He had five personalities and they were all boring!

A sceptical take on multiple personality disorder.

This week I’m going to be looking at multiple personality disorder. Actually it’s no longer called that, but I’ll go into that later. The title of my piece comes from a quip I heard from a university professor talking about someone suffering from the condition. The idea that a rare mental illness in which multiple personalities can coexist within one person is one that has captured the public’s imagination. In 1957 Joanne Woodward won the Academy Award for Best Actress for her performance in the film The Three Faces of Eve, making her the first actress to win an Oscar for portraying three different personalities. Woodward, who was at the time a relative unknown in Hollywood, would later go on to play Dr. Cornelia Wilbur in Sybil, another movie about multiple personality disorder. Sybil, played by Sally Field, had no less than 13 personalities, including two male ones – Mike and Sid. The film was based on a book from 1973 by Flora Rheta Schreiber, which became a publishing phenomenon, selling some 6 million copies around the world.

Shirley Ardell Mason, who was the inspiration for Schreiber’s book, was born and grew up in Dodge Center,Minnesota. She came from a strict Seventh-day Adventist family. Her psychotic mother had allegedly sadistically abused her when she was growing up. This mistreatment had caused her consciousness to split into many different personalities to hold the trauma, so that she wouldn’t be aware of it. She decided to seek psychiatric help and she became a patient of Dr. Connie Wilbur, a Freudian psychiatrist who had a special interest in multiple personality disorder.

Once Mason had been diagnosed with MPD, she started generating more and more personalities including babies, little boys, and teenage girls. Mason probably wasn’t faking it – she was highly suggestible, and was giving Wilbur what she wanted. Wilbur began injecting Mason regularly with sodium pentothal, which at that time was used to help people remember traumatic events that they had repressed. Under the influence of drugs and hypnosis, the very suggestible Mason uncovered more and personalities.

IN 1958 Mason tried to retract what she had said. But it was too late. Wilbur had too much at stake. The doctor used the rationale that her patient was in denial about her problems. Wilbur had too much invested in her theories and Mason’s mental illness.

When people began to recognize her as the patient portrayed in the book, Mason left West Virginia and moved to Lexington,Kentucky, to be near Wilbur. There she taught art classes at a community college and set up a gallery at her house. Mason cared for Dr. Wilbur during her cancer until her death in 1992. Mason herself died at home of breast cancer in 1998, at the age of 75.

So what is multiple personality disorder?  As I said before, we no longer use the term. In 1994, the fourth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM) it was rebranded as Dissociative Identity Disorder – DID. The rationale behind the name change was to emphasize the importance of changes to consciousness and identity rather than personality.

DID is a personality disorder in which a person has more than one discrete, separate identity. Each identity is unique, and has its own sets of memories, ideas, thoughts, ways of thinking, and purposes. The alter identities are completely unaware of the other identities, and switches between identities usually occur within seconds. The alters vary hugely both across and within individuals. The number of alters has been reported to range from one to hundreds or even thousands; one clinician reported a case of a patient with 4,500 alters. Only 200 cases of dissociative identity disorder could be found prior to 1979, whereas in 1999, more than 30,000 cases had been reported. One misconception which I would like to lay to rest is MPD is in any way connected to schizophrenia. People with schizophrenia do not have multiple personalities. They suffer from “a breakdown in the relation between thought, emotion, and behaviour, leading to faulty perception, inappropriate actions and feelings, withdrawal from reality and personal relationships into fantasy and delusion, and a sense of mental fragmentation.” Its most frequent manifestations are auditory hallucinations, paranoid delusions, and disordered speech and thinking.

While at the beginning dissociative identity disorder had many converts, in recent years growing scepticism has emerged. There are a number of reasons that have provoked this scepticism:

The dramatic epidemic in DID cases is I fear not the result of improved techniques in diagnosis and assessment, but from the actions of the therapists and the increased media attention. I am not arguing that DID patients have nothing wrong with them. There is strong evidence that many patents diagnosed with DID entered psychotherapy with psychological difficulties,. But it is the psychotherapists who have generated and maintained DID. Many of the patients had no memory of sexual abuse upon entering therapy. Only after the therapist encourages the patient, did memories of sexual abuses emerge. The late Nicholas J Spanos, a prestigious psychologist, was a DID sceptic. He argued that “patients learn to construe themselves as possessing multiple selves, learn to present themselves in terms of this construal, and learn to reorganize and elaborate on their personal biography so as to make it congruent with their understanding of what it means to be a multiple.”

Nowadays few of us would invoke demonic possession in order to explain such phenomena as epilepsy, brain damage, genetic disorders, neurochemical imbalances, or hallucinations. Yet, not too long ago, this would have been the explanation. What’s more there were experts who were able to identify these cases and exorcise the victims.  We know now that the possessed and those who “cured” them were enacting social roles. Of course to them it was all very real. What we seem to be seeing now is the latest incarnation of demonic possession.

Basic research into human memory has not uncovered any mechanism for repression and recovery of traumatic memories during childhood. The idea that memories can be recovered has been shown to have no scientific basis. Indeed it is extremely dangerous. It is incredibly easy to implant false memories. If you have a vulnerable patient, the inappropriate use of hypnosis can foster convincing pseudomemories for events that never occurred. Psychologists have implanted memories of past lives, UFO abductions satanic rites and sexual abuse. Parents have been arrested and sent to prison for abusing their children on the basis of these supposedly recovered memories. Of course childhood sexual abuse is very real, but these cases of recovered memories are based on completely unscientific methods.

But even if we assume that all the claims of abuse are true, there is a fundamental flaw in the claim that childhood trauma causes DID. If this were the case, the abuse of millions of children over the years would have caused many cases of DID. One obvious example would be the children who were brutalised by the Nazis in ghettoes, trains, and concentration camps all over Europe. However, no evidence exists that any developed it.

A cynic would argue that that this is another example of the psychology industry and its afan for manufacturing victims. Remember psychology critic Tana Dineen’s maxim: PERSON = VICTIM = USER/PATIENT = PROFIT. I have no doubt that economic incentives play a significant role but I think there is more to it than that. A crucial lesson is that beliefs can help to shape reality. Psychotherapists must therefore be aware of the possibility that their therapeutic practices may unwittingly worsen and perhaps even create psychological disorders in their patients.

Distrust me, I’m an expert

Economists give their predictions to a digit after the decimal point to show that they have a sense of humour.  Anonymous

Legends of prediction are common throughout the whole Household of Man. Gods speak, spirits speak, computers speak. Oracular ambiguity or statistical probability provides loopholes, and discrepancies are expunged by Faith.  Ursula K. LeGuin

There are two classes of forecasters: those who don’t know and those who don’t know they don’t know. J K Galbraith

___________

A few yeas back I did a piece called Really terrible predictions, which listed some of the most infamously bad predictions of the last century or so. Gems included IBM chairman Thomas Watson’s 1943 prediction that there would be a world market for five computers and Yale economics professor Irving Fisher’s claim that stocks had reached a permanently high plateau. He came up with this on October 16, 1929!

The post came back to me this summer while reading Dan Gardner’s Future Babble, a book which examines why experts are so bad at predicting the future. Of course the fact that experts sometimes get it spectacularly wrong doesn’t prove anything. As Ben Goldacre likes to say, the plural of anecdotes is not data. You need to conduct a rigorous study where hundreds of these experts – academics, intelligence analysts, economists, political scientists and even journalists – make predictions. Then you have to see how they have done.Gardner was able to find exactly this – the research of a professor of psychology at the University of Pennsylvania, Philip Tetlock. Beginning in the 1980s and for a period of twenty years Tetlock examined 27,451 forecasts by 284 experts about inflation elections, wars etc. It was an exhaustive study if ever there was one and the results did not speak highly of the experts abilities. Indeed they did little better than those proverbial dart-throwing chimps. That’s right, no better than random chance.

We need to dig more deeply into the results. The ones who were worse than average actually did worse than if they had been tossing a coin. Now that is quite an achievement! And even the ones who did better were not much better than random chance. Another paradoxical conclusion is that there was an inverse correlation between confidence and accuracy; the greater the expert’s confidence the less accurate the predictions were. According to Gardner what made the difference here was the style of thinking.

When examining the experts’ records it is helpful to use the philosopher Isaiah Berlin’s distinction, borrowed from the Greek poet Archilochus: “The fox knows many things, but the hedgehog knows one big thing.”

Tetlock analysed the difference in prediction styles in a 2005 book:

Low scorers look like hedgehogs: thinkers who “know one big thing,” aggressively extend the explanatory reach of that one big thing into new domains, display bristly impatience with those who “do not get it,” and express considerable confidence that they are already pretty proficient forecasters, at least in the long term. High scorers look like foxes: thinkers who know many small things (tricks of their trade), are sceptical of grand schemes, see explanation and prediction not as deductive exercises but rather as exercises in flexible “ad hocery” that require stitching together diverse sources of information, and are rather diffident about their own forecasting prowess.

The experts were asked many kinds of questions, not all within their area of expertise. The foxes did better when asked about their field. This is exactly what you would expect. But the bizarre thing was that the hedgehogs actually did worse when making predictions in their specialised area.

The worrying aspect about this is that everyone loves a hedgehog. They are the ones who get invited as pundits on to television shows, write in newspapers and appear on the bestseller lists. We don’t want nuance. And Tetlock found that the more famous the experts, the less accurate they were.

Psychologists were probably not surprised by Tetlock’s results. What we are dealing with here then is not merely the inherent complexity of predicting the future. We have our flawed human cognitive abilities to take into account.Gardnerlooks at the cognitive biases that can have a negative effect on our ability to predict the future. Here are some of the biases he mentions:

Optimism bias is the tendency to believe that we are better than we really are – we are all above-average in intelligence, looks etc. Getting married? Other people will end up in the divorce courts.  Starting a new business? Most fail, but mine will be different. This may seem like delusional thinking but the evolutionary advantage as is that it encourages people to take action and makes them better able to deal with setbacks. To paraphrase Jack, we can’t handle the truth.

Another danger is confirmation bias. Once we form a belief we tend to seek out and accept information that supports it and not bother to look for information that does not. And even if we are actually presented with information that doesn’t fit, we will be hypercritical, looking for any excuse to dismiss it as worthless.

Status quo bias is the tendency to see tomorrow as being like today. We lack the imagination to see beyond today’s trends. Of course, this doesn’t mean we expect nothing to change. But most attempts at prediction seem to begin with current trends, which are then projected into the future. Current trends do often continue, but the further we look into the future, the more likely it is these trends will be reversed.

Negativity bias is a predilection for doom and gloom. We are drawn to bad news or images, and we are more likely to remember them than positive information.

What is so interesting about these types of biases is that none of us are immune to them.  If someone had told me just thirty months ago that Spain would go on to win the European football championship and the World Cup in the space of two years I would have thought that they should be locked up. I assumed that all my experience in the past was valid. This is where experts can be especially dangerous. I have no problem admitting to my flawed thinking, but the experts with their experience, intelligence and expertise can actually be more prone to these psychological foibles.

At the end of the book Gardner looks at the work of controversial political scientist Bruce Bueno de Mesquita, who specialises in international relations and foreign policy.

Bueno de Mesquita doesn’t really care about the local culture, history, economy, or any of the other considerations that more traditional political scientists analyse. For him the key is self-interest and he uses game theory to make models of the future. He claims a number of impressive hits. His model predicted:

• Brezhnev being succeeded by the dark horse Andropov, who nobody at the time even considered a possibility.
• China’s crackdown on dissidents four months before Tiananmen Square
• The second Intifada and the end of the Middle East peace process, two years before it happened.

Bueno de Mesquita claims a hit rate of 90%. It sounds very impressive, but it does also make me a bit suspicious. We need to know the difficulty of these predictions. What did he get wrong? I am especially sceptical about black swans those rare and unpredictable events that can have catastrophic results. We seem to be incapable of predicting these.

I’m certainly not suggesting we leave the field to astrologers and clairvoyants But we have to recognise the difficulty of the enterprise and be aware that uncertainty is always going to be there. We sometimes just have to admit that we don’t know.

A list of cognitive biases

Wikipedia has a list of the most important cognitive biases. Here is my selection:

Anchoring – the common human tendency to rely too heavily, or “anchor,” on one trait or piece of information when making decisions.

Attentional Bias – implicit cognitive bias defined as the tendency of emotionally dominant stimuli in one’s environment to preferentially draw and hold attention.

Availability cascade – a self-reinforcing process in which a collective belief gains more and more plausibility through its increasing repetition in public discourse (or “repeat something long enough and it will become true”).

Availability heuristic – estimating what is more likely by what is more available in memory, which is biased toward vivid, unusual, or emotionally charged examples.

Backfire effect – Evidence disconfirming our beliefs only strengthens them.

Bandwagon effect – the tendency to do (or believe) things because many other people do (or believe) the same. Related to groupthink and herd behaviour.

Bias blind spot – the tendency to see oneself as less biased than other people.

Choice-supportive bias – the tendency to remember one’s choices as better than they actually were.

Clustering illusion – the tendency to see patterns where actually none exist.

Confirmation bias – the tendency to search for or interpret information in a way that confirms one’s preconceptions.

Congruence bias – the tendency to test hypotheses exclusively through direct testing, in contrast to tests of possible alternative hypotheses.

Endowment effect – the fact that people often demand much more to give up an object than they would be willing to pay to acquire it.

Experimenter’s bias – the tendency for experimenters to believe, certify, and publish data that agree with their expectations for the outcome of an experiment, and to disbelieve, discard, or downgrade the corresponding weightings for data that appear to conflict with those expectations.

Focusing effect – the tendency to place too much importance on one aspect of an event; causes error in accurately predicting the utility of a future outcome.

Framing effect – drawing different conclusions from the same information, depending on how that information is presented.

Fundamental attribution error – the tendency for people to over-emphasize personality-based explanations for behaviours observed in others while under-emphasizing the role and power of situational influences on the same behaviour.

Halo effect – the tendency for a person’s positive or negative traits to “spill over” from one area of their personality to another in others’ perceptions of them.

Hindsight bias – sometimes called the “I-knew-it-all-along” effect, the tendency to see past events as being predictable at the time those events happened.

Illusion of control – the tendency to overestimate one’s degree of influence over other external events.

Illusory correlation – inaccurately perceiving a relationship between two events, either because of prejudice or selective processing of information.

Illusory superiority – overestimating one’s desirable qualities, and underestimating undesirable qualities, relative to other people.

In-group bias – the tendency for people to give preferential treatment to others they perceive to be members of their own groups.

Just-world phenomenon – the tendency for people to believe that the world is just and therefore people “get what they deserve.”

Moral luck – the tendency for people to ascribe greater or lesser moral standing based on the outcome of an event rather than the intention.

Normalcy bias – the refusal to plan for, or react to, a disaster which has never happened before.

Omission bias – the tendency to judge harmful actions as worse, or less moral, than equally harmful omissions

Ostrich effect – ignoring an obvious (negative) situation.

Outcome bias – the tendency to judge a decision by its eventual outcome instead of based on the quality of the decision at the time it was made.

Out-group homogeneity bias – individuals see members of their own group as being relatively more varied than members of other groups.

Overconfidence effect – excessive confidence in one’s own answers to questions.

Pareidolia – a vague and random stimulus (often an image or sound) is perceived as significant, e.g., seeing images of animals or faces in clouds, the man in the moon, and hearing hidden messages on records played in reverse.

Pessimism bias – the tendency for some people, especially those suffering from depression, to overestimate the likelihood of negative things happening to them.

Positive outcome bias – the tendency of one to overestimate the probability of a favourable outcome coming to pass in a given situation.

Primacy effect – the tendency to weigh initial events more than subsequent events.

Projection bias – the tendency to unconsciously assume that others (or one’s future selves) share one’s current emotional states, thoughts and values.

Recency effect – the tendency to weigh recent events more than earlier events.

Selective perception – the tendency for expectations to affect perception.

Self-serving bias – the tendency to claim more responsibility for successes than failures. It may also manifest itself as a tendency for people to evaluate ambiguous information in a way beneficial to their interests (see also group-serving bias).

Semmelweis reflex – the tendency to reject new evidence that contradicts an established paradigm.

Status quo bias – the tendency to like things to stay relatively the same

Subjective validation – perception that something is true if a subject’s belief demands it to be true. Also assigns perceived connections between coincidences.

System justification – the tendency to defend and bolster the status quo. Existing social, economic, and political arrangements tend to be preferred, and alternatives disparaged sometimes even at the expense of individual and collective self-interest.

Ultimate attribution error – similar to the fundamental attribution error, in this error a person is likely to make an internal attribution to an entire group instead of the individuals within the group.

A sceptic’s look at Scientology

The Church of Scientology, which is now almost sixty years old, has always been controversial. To its critics it is an evil cult that abuses its members and is only interested in making money. It is famed for its litigiousness and for hounding anyone who dares to criticise it. This ruthlessness and an ability to evolve have allowed it to become a powerful force in the USA.  I have found it impossible to find any reliable figures for the number of practicing Scientologists in the world today, with estimates ranging from 250,000 to 15 million. These numbers may seem inconsequential, but with a fortune in real estate and a host of influential celebrity defenders, they are able to punch well above their weight. I have recently been reading Inside Scientology by Janet Reitman. While the book contains no earth-shattering revelations, I found I learned a lot about the history, doctrines and workings of The Church of Scientology.

I am going to define Scientology as a religion because I feel that words like cult and sect are emotive conjugations. Scientology’s beliefs may appear to be wacky, but wackiness is in the eye of the beholder. Reincarnation, exorcism, rising from the dead, refusal of blood transfusions, the Hindu caste system, the niqab, Tibetan sky burial and food taboos could also be considered strange. So, scientology may be weird. I don’t think that means it should be banned. I think the German attitude to Scientology should be censured. On the other hand, being a religion does not exempt you from criticism. Such criticism should not be considered persecution.

The Church’s founder, Lafayette Ron Hubbard, was a science fiction writer. He certainly had a colourful life, although he did seem to have a certain talent for self-aggrandisement. He also spent much of his life travelling including years at sea as the Commodore of his own private navy.

In 1950 Hubbard published Dianetics: The Modern Science of Mental Health. Two years later Dianetics was transformed into a religion. Hubbard would lead the Church until his death in 1986.  His successor and the church’s current leader David Miscavige, has been able to give the church somewhat more mainstream appeal. Miscavige, who rose to power when he was just 25, has put a lot of effort into expanding the Church’s physical presence. However, he has also made scientology more rigid and his critics accuse him of creating a climate of fear within the organisation. A number of high-ranking members have left the church. Of course, this is typical in many religions – the Catholic/Protestant/Orthodox split in Christianity or the Sunni/Shia divide in Islam are two obvious examples.

I’m going to look at Scientology’s belief system. This is not easy because of the obsessive secrecy of the church. What’s more Hubbard invented a way of describing the world that is filled with concepts and jargon that are alien to me.  I hope I don’t make too many mistakes. Scientology doesn’t help its case by maintaining many of its beliefs as secrets. They have spent millions of dollars trying to stop former members publishing their secret scriptures on the internet. This seems to be like the Catholic Church having the Virgin Birth of Jesus as a secret known only to a powerful elite.

Scientologists believe that they have lived and will live forever. They apparently sign billion-year contracts in which they commit themselves to the organisation. Scientology has its own creation myth. It involves a galactic ruler named Xenu, who controlled part of the galaxy including our own planet Earth, in those days known as Teegeeack. Faced by massive overpopulation, Xenu decided on a drastic plan. With the help of psychiatrists he called in billions of people for income tax inspections where they were instead given injections of alcohol and glycol that left them paralysed. They were put into space planes that looked exactly like DC8s (except they had rocket motors instead of propellers), and they were sent to Earth. On arrival these paralysed people were dropped into volcanoes. Hydrogen bombs were then detonated and everyone was killed. But that was not the end of the story. Billions of souls, known as thetans, were being blown around by the nuclear winds. They were captured by Xenu’s forces using an electronic ribbon and sucked into vacuum zones around the world. These souls were then packed into boxes and taken to a few huge cinemas, where they were forced to spend 36 days watching special 3D movies. These films implanted what Hubbard called “various misleading data“‘ into the memories of the defenceless thetans. This included all world religions, and Hubbard specifically attributed Roman Catholicism and the image of the Crucifixion to Xenu’s malevolent plan. The thetans were also deprived of their sense of personal identity. They clustered in groups of a few thousand. Now because there were only a few living bodies left they inhabited these bodies. Xenu was eventually overthrown and he is now a prisoner in a mountain and on one of the planets. He is kept in by a force-field powered by an eternal battery.

These body thetans are still around today. Each of us has our own thetan, causing us spiritual and mental harm. Scientologists believe we have a reactive and an analytical mind. The engram (painful memory) is stored in the reactive mind. As a result of the build-up of thousands of these engrams, we experience problems throughout our lives. The purpose of Dianetics is to rid a thetan (person) of their reactive minds. The means to do this is auditing, scientology’s form of spiritual counselling. The auditor’s basic tool is the E-meter, a skin galvanometer, that they claim helps ascertain the problems of the subject. In the sessions the auditor asks questions and takes notes about the participant’s responses. The idea is to consciously re-experience painful or traumatic events from their past in order to free themselves of their negative effects. Sessions are sold in 12-and-a-half-hour blocks, which vary in cost depending on what level you’re working on.

Once you become free of the reactive mind, you have reached Clear, but you still have the secret levels, known as the Bridge to Total Freedom, where you learn the theology and creation myth of the church and understand what it’s all about. You have advanced to a higher state of being, Operating Thetan. It is defined as “knowing and willing cause over life, thought, matter, energy, space and time.”

Scientology is famous for its celebrities. Tom Cruise, John Travolta Isaac Hayes and Kirstie Alley are names that immediately spring to mind. Jerry Seinfeld also dabbled with scientology and Charles Manson took over 150 hours of Scientology courses. The celebrities are part of the strategy of both Hubbard and Miscavige to recruit this kind of high-profile opinion shapers. This has enabled them to gain some respectability. The self-help aspect of the faith seems to go down well with the stars. John Travolta asserted that stars such as Elvis Presley and James Dean wouldn’t have died so young if they had been scientologists.  In fact, one of Elvis’s girlfriends tried to persuade him o join and he went to a scientology centre on Sunset Boulevard. Elvis was not impressed:

“Fuck those people! There’s no way I’ll ever get involved with that son-of-a-bitchin’ group. All they want is my money.’”  However, they did recruit both his wife and daughter.

The jewel in the Scientology crown is of course Tom Cruise. He originally kept his religious views to himself, but in recent years he has become vocal in his advocacy. This has helped the church but there have been downsides such as the famous sofa incident on the Oprah Winfrey show.

Another famous Cruise moment was his attack on psychiatry and criticism of Brooke Shields for her use of drugs for postpartum depression. Cruise was very much on message. Scientology’s hatred of psychiatry is long-standing and particularly vitriolic, reflecting the views of Hubbard. They even have a museum on Sunset Boulevard – Psychiatry: an Industry of Death. They certainly make some outlandish claims:

There is no such thing as chemical imbalances in the brain and that the very notion of mental illness is a fraud.

 

Between 10 and 25 percent of psychiatrists sexually assault their patients, some of them children.

 

Psychiatrists kill up to 10,000 people a year with their use of electroshock treatment 

Regular readers of my blog will know that I have been critical of such things as the Diagnostic and Statistical Manual of Mental Disorders. The DSM IV documented 374 mental disorders and they see to treat life itself as human life is a form of mental illness. But the scientologists go way beyond that and deny the existence of mental illness. Their own record on mental health leaves a lot to be desired. The e-meter has never been subjected to clinical trials.

And they have their own dark history. Elli Perkins was a professional glass artist a senior auditor at the Church of Scientology in Buffalo, New York. Her son Jeremy was diagnosed with schizophrenia in 2001. Following church policy, she rejected psychiatric care preferring to treat him with vitamins. The condition worsened to the point where Jeremy felt that his mother was poisoning him. After a failed suicide attempt, Jeremy eventually murdered her in 2003. Jeremy Perkins was found not responsible by reason of mental disease, but he was assessed as dangerously mentally ill and was committed to a secure facility.  In March 2006, an advertisement in LA Weekly blamed Tom Cruise and the Church of Scientology for the murder of Elli Perkins. The ad stated: “Thanks, Tom Cruise and the Church of Scientology, for your expert advice on mental health.”

What does the future hold for scientology? There are now third-generation Scientologists. I don’t find their beliefs very convincing. They seem to be a product of time and place. But I have no problem with people holding those beliefs.  However, there are serious questions about the way the Church behaves. They seem to have a strong authoritarian bent. This can be seen in the way Miscavige seems to intimidate the people around him. If you dare to leave the Church, you can expect severe problems. The Scientologists love to sue and harass their critics. They had a term, Fair Game, to describe policies and practices carried out by the Church of Scientology towards its enemies. Basically any tactics could be justified. Hubbard scrapped this policy because of the bad PR, but the Church still seems to be very aggressive in the gives defectors a forum in which to attack it. In the age of Wikileaks they have also been unable to protect their secrets. They face an uncertain future. In their sixty-year history they have proved adept at adapting to meet new demands. It will be fascinating how they cope in the next sixty years.

The psychopaths have taken over the asylum

The other day one teacher took issue with me for using the term sociopath in my post about Bernie Madoff, The sociopath with his name on the door. In the article I did try to reflect how we struggle to find the right words to describe such people. This theme came to my mind again after reading Jon Ronson’s latest book The Psychopath Test. The journalist, documentary filmmaker, radio presenter and nonfiction author has carved out a niche for himself as a chronicler of eccentricity. He has written four books, of which his previous one, The Men Who Stare at Goats, is the most famous. His latest book gets its title from a diagnostic tool, used to identify psychopaths created by the psychologist Robert Hare – the Hare Checklist. The Psychopathy Checklist-Revised (PCL-R) is a clinical rating scale of 20 items, which has to be administered by a suitably qualified and experienced clinician under controlled conditions.

Defining what a psychopath is can prove difficult. Psychopathy is a personality disorder characterized by an inability to form human attachment and an abnormal lack of empathy, which can be hidden behind an apparently normal outward appearance. The current definitions seem to be more concerned with the emotional rather than behavioural elements. These are people who don’t do regret, remorse or responsibility; they have different emotional responses to the rest of us. Somebody may be a psychopath, but that doesn’t mean they are going to eat somebody’s liver with some fava beans and a nice Chianti. Is there really a cure for psychopaths? How do you instil empathy? Talk therapy may actually be counterproductive, making them more skilled at manipulating others.

The difference between a psychopath and a sociopath is somewhat blurred. They are often used interchangeably; both are listed together in the fourth edition of the Diagnostic and Statistical Manual of Mental Disorders, the DSM-IV under the heading of Antisocial Personalities because they share many common traits. It is a complicated dispute for an outsider like me to grasp. Not only do experts dispute if the two terms are different, but those who believe that there is a difference argue over what those differences are.

The problems of diagnosis of mental illnesses came sharply into focus in a famous experiment from the 1970s. Psychologist David Rosenhan and seven other normal people, none of whom had ever had any psychiatric problems, got themselves admitted to various psychiatric hospitals in the USA. The only serious problem they had was getting out. Only by accepting that they were mentally ill and then pretending that they were getting better were they able to get released. The hospital staff had been unable to detect a single pseudopatient. And it got worse. Rosenhan was challenged to repeat the experiment. Only this time he didn’t send any fake patients. Nevertheless, the staff still detected large numbers of patients as impostors when they were genuinely ill. On Being Sane in Insane Places was considered a landmark study of psychiatric diagnosis. But it also took a lot of flak from the psychiatric profession. One doctor, Robert Spitzer, lambasted Rosenhan in a speech:

“If I were to drink a quart of blood and, concealing what I had done, come to the emergency room of any hospital vomiting blood, the behaviour of the staff would be quite predictable. If they labelled and treated me as having a bleeding peptic ulcer, I doubt that I could argue convincingly that medical science does not know how to diagnose that condition.”

Robert L. Spitzer is another of the key figures in Ronson’s tale. This retired professor of psychiatry was a major architect of the modern classification of mental disorders, and was undoubtedly one of the most influential psychiatrists of the 20th century. He was instrumental in getting homosexuality removed as a mental disorder.

In the early 1970s psychiatry was in a state of flux. What Spitzer wanted was to make it as objective as possible. In 1974 he was put in charge of the APA task force preparing the third edition of the DSM. Spitzer wanted to get rid of all the Freudian nonsense about the subconscious and create a common worldwide language for all. Patients for the first time could enter a clinician’s office with the reasonable expectation of an accurate diagnosis and the appropriate treatment. The key tool would be the checklist – Spitzer had been inspired by pioneers like Bob Hare.  Any psychiatrist could pick up the DSM-III—and if the patient’s overt symptoms coincided with the checklist – they would be to provide a precise diagnosis-

The DSM-III became a worldwide success, helping to shape our culture and society profoundly. The idea was to make it objective. But maybe that goal was just too ambitious. Is this really science or is it the mere pretence of knowledge? Robert Spitzer’s successor, Allen Frances, continued the tradition of welcoming new mental disorders, with their corresponding checklists, into the manual. The first edition of DSM, which first came out in 1953, had had sixty-five pages. DSM-IV has 886 pages.  DSM-V is in the pipeline for 2013. I just wonder if the Amazon will be able to survive. You can actually consult it online here.

Ronson consulted the list and found that “I instantly diagnosed myself with twelve different ones. … I was much crazier than I had imagined.”  They seem to want to label life itself a mental disorder. Reviewing the DSM-IV for Harper’s in 1997, writer L.J. Davis was sceptical

Has there ever been a task more futile than the attempt to encompass, in the work of a single lifetime, let alone in a single work, the whole of human experience? For roughly five thousand years, poets, playwrights, philosophers, and cranks have incinerated untold quantities of olive oil, beeswax, and fossil fuel in pursuit of this maddeningly elusive goal; all have failed, sometimes heroically. Not even Shakespeare could manage it; closer to our own times, Dickens, a sentimental Englishman, the son of a clerk, perhaps came closest, though he believed in spontaneous human combustion and managed to miss the entirety of the twentieth century. Despite the best efforts of minds great, small, and sometimes insane, the riddle of the human condition has remained utterly impervious to solution. Until now. According to the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (popularly known as the DSM-IV), human life is a form of mental illness.

Here are a few of 374 known mental disorders listed in DSM IV: Disorder of Written Expression, Oppositional Defiant Disorder, Selective Mutism and Arithmetic Learning Disorder. After studying the Hare checklist, Ronson began to see psychopaths lurking in every corner of society—from maximum-security prisons to the corridors of power.

One fascinating part of the book is where he deals with capitalism and psychopathy. This is not a new theme in popular culture. In Alan J. Pakula’s 1974 film, The Parallax View, the evil Parallax Corporation uses a questionnaire to recruit potential assassins. Joel Balkan’s The Corporation linked the way corporations behave to the DSM-IV’s symptoms of psychopathy. The ruthless competitiveness of modern capitalism with constant downsizing and hostile takeovers provides a perfect environment for a psychopath. Individuals who ignore the rules and are good at conning and manipulating people can thrive here. Hare expressed it like this:

”If I couldn’t study psychopaths in prison, I would go down to the Stock Exchange.”

Ronson introduces us to Al Dunlap, a retired corporate executive, best known as a turnaround specialist and downsizer. His nicknames, Chainsaw Al and Rambo in Pinstripes, will give you an idea of his fearsome reputation. A massive accounting scandal at Sunbeam-Oster led to his retirement under a cloud of suspicion.

Ronson goes down to Dunlap’sFloridamansion to do the psychopath test on him. His description is very revealing:

The first obviously strange thing about Al Dunlap’s grand Florida mansion and lavish, manicured lawns was the unusually large number of ferocious sculptures there were of predatory animals. They were everywhere: stone lions and panthers with teeth bared, eagles soaring downward, hawks with fish in their talons, and on and on, across the grounds, around the lake, in the swimming pool/health club complex, in the many rooms. There were crystal lions and onyx lions and iron lions and iron panthers and paintings of lions and sculptures of human skulls.

Dunlap’s score on the test, in the low 20s, was below the score of 30 or more which experts consider symptomatic of psychopathy. Of course here we are in the terrain of emotive conjugations. I am a leader; you are authoritarian; he is a psychopath. Ronson shows how Dunlap spins the negative traits; he turns the psychopath checklist into Who Moved My Cheese?

Of course I wouldn’t limit my analysis to capitalism. We don’t have to look too hard to find communist psychopaths. Maybe psychopathy should be seen as an evolutionary adaptation, a complex survival mechanism.  I will close with a graffito at a Liberal Party conference many years ago:

“Power corrupts and absolute power is even more fun“

The Hare Checklist

Are you a psycho? Now you can try this fun test at home. These items cover the affective, interpersonal, and behavioural features of psychopathy. Each item is rated on a score from zero to two. The sum total determines the extent your psychopathy.

1. GLIB and SUPERFICIAL CHARM — the tendency to be smooth, engaging, charming, slick, and verbally facile. Psychopathic charm is not in the least shy, self-conscious, or afraid to say anything. A psychopath never gets tongue-tied. They have freed themselves from the social conventions about taking turns in talking, for example.

2. GRANDIOSE SELF-WORTH — a grossly inflated view of one’s abilities and self-worth, self-assured, opinionated, cocky, a braggart. Psychopaths are arrogant people who believe they are superior human beings.

3. NEED FOR STIMULATION or PRONENESS TO BOREDOM — an excessive need for novel, thrilling, and exciting stimulation; taking chances and doing things that are risky. Psychopaths often have a low self-discipline in carrying tasks through to completion because they get bored easily. They fail to work at the same job for any length of time, for example, or to finish tasks that they consider dull or routine.

4. PATHOLOGICAL LYING – can be moderate or high; in moderate form, they will be shrewd, crafty, cunning, sly, and clever; in extreme form, they will be deceptive, deceitful, underhanded, unscrupulous, manipulative, and dishonest.

5. CONNING AND MANIPULATIVENESS- the use of deceit and deception to cheat, con, or defraud others for personal gain; distinguished from Item #4 in the degree to which exploitation and callous ruthlessness is present, as reflected in a lack of concern for the feelings and suffering of one’s victims.

6. LACK OF REMORSE OR GUILT — a lack of feelings or concern for the losses, pain, and suffering of victims; a tendency to be unconcerned, dispassionate, cold-hearted, and unempathic. This item is usually demonstrated by a disdain for one’s victims.

7. SHALLOW AFFECT — emotional poverty or a limited range or depth of feelings; interpersonal coldness in spite of signs of open gregariousness.

8. CALLOUSNESS and LACK OF EMPATHY — a lack of feelings toward people in general; cold, contemptuous, inconsiderate, and tactless.

9. PARASITIC LIFESTYLE – an intentional, manipulative, selfish, and exploitative financial dependence on others as reflected in a lack of motivation, low self-discipline, and inability to begin or complete responsibilities.

10. POOR BEHAVIORAL CONTROLS — expressions of irritability, annoyance, impatience, threats, aggression, and verbal abuse; inadequate control of anger and temper; acting hastily.

11. PROMISCUOUS SEXUAL BEHAVIOR – a variety of brief, superficial relations, numerous affairs, and an indiscriminate selection of sexual partners; the maintenance of several relationships at the same time; a history of attempts to sexually coerce others into sexual activity or taking great pride at discussing sexual exploits or conquests.

12. EARLY BEHAVIOR PROBLEMS — a variety of behaviours prior to age 13, including lying, theft, cheating, vandalism, bullying, sexual activity, fire-setting, glue-sniffing, alcohol use, and running away from home.

13. LACK OF REALISTIC, LONG-TERM GOALS — an inability or persistent failure to develop and execute long-term plans and goals; a nomadic existence, aimless, lacking direction in life.

14. IMPULSIVITY — the occurrence of behaviors that are unpremeditated and lack reflection or planning; inability to resist temptation, frustrations, and urges; a lack of deliberation without considering the consequences; foolhardy, rash, unpredictable, erratic, and reckless.

15. IRRESPONSIBILITY — repeated failure to fulfil or honour obligations and commitments; such as not paying bills, defaulting on loans, performing sloppy work, being absent or late to work, and failing to honour contractual agreements.

16. FAILURE TO ACCEPT RESPONSIBILITY FOR OWN ACTIONS — a failure to accept responsibility for one’s actions reflected in low conscientiousness, an absence of dutifulness, antagonistic manipulation, denial of responsibility, and an effort to manipulate others through this denial.

17. MANY SHORT-TERM MARITAL RELATIONSHIPS — a lack of commitment to a long-term relationship reflected in inconsistent, undependable, and unreliable commitments in life, including marital.

18. JUVENILE DELINQUENCY — behaviour problems between the ages of 13-18; mostly behaviors that are crimes or clearly involve aspects of antagonism, exploitation, aggression, manipulation, or a callous, ruthless tough-mindedness.

19. REVOCATION OF CONDITION RELEASE — a revocation of probation or other conditional release due to technical violations, such as carelessness, low deliberation, or failing to appear.

20. CRIMINAL VERSATILITY — a diversity of types of criminal offenses, regardless if the person has been arrested or convicted for them; taking great pride at getting away with crimes.

Muesli, the rise of chemophobia and the fetishisation of the natural

Natural – now there is a loaded word if ever there was one. My favourite use must surely be Natural American Spirit: “Taste nature. And nothing else.” Sounds enticing? Well, Natural American Spirit is actually a cigarette brand manufactured in theUnited States by the Santa Fe Natural Tobacco Company, a subsidiary of Reynolds American. The ad continued:

“You’ll never find any additives in our tobacco. What you see is what you get. Simply 100% whole-leaf natural tobacco. True authentic tobacco taste. It’s only natural.”        

I have deliberately chosen an absurd example, but what I want to point out is that the meaning of natural is very problematic. There are two points I wish to raise. Firstly the line between natural and artificial is very blurred. Agriculture is a human invention;Orangesare unknown in the wild. In medicine there is a false dichotomy between natural and artificial remedies. Modern medicine does not reject nature; many modern drugs are plant components. But modern medicine doesn’t restrict itself to plant derived substances. And anyone with a knowledge of chemistry will know the line between natural and unnatural chemicals is a fuzzy one. What about a molecule that is manufactured or synthesized but is identical to a molecule that occurs in nature? Is the synthetic molecule natural because there are absolutely no detectable differences between purified natural products and their synthesised counterparts?  Is its origin important? The bottom line is that there is no real clear demarcation line between something that is entirely natural and something that is completely artificial.

Over the last half century, synthetic chemicals increasingly have made our existence easier, safer and better. They help keep our homes clean, kill pests, and make agriculture more productive, enabling us to feed more people using less land. But these chemicals have not been universally welcomed. They have been accompanied by the rise of chemophobia, an irrational fear of chemicals. These prejudices are very real. The language around chemicals is unambiguously bad. Greenpeace talks about “chemicals out of control.” Hazardous, toxic and dangerous are usually the adjectives of choice. The mass media has had a particularly nefarious role in the vilification of chemicals. The media are frequently more interested in sensationalist headlines than reporting the underlying science, while environmentalists frequently resort to scare tactics. There is an absurd quest to lead a chemical-free life. Foods or products are advertised as “chemical free.” However, everything is made of chemicals and nothing can be ‘chemical free’. There are no alternatives to chemicals, just choices about which chemicals to use and how they are manufactured. I love this quote by research chemist Derek Lohmann at the website of sense about science:

“If someone came into your house and offered you a cocktail of butanol, iso amyl alcohol, hexanol, phenyl ethanol, tannin, benzyl alcohol, caffeine, geraniol, quercetin, 3-galloyl epicatchin, 3-galloyl epigallocatchin and inorganic salts, would you take it? It sounds pretty ghastly. If instead you were offered a cup of tea, you would probably take it. Tea is a complex mixture containing the above chemicals in concentrations that vary depending on where it is grown.”

 But for the sake let’s assume that we can agree that some things are natural and some are not. What does that tell us? Nothing. This is well-known intellectual fallacy known as the appeal to nature. It goes like this:

N is natural. Therefore, N is right or good. U is unnatural. Therefore, U is wrong or bad. As Julian Baggini has pointed out there is no factual reason to suppose that what is natural is good (or at least better) and what is unnatural is bad (or at least worse). Alas, being natural is no guarantee that a substance is safe. There are many poisons in nature, including hemlock, cyanide, arsenic, and animal and insect venoms. The carcinogens in cigarettes that cause cancer are natural components of tobacco. Henna tattoos can cause allergic reactions. Untreated water can kill, and rotting fruit contains some toxins that can make people very ill. In the late 1990s Bruce Ames, head of the Department of Molecular and Cell Biology at theUniversityofCalifornia,Berkeleyproved that cabbage has forty-nine natural pesticides in it, more than half of which are carcinogens. Nature has not been designed for our benefit. What’s more poisons are a typical evolutionary strategy used by flora and fauna.

Food is an area where these questions of natural and artificial are often debated. I tend to be a bit sceptical about organic. A 2010 review, in the American Journal of Clinical Nutrition, which did a meta-study of the last 50 years of research, showed that there were no significant differences in nutritional value and no health benefits from eating organic food. And organic food has a significant downside that was pointed out byAmes:

“The effort to eliminate synthetic pesticides … will make fruits and vegetables more expensive, decrease consumption, and thus increase cancer rates.”

Then we come to the raw food movement. I prefer the tem crudivore, but you have to be careful how you pronounce this word as you may unwittingly imply that they eat crud. Raw foods as a dietary health treatment was first developed in Switzerlandby medical doctor Maximilian Bircher-Benner. During a bout of illness he couldn’t eat any cooked food, so he began eating apples and nothing else every day. After he got over the jaundice he conducted experiments into the effects on human health of raw vegetables. In November 1897, he opened a sanatorium in Zurichcalled Vital Force. Bircher-Benner also invented muesli which was a way of encouraging people to eat raw food, as the main ingredient was raw apple, rather than the cereal or yoghurt of today. Naturally this movement has attracted its fair share of Hollywoodtypes such as Demi Moore, Woody Harrelson Ben Vereen (he played Chicken George in Roots. some of the claims of this movement are hilarious. It is especially popular in the UK, Germanyand of course California. Restaurants catering to a raw food diet have opened in large cities, and numerous all-raw cookbooks have been published. The proponents of raw food argue that uncooked food is “living” and that pasteurization “kills” food. There is little scientific evidence to back up their claims; there are only minimal differences in the nutritional value of food that is raw versus lightly or even moderately cooked. Even if they were right about the evidence, I would still disagree with crudivores. For me cooking is one our greatest human inventions.

For Prince Charles the price of prosperity has been “a progressive loss of harmony with the flow and rhythm of the natural world”. I have tried to show that this mythical world never existed. As this New Yorker cartoon showed, we may have had cleaner air purer water, exercised more and eaten lots of free-range stuff but most people didn’t live past 30. The invention of synthetic chemicals has been on the whole positive for humanity. They are monuments to mankind’s progress. I am not saying that chemicals cannot be dangerous.Bhopal and asbestos are two relevant examples.  But we need to take a more mature attitude – we need to forget about this mythical world without chemicals.

Labelling a chemical toxic or a contaminant is meaningless. It always depends on the size of the dose. Moreover, chemicals do not have the same effects on everybody; people can react differently to the same dose. We are now able to detect chemicals in parts per billion. But this does not mean that these miniscule doses are dangerous. This is why the safe exposure levels that are published for chemicals tend to be well below the levels likely to cause harm.

Since the 1960s we have been hearing stories of how the use of synthetic chemicals, was going to cause a massive cancer epidemic. I don’t see evidence of this being caused by synthetic chemicals. Outside the workplace, very few cases of cancer are believed to be caused by exposure to chemicals in the environment. The more relevant fact is lifestyle and the fact that we are living much longer. Establishing correlation is extremely tricky. Just because a chemical was present when an effect occurred does not demonstrate causation. Cancer clusters may just prove to be random variations.

We cannot avoid trade-offs. Even where chemicals are potentially harmful, we have to balance the potential risks of any chemical against the benefits they bring. For example, when insects attack African farms, threatening rural survival, it may be better if farmers spray pesticide even if this means they might inhale some of it themselves. In the nineteenth century there was anxiety about using powdered chlorine bleach to disinfect water it reduced the bacteria count spectacularly and helped to eradicate typhoid.

The blanket demonization of the chemical industry is illogical and dangerous. We are going to need chemists who can find new ways of making fertilisers or plastics. We face new problems and we will need a new greener chemical industry to help us meet the challenges of the twenty-first century.

The secret history of acupuncture

The fact that acupuncture has been used successfully in China for 2000 years with very few side effects is something that most surgeons, doctors and pharmacologists could only wish for. John Wood, medical acupuncturist from London.

Theory and practice are based on primitive and fanciful concepts of health and disease that bear no relationship to present scientific knowledge. The National Council Against Health Fraud 1990 description of acupuncture.

Psychologists can list plenty of other things that could explain the apparent response to acupuncture. Diverting attention from original symptoms to the sensation of needling, expectation, suggestion, mutual consensus and compliance demand, causality error, classic conditioning, reciprocal conditioning, operant conditioning, operator conditioning, reinforcement, group consensus, economic and emotional investment, social and political disaffection, social rewards for believing, variable course of disease, regression to the mean – there are many ways human psychology can fool us into thinking ineffective treatments are effective. Then there’s the fact that all placebos are not equal – an elaborate system involving lying down, relaxing, and spending time with a caring authority can be expected to produce a much greater placebo effect than simply taking a sugar pill. Harriet Hall, Puncturing the Acupuncture Myth

_________

 

Acupuncture is perhaps the most misunderstood of all the so-called complementary/alternative medicine (CAM) treatments – almost everything you’ve ever heard about acupuncture is wrong. It is a history which is rather convoluted. But, before we go into it we need to get a working definition. Webster’s dictionary defines acupuncture thus:

A procedure used in or adapted from Chinese medical practice in which specific body areas are pierced with fine needles for therapeutic purposes or to relieve pain or produce regional anaesthesia. For its supporters acupuncture represents ancient Chinese wisdom. It has evolved over thousands of years of experimentation; if it didn’t work, it wouldn’t exist today.  It is certainly true that acupuncture goes back a very long way.  However, acupuncture should not be seen as exclusively Chinese. it needs to be put into a wider historical and geographical context.

Ötzi the Iceman, Europe’s oldest natural human mummy, lived about 5,300 years ago. He was found in September 1991 in the Ötztal Alps on the border between Austria and Italy. His mummified body is exceptionally well-preserved: Ötzi had tattoos running along his back, right knee and left ankle. They were not decorative and he even had some in areas that had been covered in hair. The mummy and other mummies found with similar non-decorative tattoos has led a number of researchers to conclude that this shows a treatment akin to acupuncture. Ötzi apparently suffered from arthrosis of the lumbar spine. What is interesting about the marks on his body is that they coincide with points usually used by acupuncturists to treat this condition! This may be a coincidence but I think acupuncture has to be seen as belonging to a pre-scientific paradigm of medicine.

In the quote by John Wood that I used in the introduction there is a fallacy known as the argument from antiquity, or appeal to tradition. Because we have been doing something for thousands of years does not make it right. Galen’s theory of the four humours was popular for two millennia. Doctors thought that bloodletting was an effective treatment based on anecdotal evidence. I have nothing against Galen. He was doing the best he could in those days. What I find depressing is that people now want to take us back to those pre-scientific times.

Traditional Chinese medicine is based o Daoism, which believes that all parts of the universe are interconnected. As Chinese medicine forbade dissection, their understanding of human physiology was based on the external world and not on what was going on inside the body. Their 365 divisions of the body were based on the number of days in a year, and the 12 meridians are believed to be based on the 12 major rivers that run through China. The similarity with what was happening in Europe is clear; traditional acupuncture points were very similar to the bloodletting or lancing locations that were being used in Europe. This foundation is problematic for me. We are dealing with philosophies of illness, not scientific theories of disease. They were developed in an era dominated by superstition. I found it hard to take Sharon Stone seriously when she claimed that the 2008 Chinese earthquakes were caused by bad karma. I have a similar opinion of the notion that disease is caused by failure to live in harmony with the Dao. Scientific medicine, which is based on the germ theory of disease and the study of human anatomy and human physiology, is more convincing than TCM explanations. The qi force has never been discovered in physics or human physiology. Maybe supporters will try to claim that qi is metaphorical but I don’t want to be cured with metaphors.

Chinese paediatrician Cheng Dan’an reformed acupuncture in the 1930s, seeking to distance it from bloodletting. Traditional acupuncture points were moved from over veins to over nerves. This modern version of acupuncture is what is taught in the West. Chairman Mao helped give a big boost to acupuncture. It was Mao’s government that coined the term traditional Chinese medicine – TCM. His barefoot doctor campaign of the 1960s was a backlash against Western-style elite medicine. Acupuncturists were a cheap way to provide healthcare to the masses. Acupuncture, which had been banned, was now regarded as equal to Western medicine. Of course Mao himself wasn’t treated with TCM.

It was in the 1970s that TCM began to emigrate west. It meshed perfectly with the hippy/counterculture zeitgeist. Acupuncture, which was part of this trend, was a therapy that could heal everything. President Nixon’s visit to China in 1972 provided an excellent opportunity to promote it. The American delegation saw a patient undergoing major surgery while fully awake, receiving acupuncture instead of anaesthesia. Alas all was not what it seemed to be. The “lucky” patients were chosen for their high pain tolerance and had received intense political indoctrination. And just to make sure, they supplemented the acupuncture with sedatives, narcotics, and local anaesthetics. Historian Paul Unschuld has a damning verdict on acupuncture anaesthesia:

Attempts to use needles instead of drugs to achieve anaesthesia even in major surgical operations have in the meantime slipped into deserved oblivion, just as much as collective management and public self-criticism. It was not until after the ‘Great Proletarian Cultural Revolution’ in 1976 and the opening of China in 1978 that Chinese doctors were able to report, without personal risk, about the pain that patients had been expected to endure through therapy applied in operating theatres not on the basis of scientific knowledge, but in accordance with the ideological precepts of the Communist Party.

What about the clinical research for acupuncture? Although it is notoriously difficult to conduct scientific trials, acupuncture has been one of the most studied fields of alternative medicine. The principal difficulty lies in carrying out double blind trials where neither the practitioner nor the patient know the treatment is real or fake. There are a number of ways of testing: Sham acupuncture involves putting the needles in the wrong places, whereas placebo acupuncture uses a placebo needle. This is a real acupuncture needle with its tip removed. It is designed in such a way that the patient cannot tell if needle has penetrated the skin.

What do the results show? A review of trials of acupuncture for back pain showed that the studies which were properly blinded showed a tiny benefit for acupuncture, which was not statistically significant. The trials which were not blinded showed a massive, statistically significant benefit for acupuncture. How can we explain these results?

I am not convinced that what we see is anything other than the placebo effect. Admittedly, it is a superior version of the effect. While receiving acupuncture, you will be lying down on a table for 30 to 60 minutes. There will be pleasant music playing in the background. As the acupuncturist touches the acupuncture points you will get a pleasant massage. Besides this there is the positive effect of the therapeutic   interaction. It would be surprising if it didn’t produce a greater effect than simply taking a sugar pill. Acupuncture does release endorphins. And a 2010 study found that acupuncture needle caused the local release of a chemical known as adenosine, which helped to reduce local pain and inflammation.  

However none of this justifies the hype surrounding acupuncture. Considering the inconsistent research results and the improbability of qi and meridians, my verdict has to be negative. Scientific knowledge is like a torch illuminating our dark world. Why ignore this knowledge and replace it with the fairy tales of people who did not have the slightest conception of how the human body worked?

*If you are interested in this area, check out Steven Novella’s NeuroLogicaBlog. The other site I would recommend is Science-Based Medicine. In particular retired doctor Harriet Hall has written some excellent articles debunking Acupuncture.

Medical myths

Medicine is one field which is particularly prone to myths. Even doctors can fall victim to these false ideas.  Here are a few typical ones:

Vitamin C prevents you from catching a cold.

There is a link between additives and food, and hyperactivity or behavioural changes.

You can sweat toxins out of your body.

You lose most of your body heat through your head.

Hair and fingernails continue to grow after death.

Carrots can improve your eyesight.

If you shave, your hair will grow back faster.

There are effective cures for hangovers.

Mobile phones create considerable electromagnetic interference in hospitals.

You shouldn’t go swimming immediately after you’ve eaten.

Back pain should be treated with bed rest.

Chocolate causes acne.

Cold weather causes colds.

Jellyfish stings can be eased by urine.

This is all very well in practice, but will it work in theory?*

There are some ideas so wrong that only a very intelligent person could believe in them. George Orwell

To the man-in-the-street, who,

I’m sorry to say,

Is a keen observer of life,

The word ‘Intellectual’ suggests straight away

A man who’s untrue to his wife.  WH Auden

Now, we must be careful to make a distinction between the intellectual and the person of intellectual achievement. The two are very very different animals. There are people of intellectual achievement, who increase the sum of human knowledge, the powers of human insight, and analysis. And then there are the intellectuals. An intellectual is a person knowledgeable in one field who speaks out only in others. Starting in the early 20th century, for the first time an ordinary story teller, a novelist, a short story writer, a poet, a playwright, in certain cases a composer, an artist, or even an opera singer could achieve a tremendous eminence by becoming morally indignant about some public issue. It required no intellectual effort whatsoever. Suddenly he was elevated to a plane from which he could look down upon ordinary people. Conversely—this fascinates me—conversely, if you are merely a brilliant scholar, merely someone who has added immeasurably to the sum of human knowledge and the powers of human insight, that does not qualify you for the eminence of being an intellectual. Tom Wolfe Commencement Address to the Boston University Class of 2000.

 

____________________

I suppose I am a product of a certain type of British worldview, which tends to be suspicious of intellectuals. You have to understand that in Britain to call someone an intellectual is definitely not a compliment. There is a kind of British exceptionalism - We like to think that we don’t do intellectuals. It’s basically “no intellectuals please, we’re British”.  In his 1963 book A State of England Anthony Hartley claimed that “no people has ever distrusted and despised the intellect and intellectuals more than the British.” To understand the mentality we need to compare ourselves to the French. We have cultivated this mythical vision of ourselves as a practical, no-nonsense nation that doesn’t hold with all this Frenchified philosophising. “British intellectual” still seems to be an oxymoron. Part of this opposition is undoubtedly resistance to the label – the very word is irritating. It speaks to us of arrogance, pretentiousness and sophistry. We do not accept the idea of this special caste whose superior knowledge enables them to dispense their wisdom to the masses. This British ambivalence/hostility towards intellectuals goes back at least as far as the French Revolution. Conservative British thinkers like Edmund Burke believed that it was abstract ideas from idealistic philosophers that had sparked the descent into chaos and extreme violence.

Before we go any further we need a working definition of intellectual. The British academic Stefan Collini distinguished between three types of intellectual. The first category, the sociological, is based on occupation and includes writers, journalists, academics and teachers. The second category, the subjective, is more personal and refers to someone interested in ideas, who reads a lot, and generally pursues the life of the mind. The third and final category refers to the cultural intellectual. This type of intellectual is one whose creative, analytical or scholarly achievement gives them ‘cultural authority’. This is the type of intellectual I want to analyse today. In this analysis I have been influenced by Paul Johnson and Thomas Sowell who have both written scathing indictments of intellectuals. There is a course an irony here – they lambast intellectuals and yet they are intellectuals. In his 1988 work Intellectuals Johnson criticised Rousseau for being a sleazebag. This may well be true but for me it is irrelevant. What I am interested in is whether his ideas are accurate. Do they actually work? Sowell’s book, Intellectuals and Society, was published in 2010 I find Sowell too partisan but he does make some telling hits. Here are three of his criticisms:

The first criticism relates to what we mean by knowledge. There are many kinds of knowledge diffused throughout society. Much of this knowledge may not be high-powered stuff, but that does not make it inconsequential. This has been a constant theme in my blog. This was the big problem of the Soviet Union. They thought that the intelligentsia could run the economy from on high, but those experts didn’t know as much as the citizens on the ground whose knowledge they were overriding.

The second criticism is that while intellectuals have special knowledge in their narrow area of expertise, this does not mean that they have any special understanding beyond this. In science we can see the dangers of abandoning what you know. Real scientists tend to have their expertise in a single area of science. There are brilliant Nobel Laureates who have made fundamental contributions to our understanding of science. A case in point is that of Linus Pauling, one of the first scientists to work in the fields of quantum chemistry and molecular biology. Later in his career he created a pseudoscience, Orthomolecular Biology. Pauling proposed that megadoses of vitamin C could effectively treat several illnesses, most notably cancer and the common cold. Advocates of this pseudoscience claimed that their findings were being suppressed by a conspiracy of mainstream medicine and the pharmaceutical industry. The tragedy is that bad ideas can have terrible consequences; Matthias Rath, a former associate of Linus Pauling, accused Big Pharma of poisoning patients with their HIV medication. In 2005 his foundation distributed pamphlets in poor black South African townships urging HIV-positive people to use vitamins, such as the ones he was selling, to treat HIV/AIDS. Scientists are not the only ones who can overextend themselves. I remember a Craig Brown anecdote about Gore Vidal. The American author was being interviewed and was speaking with apparent expertise and great authority about the British secret services. However, Brown rapidly became disillusioned when Vidal began talking about “M-Fifteen” and ‘“M-Sixteen.” Maybe he was an expert on British motorways!

The final criticism refers to the accountability of intellectuals. It was HL Mencken who argued that science was fundamentally anti-intellectual because it distrusted pure reason, and demanded the production of objective fact. If you design a bridge and it collapses, you have failed. In the marketplace if you make a mistake, you will pay a heavy price. That is of course, if you are not too big to fail. However, many of those who are called intellectuals live in a world with no such accountability. The world of ideas is by its nature different. Intellectuals are usually judged by whether those ideas sound good to other intellectuals or how they resonate with the media and the public.

Ideas are important and those who create and disseminate them have an impact on society that goes way beyond their actual numbers. Who could have imagined the impact a German émigré beavering away at the British library would have? But Karl Marx’s ideas went on to change the world. The Ronald Reagan revolution was preceded by the work of many conservative intellectuals. This John Maynard Keynes quote seems relevant here: “The ideas of economists and political philosophers, both when they are right and when they are wrong, are more powerful than is commonly understood. Indeed the world is ruled by little else. Practical men, who believe themselves to be quite exempt from any intellectual influence, are usually the slaves of some defunct economist.”

Have intellectuals made the world a better place? A glance at the historical record should make anyone sceptical about their role.  Some of the most distinguished intellectuals in the Western world in the 1930s enthusiastically lauded the Soviet Union, while man-made famines wreaked havoc on the countryside and millions languished in the gulags. In the early years of the Cold War, historian Professor A.J.P. Taylor argued that Britain should ally herself with the Soviet Union against the United States. Chairman Mao also had a fan club among the intelligentsia. I recently heard Tony Benn say that Mao’s legacy was important in China’s current prosperity. Harold Pinter was a founder of a private discussion group, the June 20th Society, whose members included his wife,  Antonia Fraser, Ian McEwan, Michael Holroyd, John Mortimer, Salman Rushdie and Germaine Greer, writers who generally opposed Thatcherism. With great self-importance and no sense of perspective Pinter declared: ‘We have a precise agenda and we are going to meet again and again until they break the windows and drag us out’. What annoys me is that these people are accorded great respect, as if they possessed magical powers to interpret society.

We may say we are anti-intellectual but British exceptionalism has been exaggerated.  Britain has a rich intellectual tradition on both the left and the right.  A country that has produced Adam Smith, David Hume, Edmund Burke John Stuart Mill, Bertrand Russell, John Maynard Keynes, George Orwell and Roger Scruton has nothing to feel ashamed about. Nowadays the BBC has programmes like In Our Time, Start the Week and Night Waves. If you prefer the printed word, you have Prospect Magazine, The London Review of Books and The Times Literary Supplement. And online you can listen to podcasts from the LSE or the RSA. I am not anti-intellectual. The notion that you can teach intelligent design in a science class horrifies me. I find Sarah Palin frightening. I am in favour of the debate of ideas. However, historical evidence suggests we should treat intellectuals’ pronouncements with a megadose of scepticism.

*Apocryphal remark made by a French diplomat to his British counterpart.