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.
How did Andrew Anglin go from being an antiracist vegan to the alt-right’s most vicious troll and propagandist—and how might he be stopped?
On December 16, 2016, Tanya Gersh answered her phone and heard gunshots. Startled, she hung up. Gersh, a real-estate agent who lives in Whitefish, Montana, assumed it was a prank call. But the phone rang again. More gunshots. Again, she hung up. Another call. This time, she heard a man’s voice: “This is how we can keep the Holocaust alive,” he said. “We can bury you without touching you.”
When Gersh put down the phone, her hands were shaking. She was one of only about 100 Jews in Whitefish and the surrounding Flathead Valley, and she knew there were white nationalists and “sovereign citizens” in the area. But Gersh had lived in Whitefish for more than 20 years, since just after college, and had always considered the scenic ski town an idyllic place. She didn’t even have a key to her house—she’d never felt the need to lock her door. Now that sense of security was about to be shattered.
Should you drink more coffee? Should you take melatonin? Can you train yourself to need less sleep? A physician’s guide to sleep in a stressful age.
During residency, Iworked hospital shifts that could last 36 hours, without sleep, often without breaks of more than a few minutes. Even writing this now, it sounds to me like I’m bragging or laying claim to some fortitude of character. I can’t think of another type of self-injury that might be similarly lauded, except maybe binge drinking. Technically the shifts were 30 hours, the mandatory limit imposed by the Accreditation Council for Graduate Medical Education, but we stayed longer because people kept getting sick. Being a doctor is supposed to be about putting other people’s needs before your own. Our job was to power through.
The shifts usually felt shorter than they were, because they were so hectic. There was always a new patient in the emergency room who needed to be admitted, or a staff member on the eighth floor (which was full of late-stage terminally ill people) who needed me to fill out a death certificate. Sleep deprivation manifested as bouts of anger and despair mixed in with some euphoria, along with other sensations I’ve not had before or since. I remember once sitting with the family of a patient in critical condition, discussing an advance directive—the terms defining what the patient would want done were his heart to stop, which seemed likely to happen at any minute. Would he want to have chest compressions, electrical shocks, a breathing tube? In the middle of this, I had to look straight down at the chart in my lap, because I was laughing. This was the least funny scenario possible. I was experiencing a physical reaction unrelated to anything I knew to be happening in my mind. There is a type of seizure, called a gelastic seizure, during which the seizing person appears to be laughing—but I don’t think that was it. I think it was plain old delirium. It was mortifying, though no one seemed to notice.
Hillary Clinton once tweeted that “every survivor of sexual assault deserves to be heard, believed, and supported.” What about Juanita Broaddrick?
If the ground beneath your feet feels cold, it’s because hell froze over the other day. It happened at 8:02 p.m. on Monday, when The New York Times published an op-ed called “I Believe Juanita.”
Written by Michelle Goldberg, it was a piece that, 20 years ago, likely would have inflamed the readership of the paper and scandalized its editors. Reviewing the credibility of Broaddrick’s claim, Goldberg wrote that “five witnesses said she confided in them about the assault right after it happened,” an important standard in reviewing the veracity of claims of past sex crimes.
But Goldberg’s was not a single snowflake of truth; rather it was part of an avalanche of honesty in the elite press, following a seemingly innocuous tweet by the MSNBC host Chris Hayes. “As gross and cynical and hypocritical as the right’s ‘what about Bill Clinton’ stuff is,” he wrote, “it’s also true that Democrats and the center left are overdue for a real reckoning with the allegations against him.”
From Eve to Aristotle to Sarah Huckabee Sanders, a brief history of looking at half the population and assuming the worst
The picture was striking. The military airplane. The sleeping woman. The outstretched hands. The mischievous smile. The look what I’m getting away with impishness directed at the camera.
On Thursday, Leeann Tweeden, a radio host and former model, came forward with the accusation that Senator Al Franken, of Minnesota, had kissed her against her will during a 2006 USO trip to Kuwait, Iraq, and Afghanistan. In a story posted to the website of Los Angeles’s KABC station, Tweeden shared her experience with Franken. She also shared that photo. “I couldn’t believe it,” she wrote. “He groped me, without my consent, while I was asleep.”
I felt violated all over again. Embarrassed. Belittled. Humiliated.
How dare anyone grab my breasts like this and think it’s funny?
I told my husband everything that happened and showed him the picture.
I wanted to shout my story to the world with a megaphone to anyone who would listen, but even as angry as I was, I was worried about the potential backlash and damage going public might have on my career as a broadcaster.
But that was then, this is now. I’m no longer afraid.
What the United States can learn from protest and political organizing in the Nordic countries.
Liberals in the United States wistfully regard Scandinavia as a kind of social utopia, while conservatives denounce it as a socialist state where government overreach is ubiquitous. Yet across the political spectrum, Americans believe it would be impossible to adopt the Nordic model.
That’s the starting point for Viking Economics: How the Scandinavians Got it Right—and How We Can, Too, a new book from George Lakey, a former Eugene M. Lang visiting professor for issues of social change at Swarthmore College. Lakey, however, rejects that premise, arguing instead that Americans can adapt the Nordic model to fit the United States, reducing the wealth gap and improving the quality of life for all Americans as a result.
More comfortable online than out partying, post-Millennials are safer, physically, than adolescents have ever been. But they’re on the brink of a mental-health crisis.
One day last summer, around noon, I called Athena, a 13-year-old who lives in Houston, Texas. She answered her phone—she’s had an iPhone since she was 11—sounding as if she’d just woken up. We chatted about her favorite songs and TV shows, and I asked her what she likes to do with her friends. “We go to the mall,” she said. “Do your parents drop you off?,” I asked, recalling my own middle-school days, in the 1980s, when I’d enjoy a few parent-free hours shopping with my friends. “No—I go with my family,” she replied. “We’ll go with my mom and brothers and walk a little behind them. I just have to tell my mom where we’re going. I have to check in every hour or every 30 minutes.”
Those mall trips are infrequent—about once a month. More often, Athena and her friends spend time together on their phones, unchaperoned. Unlike the teens of my generation, who might have spent an evening tying up the family landline with gossip, they talk on Snapchat, the smartphone app that allows users to send pictures and videos that quickly disappear. They make sure to keep up their Snapstreaks, which show how many days in a row they have Snapchatted with each other. Sometimes they save screenshots of particularly ridiculous pictures of friends. “It’s good blackmail,” Athena said. (Because she’s a minor, I’m not using her real name.) She told me she’d spent most of the summer hanging out alone in her room with her phone. That’s just the way her generation is, she said. “We didn’t have a choice to know any life without iPads or iPhones. I think we like our phones more than we like actual people.”
The 93-year-old kleptocrat won’t remain the ruler of Zimbabwe for long.
Despite mounting calls for his resignation, Robert Mugabe has vowed to stay on as president of Zimbabwe, further extending his nearly four-decade reign in office. The next 48 hours will be crucial, as Mugabe could be impeached when parliament reconvenes on Tuesday. The unfolding political drama in Zimbabwe remains muddled at best and follows a stunning series of events, including a de facto military coup last week and a historic mass demonstration in Harare on Saturday, in which jubilant citizens marched hand-in-hand with the same military officials who had long abused their rights with impunity.
On Sunday, the momentum towards Mugabe’s probable ouster picked up steam when the ruling ZANU-PF party voted to expel longtime stalwarts, including Mugabe and his wife Grace, who had been leader of the influential women’s league and, until last week, the president’s presumed successor. Emmerson Mnangagwa, a former vice president and Mugabe protégé, was installed as new party leader. Mnangagwa is now expected to assume the presidency and lead a potential transitional authority.
The Netflix show, more than any other Marvel product, explores the idea that the country’s systems are fundamentally broken.
The Punisher, Netflix and Marvel’s new 13-episode drama about a superhero whose superpower is killing people with guns, is debuting in a very different environment to the one the character was conceived in. When the vigilante Frank Castle first appeared in an issue of The Amazing Spider-Man in 1974, the American psyche was more preoccupied with serial killers and mob violence than with mass shooters. Punisher, a former Marine Corps sniper, turned the merciless tactics of organized criminals against them, displaying no qualms about executing gangsters. He employed what amounted to an arsenal of military-grade weapons. His accoutrements were guns, guns, and more guns.
In 2017, a dizzying number of disturbed gunmen have given the imagery and mythology of Punisher an even darker resonance. In October, a mass shooting in Las Vegas left 58 people dead, excluding the perpetrator. A month later, a 26-year-old former member of the U.S. Air Force killed 26 people in a church in Texas. It’s a discomfiting news landscape in which to absorb The Punisher, whose opening credits caress silhouetted weaponry as brazenly as James Bond title sequences undulate around women’s bodies.
The nation wants to eradicate all invasive mammal predators by 2050. Gene-editing technology could help—or it could trigger an ecological disaster of global proportions.
The first thing that hit me about Zealandia was the noise.
I was a 15-minute drive from the center of Wellington, New Zealand’s capital city, but instead of the honks of horns or the bustle of passersby, all I could hear was birdsong. It came in every flavor—resonant coos, high-pitched cheeps, and alien notes that seemed to come from otherworldly instruments.
Much of New Zealand, including national parks that supposedly epitomize the concept of wilderness, has been so denuded of birds that their melodies feel like a rare gift—a fleeting thing to make note of before it disappears. But Zealandia is a unique 225-hectare urban sanctuary into which many of the nation’s most critically endangered species have been relocated. There, they are thriving—and singing. There, their tunes are not a scarce treasure, but part of the world’s background hum. There, I realized how the nation must have sounded before it was invaded by mammals.
The CNN correspondent on journalism, hypocrisy, how a Twitter fave can ruin his morning, and why he has a poster of George Wallace hanging in his office
Jake Tapper sometimes wakes up angry. This may be a good thing for America.
Amid the chaos of the Donald Trump presidency, and the deep partisanship that filters through seemingly all aspects of American life in 2017, Tapper is motivated by the same forces that have animated much of his career in journalism. He can’t stand hypocrisy. He can’t stand unfairness. He can’t stop talking about it.
“I recognize that it’s probably a pain in the ass for a lot of people now,” he told The Atlantic. “But it is just who I am.”
“I’m just like, I don’t want any of this to be happening,” he added. “There are so many lies and so much indecency, and I’m not only talking about President Trump. There is just a world of it exploding—and we are, I fear, as a nation, becoming conditioned and accepting of it. And it’s horrific.”