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.
Russia's strongman president has many Americans convinced of his manipulative genius. He's really just a gambler who won big.
I. The Hack
The large, sunny room at Volgograd State University smelled like its contents: 45 college students, all but one of them male, hunched over keyboards, whispering and quietly clacking away among empty cans of Juicy energy drink. “It looks like they’re just picking at their screens, but the battle is intense,” Victor Minin said as we sat watching them.
Clustered in seven teams from universities across Russia, they were almost halfway into an eight-hour hacking competition, trying to solve forensic problems that ranged from identifying a computer virus’s origins to finding secret messages embedded in images. Minin was there to oversee the competition, called Capture the Flag, which had been put on by his organization, the Association of Chief Information Security Officers, or ARSIB in Russian. ARSIB runs Capture the Flag competitions at schools all over Russia, as well as massive, multiday hackathons in which one team defends its server as another team attacks it. In April, hundreds of young hackers participated in one of them.
Russian billionaire Yuri Milner says if the space rock 'Oumuamua is giving off radio signals, his team will be able to detect them—and they may get the results within days.
The email about “a most peculiar object” in the solar system arrived in Yuri Milner’s inbox last week.
Milner, the Russian billionaire behind Breakthrough Listen, a $100 million search for intelligent extraterrestrial life, had already heard about the peculiar object. ‘Oumuamua barreled into view in October, the first interstellar object seen in our solar system.
Astronomers around the world chased after the mysterious space rock with their telescopes, collecting as much data as they could as it sped away. Their observations revealed a truly unusual object with puzzling properties. Scientists have long predicted an interstellar visitor would someday coast into our corner of the universe, but not something like this.
Attacks on the special counsel aren’t about misconduct—instead, they’re aimed at discrediting the very idea of professionalism.
If you’re not a regular consumer of pro-Trump media outlets, it could be easy to underestimate or overlook the recent onslaught of attacks on Special Counsel Robert Mueller. There are a couple reasons for that. One is that this discourse exists almost entirely within that media ecosystem (which is distinct from, though overlapping with, the broader world of conservative media). The other is that critics have been calling for Mueller’s dismissal and an end to his probe since it was announced. Nonetheless, the intensity of the recent spree is notable, as is the gradual shift from ostensibly politically neutral critiques to openly partisan ones.
“Mueller is corrupt. The senior FBI is corrupt. The system is corrupt,” former House Speaker Newt Gingrich said on Fox News. The channel’s legal analyst Gregg Jarrett said Mueller was employing the FBI “just like the old KGB,” which Sean Hannity piously told viewers was “not hyperbole.” Using chilling language, Fox host Jeanine Pirro said, “There is a cleansing needed at the FBI and Department of Justice. It needs to be cleansed of individuals who should not just be fired but need to be taken out in handcuffs.”
The movie knows little—and cares less—about how people fall in love.
I confess that it wasn’t until recently that I understood the degree to which Love Actually, the 2003 romantic comedy by writer/director Richard Curtis, had been gradually reevaluated and granted the status of a “classic” holiday film. For me, the news came by way of a November Vulture piece that began, “It might be hard to recall, but the film that has now become a beloved holiday classic was one that initially received a flurry of mixed reviews.”
My own review was among several cited. I’ve of course always known that my take on Love Actually was more unforgiving than most. But beloved holiday classic? Really?
Well yes, evidently. Over the course of several conversations with friends and colleagues, some of them conducted with good cheer but at high volume—I refer interested parties to the Twitter feeds of Atlantic employees on the afternoon of November 20th—it was confirmed to me that a considerable number of people not only consider Love Actually a classic, but go so far as to watch the movie annually as a holiday tradition.
There is clear evidence that it’s best to show children relationship skills that never escalate to physical harm.
Spanking looks to be instantlyeffective. If a child is misbehaving—if he keeps swearing, or playing with matches—and then you spank that child, the behavior stops immediately.
The effect is so apparently obvious that it can drive a sort of delusion. Lived experience tends to be more powerful than facts. One of the few memories that many people retain from early childhood is times they were spanked. The desire to believe it was “for our own good” is strong, if only because the alternative interpretation is bleak.
It’s in the face of personal experiences like these that science has been flailing for generations. Some 81 percent of Americans believe spanking is appropriate, even though decades of research have shown it to be both ineffective and harmful. The refrain I keep hearing is, “Well, I got spanked, and I turned out okay.”
“The U.S. is now the most unpredictable actor in the world today.”
As conflicts ignite and burn and flicker out around the world, U.S. officials assess the dangers they represent back home. Not all of these conflicts directly threaten American interests, which is why the Council on Foreign Relations conducts an annual survey to help U.S. leaders prioritize threats in the year ahead. For the past decade, this survey has focused on the risks posed to America by foreign actors. Now it’s reckoning with the risks America poses to the world—and to itself.
“The U.S. is now the most unpredictable actor in the world today, and that has caused profound unease,” said Paul Stares, the director of CFR’s Center for Preventive Action, which produces the annual survey. “You used to be able to pretty much put the U.S. to one side and hold it constant, and look at the world and consider where the biggest sources of unpredictability, insecurity are. Now you have to include the U.S. in that. … No one has high confidence how we [Americans] would react in any given situation, given how people assess this president.” This president might welcome the development. “I don’t want people to know exactly what I’m doing—or thinking,” Donald Trump wrote in 2015. “It keeps them off balance.”
The depiction of uncomfortable romance in "Cat Person" seems to resonate with countless women.
Recent months make it seem like humanity has lost the instruction manual for its “procreate” function and has had to relearn it all from scratch. After scores of prominent men have been fired on sexual-assault allegations, confusion reigns about signals, how to read them, and how not to read into them. Some men are wondering if hugging women is still okay. Some male managers are inviting third parties into performance reviews in order to avoid being alone with women. One San Francisco design-firm director recently said holiday parties should be canceled, as The New York Times reported, “until it has been figured out how men and women should interact.”
Into this steps “Cat Person,” a New Yorker fiction story by Kristen Roupenian that explores how badly people can misread each other, but also how frightening and difficult sexual encounters can be for women, in particular. “It isn’t a story about rape or sexual harassment, but about the fine lines that get drawn in human interaction,” Deborah Treisman, The New Yorker’s fiction editor, told me.
The cryptocurrency is almost certainly due for a major correction. But its long-term value remains a mystery.
To call Bitcoin the biggest and most obvious bubble in modern history may be a disservice to its surreality.
The price of bitcoin has doubled four times this year. In early January, one bitcoin was worth about $1,000. By May, it hit $2,000. In June, it breached $4,000. By Thanksgiving, it was $8,000. Two weeks later, it was $16,000.
This astronomical trajectory might make sense for a new public company with accelerating profits. Bitcoin, however, has no profits. It’s not even a company. It is a digital encrypted currency running on a decentralized network of computers around the world. Ordinary currencies, like the U.S. dollar, don’t double in value by the month, unless there’s a historic deflationary crisis, like the Panic of 1837. Instead, bitcoin’s behavior more resembles that of a collectible frenzy, like Beanie Babies in the late 1990s.
Kristen Roupenian’s viral New Yorker short story is not an essay—but many have seen it as one.
In fiction-writing—before characters can be developed, before plots can be sketched, before tensions can be introduced, and attendant arcs molded and stretched—the author must first make a series of much more basic decisions: How will the story be told? Who, in the context of the story itself, will tell it? Who will be given a person and a voice within this hermetic little universe? Who will not? Why? Why not? These are the defining cosmological questions of every work of fiction, the ones that will shape everything else that comes to exist in the author’s—and the story’s—manufactured world.
Kristen Roupenian, in “Cat Person,” the New Yorker short story that has been, and continues to be, going viral, selected as her storyteller a classic, third-person omniscient narrator: the Godlike entity, seeing all and telling some. And then Roupenian—the subsidiary, and yet much more complicated decision—focused her narrator’s attentions entirely on the perspective of her protagonist, a 20-year-old college student named Margot. It is from Margot’s perspective—her perspective as filtered through this particular story’s author-God—that Roupenian’s story unfolds: Margot meets a man named Robert, several years her senior, and then successively flirts with him, texts with him, goes on a date with him, sleeps with him, and, finally, breaks up with him.
There’s a fiction at the heart of the debate over entitlements: The carefully cultivated impression that beneficiaries are simply receiving back their “own” money.
One day in 1984, Kurt Vonnegut called.
I was ditching my law school classes to work on the presidential campaign of Walter Mondale, the Democratic candidate against Ronald Reagan, when one of those formerly-ubiquitous pink telephone messages was delivered to me saying that Vonnegut had called, asking to speak to one of Mondale’s speechwriters.
All sorts of people called to talk to the speechwriters with all sorts of whacky suggestions; this certainly had to be the most interesting. I stared at the 212 phone number on the pink slip, picked up a phone, and dialed.
A voice, so gravelly and deep that it seemed to lie at the outer edge of the human auditory range, rasped, “Hello.” I introduced myself. There was a short pause, as if Vonnegut were fixing his gaze on me from the other end of the line, then he spoke.