Just because one doctor failed to follow the rules doesn't invalidate the entire field of psychiatry.
Scientology seems to be having a rough go of it lately, what with high-profile defections that include its leader's father and its founder's granddaughter. The organization also appears to be on the verge of losing Suri Cruise just as she's getting old enough to join in some of its special rituals. Even media titan Rupert Murdoch, well-acquainted with the attentions of conspiracy theorists and parliamentary inquiries alike, is on the record labeling Scientologists as "creepy, maybe even evil."
But Scientology is still heartily charging forth in its epic battle against the dark forces of psychiatry, sometimes scoring undeniable battlefield wins. Unfortunately, aided by unwitting state regulators and media, the Scientologists are slaying creaky old windmills, not the dragons they imagine. Founder L. Ron Hubbard considered the medical study and treatment of disordered thought, abnormal mood and bad behavior as something of a threat to the pseudo-scientific religion he devised to clear up all these matters. L. Ron baked in so much suspicion towards psychiatrists, I wonder if the group's founder wasn't concerned with what diagnosis shrinks might hand him if they ever got him on the couch.
Little wonder then that the Church of Scientology operates a subsidiary whose sole aim is to discredit and dismantle the field of psychiatry. The subsidiary flies by the benign moniker "Citizens Commission on Human Rights," which sounds like it might be a UN-affiliated NGO. The group incessantly employs classic propaganda techniques like trumpeting each instant of an errant psychiatrist as emblematic of the entire field. A favorite strategy is zeroing in on poorly funded government mental health facilities and blaming the clinicians who toil there for their lack of proper resources, rather than acknowledging the dearth of societal support for funding mental health care and the full array of community supports needed to deinstitutionalize the sickest patients. If anything, CCHR's campaigns undermine public support for mental health treatment, especially in countries with more unsophisticated representatives and gullible media.
When you watch self-congratulating CCHR videos cataloging shoddy conditions in the world's most underfunded and poorly managed mental health facilities over the years, Scientologists hope you'll accept their slippery logic that these events say something about the validity of psychiatry as a whole. Of course they do not, no more so than any case of medical malpractice in any field, in any country, brings down validity of medicine as a whole. Mental illnesses are disease processes rooted in biology still under research by medical scientists that require intervention by mental health clinicians who stay abreast of an evolving body of scientific knowledge. The auditing sessions and e-meters L. Ron prescribed bear no resemblance to this reality.
So you can see why any critically minded reader will want to know when Scientology is the driving force behind any given brouhaha. But readers of a recent four-article investigative series in the Austin American Statesman were instead informed that an enviably safe physical treatment was controversial as evidenced by the concerns of the humanitarians at CCHR, which was described only as "a mental health watchdog group." As the Statesman reported, CCHR succeeded in getting the Texas Department of State Health Services to investigate psychiatrist Allen Childs for conducting research without proper certification from his hospital's review board. Consumers of the newspaper series like the author of this article at the Austinist can be forgiven for getting the impression that a state hospital psychiatrist had actively experimented with a dangerous form of electrotherapy called Cranial Electrotherapy Stimulation (CES). Yet all public evidence suggests nothing of the sort occurred.
I do not believe that the Statesman or Texas officials knew they were also serving as functionaries in a Scientology campaign. If so I think that Scientology's role would have made its way into at least one of the four Statesman articles:
The articles report how CCHR complained to state officials about Dr. Childs publishing two studies (2005 and 2007) including patients from North Texas State Hospital without institutional review board (IRB) approval. Dr. Childs was working with a population of intellectually disabled adults prone towards violence that other state facilities couldn't treat, referring them to the North Texas facility because of its high-security behavior management unit. Dr. Childs realized that the CES treatment reduced the number of violent outbursts without any significant side effects, something medication couldn't do for these patients. He made CES part of his routine medical practice so as to use as little medication as possible. When he decided to report his experience to others, he should have gone to an IRB for the OK -- a panel of medical and community representatives who evaluate research designs for any potential risk to the participants. IRBs have the power to entirely veto projects or demand modifications to research protocols. Texas officials quickly found that no IRB approvals existed for Dr. Child's two papers, and their investigation snowballed from there. As reported in the final article, Dr. Childs resigned. He'd already wound down his practice at the hospital before this episode. He did not respond to the Statesman for comment (nor to the state inquiry, it appears).
The head of the University of Texas College of Pharmacy took a particular interest in the Statesman articles. Dean Lynn Crismon provided statistical and research design assistance for some of Dr. Child's CES research in the late 1980's and was shocked to read how his old associate had gone off the rails. His research back then included IRB approvals. But when I explained to Dr. Crismon that Scientology had successfully targeted his old research partner, their involvement instantly tempered his interpretation of the newspaper articles. A full time administrator now long after his brief association with Dr. Childs, Dr. Crismon went on to spend a significant portion of his research career evaluating methodologies for improving care in public mental health systems. He and his team were the sometime target of CCHR press releases that he believes distorted his record.
What provoked the ire of state hospital officials, the lack of IRB approval, was a bit of a moving target, Dr. Crismon pointed out. For most of Dr. Childs' career, IRB approval would not have been the standard for the type of research he was conducting. Dr. Childs was using a technology that had been FDA approved for over 30 years to treat depression, anxiety and insomnia and whose only known side effects (like headaches and tingling) are so rare, benign and self-limited they would be the envy of most pharmaceuticals. CES passed its most recent FDA safety review just this past March. Dr. Childs secured approval to use the device (marketed as Alpha Stim) from his hospital's therapeutics committee and by its ethics panel, then obtained proper consent from each patient before use. He went on to make this stimulator a part of his routine practice, finding that it helped lower aggression. So he started using it for that problem more and more. Other doctors followed suit.
This is a very common evolution in routine medical practice seen with any number of devices, procedures and medications. All doctors use treatments "off label." This isn't an experiment. Dr. Childs then decided to collect his cases and report about his success so other doctors could consider trying it themselves. There is no question that an IRB would have approved the study, in fact they most likely would have issued a "waiver." When a doctor is using his own clinical data and masking any information that could identify the individual patients involved, there is essentially no risk to the patients. A pro-active "experiment" is not occurring, only a review and synthesis of clinical records. The relevant federal regulation specifically excludes this type of work:
Research involving the collection or study of existing data, documents, records, pathological specimens, or diagnostic specimens, if these sources are publicly available or if the information is recorded by the investigator in such a manner that subjects cannot be identified, directly or through identifiers linked to the subjects.
It didn't become the norm for clinicians to ask IRBs to vet this kind of publication until around the year 2000, according to Dr. Crismon, who has served on IRB's for 19 years including a period as chairman of the Texas Behavioral Health IRB. Today the University of Florida tells its staff that case studies with three or fewer patients need not go before its IRB. That number appears to be an internally developed rule of thumb; federal statutes don't include any such guidance. Dr. Childs's 2005 paper involved nine patients.
CES raised red flags for Scientologists because of the "electrical" aspect. Scientology considers electroconvulsive therapy (aka "electroshock") to be torture, and has a penchant conflating other electrical treatments with that therapy. ECT can send an entire amp of current through the brain. By contrast CES operates on the level of hundreds of microamps, over a thousand times smaller. Worn on each earlobe, you can walk about and do your business while having a CES treatment for thirty minutes or an hour. Users have full control to take it off at any time. I tried it on my back once a few years ago and didn't feel anything (it is no longer "cranial" stimulation when applied to the back, of course). It's powered by a 9-volt battery.
Cranial electrotherapy stimulation has not entered the medical mainstream despite its many decades on medical supply store shelves. Its second-class status becomes obvious on the principle manufacturer's website which features heavy direct-to-consumer appeals. CES isn't important enough to be discussed in medical schools, and seems to be embraced only quite spottily in psychiatry, neurology and related fields. Its unpopularity doesn't stem from any concerns about safety, however; the general impression is that there are other, more effective and well-studied treatments available (including full-bore electroconvulsive therapy). Ironically, considering Scientology's concerns, many clinicians have trouble believing a few microamps can do anything. By all accounts, Dr. Childs is one of the true believers, speaking at conferences across the country. I spoke with a neurologist who recalled one of his talks in the 1990s. Dr. Childs came off overly enthusiastic but sincere, I am told.
Despite its place in the nightmares of Scientologists everywhere, electricity is reaching a new heyday in medicine thanks to more sophisticated and targeted technologies like transcranial magnetic stimulation and deep brain stimulation, both recent FDA-approved technologies that offer more anatomical localization than CES. As electrical stimulators continue to miniaturize and start recharging over the air, a great many medical applications lie ahead in the next few decades.
So Dr. Childs conducted a study that nobody questions would have met perfunctory approval, had he only bothered to submit it. He did his work in an era when norms for this type of research were evolving. I think these facts should attenuate our condemnation of his actions, which should not be viewed through the perverted lens of Scientology's hate for the psychiatric profession, but rather as the error of an overzealous clinician committed to doing anything he can do help some of the most helpless people in the state psychiatric population. There were other misdeeds uncovered in the course of the investigation: Dr. Childs is accused of filming some of his patients without their consent and speaking judgmentally about their behavior in a talk accompanied by the video; he did not disclose in his second paper that he had become a consultant for the device company after the first paper. These are serious charges and there are no available facts that mitigate them. I have not seen the video, so the excerpts as reported are out-of-context. Was video consent ever obtained? Was Dr. Childs consulting for Alpha Stim at the time of his 2007 paper? Dr. Childs is not cooperating with the state (it seems) or granting interviews, so we don't know.
This collection of errors is certainly enough for state officials to demand Dr. Child's resignation, particularly if he is unwilling to defend himself. But just as important in the whole affair is the fact that the state of Texas and the Austin American Statesman were made unwitting players in a staged production by the Church of Scientology, some of the greatest showmen on earth. They'd like Dr. Allen Childs's mistakes to go towards discrediting the entire field of psychiatry. The true lessons in this tale are wholly different. I've spoken with three people who knew Allen Childs and all describe a sincere and passionate and perhaps rather excitable man. He made no secret of the fact that he was submitting his cases for publication, and he appears to have been simply ignorant of the need for IRB approval; perhaps his ignorance extended to his use of video as well. Could the state hospital have done a better job of educating its staff and supporting their research? Did the journals prompt Dr. Childs for certification of his IRB approvals?
I will not give Dr. Childs the benefit of the doubt while he is able yet unwilling to speak for himself. However, I do not see any evidence that he harmed patients beyond using their images in the video (as described). In fact the results he reports warrant further randomized, controlled investigation. The resignation of this well-meaning psychiatrist means little for the safety of his former patients, but it means a lot to Scientology. If CCHR's new strategy is to comb the psychiatric literature for instances where an IRB is MIA, psychiatry had better prepare for battlefield earth.
In an NPR interview, the Pretenders singer compared comments about her book—and its description of her sexual assault—to a “lynch mob.”
In maybe one of the most uncomfortable NPR interviews since Joaquin Phoenix went on Fresh Air, the Pretenders singer Chrissie Hynde spoke with Morning Edition’s David Greene on Tuesday about her book, Reckless. Or, more specifically, about the mass outrage sparked by the section in which she writes about being sexually assaulted at the age of 21 by a group of bikers, and of taking “full responsibility” for it.
GREENE: I’ll just read a little bit here: “The hairy horde looked at each other. It was their lucky day. ‘How bout yous come to our place for a party.’” And you ended up with them, and then you proceeded to describe what they were asking you to do. “‘Get your bleeping clothes off, shut the bleep up, hurry up, we got bleep to do, hit her in the back of the head so it don’t leave no marks.’” This certainly sounds like an awful, awful experience with these men.
HYNDE: Uh, yeah. I suppose, if that’s how you read it, then that, yeah. You know, I was having fun, because I was so stoned. I didn’t even care. That’s what I was talking about, I was talking about the drugs more than anything, and how f***** up we were. And how it impaired our judgment to the point where it just had gotten off the scale.
Here’s what happens if astronomers make contact with a civilization on another planet.
The false alarm happened in 1997.
The Green Bank Radio Observatory in Green Bank, West Virginia, was picking up some unusual signals—and Seth Shostak, then the head of the Center for Search for Extraterrestrial Intelligence (SETI) Research in Mountain View, Caifornia, was convinced that they had come from intelligent life somewhere in the universe.
“It looked like it might be the real deal,” Shostak recalled. Within a few hours, he had a call from The New York Times.
But within a day, it became clear that the source of excitement was actually a European satellite. To make matters worse, a second telescope in Georgia, which would have told the scientists about the true nature of the signal, wasn’t working.
American politicians are now eager to disown a failed criminal-justice system that’s left the U.S. with the largest incarcerated population in the world. But they've failed to reckon with history. Fifty years after Daniel Patrick Moynihan’s report “The Negro Family” tragically helped create this system, it's time to reclaim his original intent.
By his own lights, Daniel Patrick Moynihan, ambassador, senator, sociologist, and itinerant American intellectual, was the product of a broken home and a pathological family. He was born in 1927 in Tulsa, Oklahoma, but raised mostly in New York City. When Moynihan was 10 years old, his father, John, left the family, plunging it into poverty. Moynihan’s mother, Margaret, remarried, had another child, divorced, moved to Indiana to stay with relatives, then returned to New York, where she worked as a nurse. Moynihan’s childhood—a tangle of poverty, remarriage, relocation, and single motherhood—contrasted starkly with the idyllic American family life he would later extol.
Forget the Common Core, Finland’s youngsters are in charge of determining what happens in the classroom.
“The changes to kindergarten make me sick,” a veteran teacher in Arkansas recently admitted to me. “Think about what you did in first grade—that’s what my 5-year-old babies are expected to do.”
The difference between first grade and kindergarten may not seem like much, but what I remember about my first-grade experience in the mid-90s doesn’t match the kindergarten she described in her email: three and a half hours of daily literacy instruction, an hour and a half of daily math instruction, 20 minutes of daily “physical activity time” (officially banned from being called “recess”) and two 56-question standardized tests in literacy and math—on the fourth week of school.
That American friend—who teaches 20 students without an aide—has fought to integrate 30 minutes of “station time” into the literacy block, which includes “blocks, science, magnetic letters, play dough with letter stamps to practice words, books, and storytelling.” But the most controversial area of her classroom isn’t the blocks nor the stamps: Rather, it’s the “house station with dolls and toy food”—items her district tried to remove last year. The implication was clear: There’s no time for play in kindergarten anymore.
National Geographic Magazine has opened its annual photo contest, with the deadline for submissions coming up on November 16, 2015.
National Geographic Magazine has opened its annual photo contest, with the deadline for submissions coming up on November 16, 2015. The Grand Prize Winner will receive $10,000 and a trip to National Geographic headquarters to participate in its annual photography seminar. The kind folks at National Geographic were once again kind enough to let me choose among the contest entries so far for display here. Captions written by the individual photographers.
What went wrong with the conversion ministry, according to Alan Chambers, who once led its largest organization
In 2001, Alan Chambers was hired as the president of the world’s largest ex-gay ministry, Exodus International. That same year, U.S. Surgeon General David Satcher issued a report that stated, “there is no valid evidence showing that sexual orientation can be changed.”
Like most conservative Christian leaders at the time, Chambers considered the countercultural nature of his work a point of pride. During the latter part of the 20th century, Exodus and similar conservative groups promoted the idea that gay people could—and should try to—become straight. Ex-gay leaders traveled to churches and appeared on television news programs citing a litany of examples of happily married “former homosexuals” to demonstrate that sexual orientation is a choice and that change is possible.
Two hundred fifty years of slavery. Ninety years of Jim Crow. Sixty years of separate but equal. Thirty-five years of racist housing policy. Until we reckon with our compounding moral debts, America will never be whole.
And if thy brother, a Hebrew man, or a Hebrew woman, be sold unto thee, and serve thee six years; then in the seventh year thou shalt let him go free from thee. And when thou sendest him out free from thee, thou shalt not let him go away empty: thou shalt furnish him liberally out of thy flock, and out of thy floor, and out of thy winepress: of that wherewith the LORD thy God hath blessed thee thou shalt give unto him. And thou shalt remember that thou wast a bondman in the land of Egypt, and the LORD thy God redeemed thee: therefore I command thee this thing today.
— Deuteronomy 15: 12–15
Besides the crime which consists in violating the law, and varying from the right rule of reason, whereby a man so far becomes degenerate, and declares himself to quit the principles of human nature, and to be a noxious creature, there is commonly injury done to some person or other, and some other man receives damage by his transgression: in which case he who hath received any damage, has, besides the right of punishment common to him with other men, a particular right to seek reparation.
In the name of emotional well-being, college students are increasingly demanding protection from words and ideas they don’t like. Here’s why that’s disastrous for education—and mental health.
Something strange is happening at America’s colleges and universities. A movement is arising, undirected and driven largely by students, to scrub campuses clean of words, ideas, and subjects that might cause discomfort or give offense. Last December, Jeannie Suk wrote in an online article for The New Yorker about law students asking her fellow professors at Harvard not to teach rape law—or, in one case, even use the word violate (as in “that violates the law”) lest it cause students distress. In February, Laura Kipnis, a professor at Northwestern University, wrote an essay in The Chronicle of Higher Education describing a new campus politics of sexual paranoia—and was then subjected to a long investigation after students who were offended by the article and by a tweet she’d sent filed Title IX complaints against her. In June, a professor protecting himself with a pseudonym wrote an essay for Vox describing how gingerly he now has to teach. “I’m a Liberal Professor, and My Liberal Students Terrify Me,” the headline said. A number of popular comedians, including Chris Rock, have stopped performing on college campuses (see Caitlin Flanagan’s article in this month’s issue). Jerry Seinfeld and Bill Maher have publicly condemned the oversensitivity of college students, saying too many of them can’t take a joke.
The country has seen periods of turmoil before. But this time may be different.
I am usually an optimist when it comes to Turkey’s future. Indeed, I wrote a whole book about The Rise of Turkey. But these days, I’m worried. The country faces a toxic combination of political polarization, government instability, economic slowdown, and threats of violence—from both inside and outside Turkey—that could soon add up to a catastrophe. The likelihood of that outcomeis increasing amid Russia’s bombing raids in Syria in support of its ally, Syrian President Bashar al-Assad, which threaten to debilitate the moderate rebels and boost the extremists in Syria’s civil war, while leaving Turkey to deal with two unruly neighbors: Assad and ISIS.
Of course, Turkey has gone through periods of political and economic crisis before. During the 1970s, the country’s economy collapsed, and the instability led to fighting among right- and left-wing militant groups and security forces that killed thousands of people. Then, in the 1990s, Turkey was pummeled by triple-digit inflation and a full-blown Kurdish insurgency that killed tens of thousands. Turkey survived both those decades. The historian in me says that Turkey will be able to withstand the coming shock this time as well.
“Vaccine hesitancy” is a delicate way of phrasing a serious public-health problem. The World Health Organization defines it as “delay in acceptance or refusal of vaccines despite availability of vaccination services.”
There’s a tendency to treat these vaccine-hesitant people as a monolith, the “anti-vaxers” who are putting everyone at risk. But people who don’t vaccinate aren’t just a homogenous mob of parents who fear toxins and want their kids to be exposed to chicken pox “the natural way.” There are a variety of reasons why people decide not to vaccinate, and a new paper by researchers at Rutgers University and Germany’s University of Erfurt and RWTH Aachen University, published in Policy Insights from the Behavioral and Brain Sciences, breaks down the psychology of four different types of non-vaccinators, in the hopes of finding effective strategies to change their minds.