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.
Lip service to the crucial function of the Fourth Estate is not enough to sustain it.
It’s not that Mark Zuckerberg set out to dismantle the news business when he founded Facebook 13 years ago. Yet news organizations are perhaps the biggest casualty of the world Zuckerberg built.
There’s reason to believe things are going to get worse.
A sprawling new manifesto by Zuckerberg, published to Facebook on Thursday, should set off new alarm bells for journalists, and heighten news organizations’ sense of urgency about how they—and their industry—can survive in a Facebook-dominated world.
Facebook’s existing threat to journalism is well established. It is, at its core, about the flow of the advertising dollars that news organizations once counted on. In this way, Facebook’s role is a continuation of what began in 1995, when Craigslist was founded. Its founder, Craig Newmark, didn’t actively aim to decimate newspapers, but Craigslist still eviscerated a crucial revenue stream for print when people stopped buying newspaper classifieds ads.
On Saturday, the president slipped away from the doubters in Washington to address a Florida crowd filled with loyal supporters.
MELBOURNE, Fla.—After four miserable weeks of being locked up in presidential prison—starved of affection, suffocated by bureaucracy, tormented by the press—Donald Trump made a break for it Saturday.
Touching down just before sunset here in the heart of Trump Country, the president was greeted as he emerged from Air Force One by an adoring crowd of 9,000 super-fans, many of whom had stood in line for hours to see him speak. Trump made no effort at masking his gratitude. “I’m here because I want to be among my friends,” he told them, adding, “I also want to speak to you without the filter of the fake news.”’
The rally was widely trumpeted in the press as a return to the campaign trail, and it’s easy to see why. The event had all the trappings of Trump-style electioneering—he deployed the same slogans, recycled the same stump-speech rhetoric, and walked out on stage to the same soundtrack. What’s more, the White House made clear earlier this week that the rally was being funded not by the federal government but by his campaign, making this perhaps the earliest launch to a reelection bid in history.
When my wife was struck by mysterious, debilitating symptoms, our trip to the ER revealed the sexism inherent in emergency treatment.
Early on a Wednesday morning, I heard an anguished cry—then silence.
I rushed into the bedroom and watched my wife, Rachel, stumble from the bathroom, doubled over, hugging herself in pain.
“Something’s wrong,” she gasped.
This scared me. Rachel’s not the type to sound the alarm over every pinch or twinge. She cut her finger badly once, when we lived in Iowa City, and joked all the way to Mercy Hospital as the rag wrapped around the wound reddened with her blood. Once, hobbled by a training injury in the days before a marathon, she limped across the finish line anyway.
So when I saw Rachel collapse on our bed, her hands grasping and ungrasping like an infant’s, I called the ambulance. I gave the dispatcher our address, then helped my wife to the bathroom to vomit.
The preconditions are present in the U.S. today. Here’s the playbook Donald Trump could use to set the country down a path toward illiberalism.
It’s 2021, and President Donald Trump will shortly be sworn in for his second term. The 45th president has visibly aged over the past four years. He rests heavily on his daughter Ivanka’s arm during his infrequent public appearances.
Fortunately for him, he did not need to campaign hard for reelection. His has been a popular presidency: Big tax cuts, big spending, and big deficits have worked their familiar expansive magic. Wages have grown strongly in the Trump years, especially for men without a college degree, even if rising inflation is beginning to bite into the gains. The president’s supporters credit his restrictive immigration policies and his TrumpWorks infrastructure program.
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Radical longevity may change the way we live—and not necessarily for the better.
“So, you don’t want to die?” I asked Zoltan Istvan, then the Transhumanist candidate for president, as we sat in the lobby of the University of Baltimore one day last fall.
“No,” he said, assuredly. “Never.”
Istvan, an atheist who physically resembles the pure-hearted hero of a Soviet children’s book, explained that his life is awesome. In the future, it will grow awesomer still, and he wants to be the one to decide when it ends. Defying aging was the point of his presidential campaign, the slogan of which could have been “Make Death Optional for Once.” To (literally) drive the point home, he circled the nation in the “Immortality Bus,” a brown bus spray-painted to look like a coffin.
He knew he’d lose, of course, but he wanted his candidacy to promote the cause of transhumanism—the idea that technology will allow humans to break free of their physical and mental limitations. His platform included, in part, declaring aging a disease. He implanted a chip in his hand so he could wave himself through his front door, and he wants to get his kids chipped, too. He’d be surprised, he told me, if soon “we don’t start merging our children with machines.” He’d like to replace his limbs with bionics so he can throw perfectly in water polo. Most of all, he wants to stick around for a couple centuries to see it all happen, perhaps joining a band or becoming a professional surfer, a long white beard trailing in his wake.
The Scandinavian country is an education superpower because it values equality more than excellence.
The Scandinavian country is an education superpower because it values equality more than excellence.
Everyone agrees the United States needs to improve its education system
dramatically, but how? One of the hottest trends in education reform lately
is looking at the stunning success of the West's reigning education
Trouble is, when it comes to the lessons that Finnish schools have to offer,
most of the discussion seems to be missing the point.
The small Nordic country of Finland used to be known -- if it was known for
anything at all -- as the home of Nokia, the mobile phone giant. But lately
Finland has been attracting attention on global surveys of quality of
life -- Newsweek ranked it number one last year -- and Finland's national
education system has been receiving particular praise, because in recent
years Finnish students have been turning in some of the highest test scores
in the world.
Narcissism, disagreeableness, grandiosity—a psychologist investigates how Trump’s extraordinary personality might shape his possible presidency.
In 2006, Donald Trump made plans to purchase the Menie Estate, near Aberdeen, Scotland, aiming to convert the dunes and grassland into a luxury golf resort. He and the estate’s owner, Tom Griffin, sat down to discuss the transaction at the Cock & Bull restaurant. Griffin recalls that Trump was a hard-nosed negotiator, reluctant to give in on even the tiniest details. But, as Michael D’Antonio writes in his recent biography of Trump, Never Enough, Griffin’s most vivid recollection of the evening pertains to the theatrics. It was as if the golden-haired guest sitting across the table were an actor playing a part on the London stage.
“It was Donald Trump playing Donald Trump,” Griffin observed. There was something unreal about it.
During the late 19th century, blacks and whites in the South lived closer together than they do today.
CHARLOTTE, N.C.—Growing up here in the 1940s and 1950s, Sevone Rhynes experienced segregation every day. He couldn’t visit the public library near his house, but instead had to travel to the “colored” library in the historically black area of Brooklyn, a neighborhood that used to be in the center of Charlotte. He attended a school for black children, where he received second-hand books, and where the school day was half the length of that of white schools, because the black school had too many children and not enough funds. Sixty years later, he says, Charlotte is still a segregated city. “People who are white want as little to do with black people as they can get away with,” he told me.
This is, unfortunately, not a surprising account of North Carolina, or of the South more generally. The South of the 1950s was the land of fire hoses aimed at black people who dared protest Jim Crow laws. Today, schools in the South are almost as segregated as they were when Sevone Rhymes was a child. Southern cities including Charlotte are facing racial tensions over the shootings of black men by white policemen, which, in Charlotte’s case, led to massive protests and riots.
Viewers who watched it themselves saw a rambling, misleading performance. But those who relied on conservative cable newscasts or talk radio hosts got a very different impression.
On Thursday, Donald Trump gave a press conference that was rife with untruths and evasions. Let’s begin with specific examples of demonstrable falsehoods, so that readers who are favorable to the president won’t have to trust my characterization:
Bragging about all the electoral votes he won, Trump said, “We got 306 because people came out and voted like they've never seen before so that's the way it goes. I guess it was the biggest electoral college win since Ronald Reagan.” That is false. As CBS News notes, “In 2012, President Obama defeated his GOP rival, Mitt Romney, with 332 electoral votes. In 2008, Obama won the election against Sen. John McCain, R-Arizona, with 365 electoral votes. In 1996, President Clinton defeated Republican Bob Dole with 379 votes. In 1992, Clinton won against President George H.W. Bush, the incumbent, with 370 electoral votes. In 1988, Bush won the presidency with 426 votes.” And Trump even misstated how many votes he won. It was 304.
“Let me tell you about the travel ban,” Trump said, referring to the executive order that his press secretary, Sean Spicer, heatedly said wasn’t a travel ban. “We had a very smooth rollout of the travel ban. But we had a bad court. Got a bad decision.” Even apart from multiple unfavorable court rulings, the roll-out was anything but smooth. There was massive confusion about whether the surprise policy would affect permanent U.S. residents with green cards. Many were detained or turned away as protesters flocked to airports. Later the administration reversed itself. Ben Wittes went deep in the weeds on the rest of the incompetent, dysfunctional implementation of the order. Trump later said, “the only problem that we had is a bad court. We had a court that gave us what I consider to be, with great respect, a very bad decision. Very bad for the safety and security of our country. The rollout was perfect.”
Trump was asked, “Can you say whether you are aware that anyone who advised your campaign had contacts with Russia during the course of the election?” He said aside from Mike Flynn, the answer is no. In fact, he went even farther. “Russia is a ruse. I have nothing to do with Russia. Haven't made a phone call to Russia in years. Don't speak to people from Russia. Not that I wouldn't. I just have nobody to speak to. I spoke to Putin twice. He called me on the election. I told you this. And he called me on the inauguration, a few days ago. We had a very good talk, especially the second one, lasted for a pretty long period of time … I have nothing to do with Russia. To the best of my knowledge no person that I deal with does. Now, Manafort has totally denied it. He denied it. Now people knew that he was a consultant over in that part of the world for a while, but not for Russia. I think he represented Ukraine or people having to do with Ukraine, or people that—whoever.”
In doing so, Trump effectively denied the veracity of a recent New York Times report asserting, “phone records and intercepted calls show that members of Donald J. Trump’s 2016 presidential campaign and other Trump associates had repeated contacts with senior Russian intelligence officials in the year before the election, according to four current and former American officials.”
I don’t know if Trump or his team are guilty of any wrongdoing with regard to Russia. But Trump’s statement that he has “nothing to do with Russia” elides the fact that Trump made millions partnering with a Russian billionaire, Aras Agalarov, to host the Miss Universe pageant in Moscow in 2013. And in April 2016, when his campaign hosted an invitation-only campaign speech in Washington, D.C., that focused on foreign policy, Russian ambassador Sergey Kislyak attended Trump’s speech and sat in the front row.
As for people that he deals with, Rex Tillerson, his new secretary of state, was longtime director of a U.S.-Russia oil firm, and was awarded the Russian Order of Friendship by Vladamir Putin. “Carter Page, an early foreign policy adviser to Donald J. Trump who was scrutinized by the F.B.I. on suspicion of private communications with senior Russian officials over the summer, was back in Moscow on Thursday,” the New York Timesreported in December. Page, Flynn, and Manafort all resigned over murky Russia ties.
Perhaps this is all a series of innocent coincidences. But Trump misleads Americans into thinking there is no valid reason for suspicion when he falsely claims outright that neither he nor any person he deals with has ties to Russia.
Presidents are supposed to show empathy for their anxious constituents. But when it comes to anti-Semitism, the only person Trump shows empathy for is himself.
The most bizarre and unsettling moment in President Trump’s bizarre and unsettling press conference this Thursday came near the end. Trump, who had been insulting the journalists questioning him for more than 90 minutes, declared that, “I want to find a friendly reporter.”
Then he spied Jake Turx of the magazine Ami, a bearded man attired in the white shirt and black velvet kippa (skullcap) typical of ultra-Orthodox Jews. “Are you a friendly reporter?” Trump asked. “Watch how friendly he is. Wait. Wait. Watch how friendly he is. Go ahead.”
This is not normal. Presidents don’t usually announce that they want an easy question. It’s possible that Trump saw Turx’s distinctive appearance and guessed that he would be “friendly,” since the ultra-Orthodox supported Trump at substantially higher rates than other Jews.