our brains determine how art works on us, what does that tell us about art, or us — could studying the way we’re wired determine crisply that the ‘Mona Lisa’ is truly great, or do we need some history to tell us how a complex painting speaks, or not, to all its different viewers?


The Third International Conference on Neuroesthetics, subtitled ‘Emotions in Art and the Brain,’ was held earlier this month at the Berkeley Art Museum and tried to get a start at least on answering such questions. It was a showcase for the progress that’s been made in figuring out what goes on in the brain when art is seen or made.” —Washington Post

More on the neurology of creativity, with the complementary (and at least as interesting) question of that is happening when one has an aesthetic experience. However, the article ends with the same question I have — why assume there is just one sort of aesthetic experience and any uniformity to the neurology behind it?

Staging the Next Fantasy Blockbuster

“His Dark Materials, which began as a trilogy of young-adult novels with extravagant themes but humble commercial expectations, has turned into a serious international phenomenon and bestowed on its author the sort of celebrity that prompted him to move to a house with an unlisted address. The books, luminous adventures that address life after death, religious faith and the complicated intermingling of good and evil, have been translated into 37 languages and sold more than 7 million copies in Britain and the United States alone.” —New York Times

Why the Golden Globes are a joke

Hollywood gives awards voters star treatment:

“What is the Hollywood Foreign Press Association? Though the group claims to represent the world media that connect Hollywood to its vast international audience, few of the world’s most prominent publications are members. Correspondents for Le Monde, The Times of London and Yomiuri Shimbun are not members.


Some major publications, including the Italian newspaper La Repubblica and the German newspaper Stern, are represented, but the association has repeatedly rejected applications from prominent foreign publications while accepting freelancers for small publications in Bangladesh and South Korea. Members need write only four articles a year to maintain active membership. The group accepts a maximum of five new members a year, and each member must be accepted unanimously. Last year, three members of the association died, but it accepted only one new member, Margaret Gardiner, who writes for South African publications.


There is little question that members of the association would get little attention if they did not have the Golden Globes.” —Chicago Tribune

Not that critics for the ‘major publications’ are the only ones entitled to their opinions…

Secret of historic code:

It’s gibberish: “t is covered with drawings of fantastic plants, strange symbols and naked women.

Its language is unknown and unreadable, though some believe it bears a message from extraterrestrials. Others say it carries knowledge of a civilisation that is thousands of years old.

But now a British academic believes he has uncovered the secret of the Voynich manuscript, an Elizabethan volume of more than 200 pages that is filled with weird figures, symbols and writing that has defied the efforts of the twentieth century’s best codebreakers and most distinguished medieval scholars.” —Observer.UK

R.I.P. ‘Captain Kangaroo’

//graphics7.nytimes.com/images/2004/01/24/arts/Keeshan2184.jpg' cannot be displayed]

“Bob Keeshan, who delighted millions of children and their parents for three decades as television’s gentle, patient Captain Kangaroo and before that as the original Clarabell the Clown on the old ‘Howdy Doody Show,’ died yesterday in Vermont, his family said in a statement to The Associated Press. He was 76.” —New York Times