Rowman & Littlefield Publishing Group

The Mind and its Minders

By Michael J. Reznicek M.D.

The history of psychology is littered with fads and fallacies: the four humors of Hippocrates, phrenology, Freudianism and behaviorism to name a few. More recently we’ve seen the “biochemical imbalance” theory of emotional problems, which has led to a robust pharmaceutical industry to “treat” imbalances.

These seemingly disparate movements share a similar perspective on mental life, namely, that the mind is controlled by mechanistic forces. Whether the forces are hormones, genes, unconscious dynamics, reflexes or neurotransmitters, human consciousness has always been viewed as a byproduct. According to the theory, you may think you’ve been making independent decisions in life, but in reality you’ve been a marionette, performing a scripted dance.

In college I remember thinking that many psychological theories bore an uncanny resemblance to Marxism: reductionistic explanations of human behavior followed by grand prescriptions that seemed to benefit the theorists more than they helped the stated beneficiaries. Centrally-planned economies fail because they misjudge human nature. Creativity and productivity flourish only when there is political and economic freedom. When people feel they can control their destiny, they begin to create it.

Modern psychology is on the cusp of a scientific revolution, and it’s long overdue. Neuroscience has recently shown that the brain is highly plastic and constantly changes to meet the demands that individuals place on themselves. Challenge yourself mentally or physically and your brain will adapt to improve your efficiency and accuracy.

The field of genetics is also undergoing a revolution. Both thoughts and behaviors can open access to genes, which then send instructions throughout the body to reinforce whatever it is we are doing. This heretofore unknown function—what we call “epigenetics”—appears to mediate the plasticity we find in the brain. It’s now more accurate to say that the mind controls biology, rather than vice versa.

In my book, Blowing Smoke: Rethinking the War on Drugs without Prohibition and Rehab, I address one area of old-school psychology—the disease model of addictions—and argue that it neither fits nor helps the problem of drug abuse. Neuroscience and the Berlin Wall teach us something important about the human condition: people thrive when they are not held back. After working with many substance abusers, I’m convinced most of them would move toward moderation if we quit telling them they are diseased, and instead give them their freedom.

Michael J. Reznicek , M.D., is a clinical psychiatrist in Washington state with over 20 years of experience. He has practiced in the military, in hospital-based community settings, in prisons and in state hospitals. He has been a guest on numerous talk-radio shows at the local, national, and international levels to discuss drug abuse.

Addicted to Addictions

By David J. Ley

A few weeks ago, a woman came up to me after a presentation I had given, on why I believed sex addiction was a dangerous myth. She was in tears, as she told me about her son whom she had lost about a decade ago to the ravages of alcoholism. She told me that near the end of his life, her son was in a very expensive private-pay treatment facility, and called her up to ask if he had ever been sexually abused.

As this mother told me this story, and disclosed this part, a look of anguish creased her face. “I told him that I didn’t think he ever was, and he told me that at the facility, therapists had told him that not only was he an alcoholic, but that he was a sex addict as well. And that his sex addiction must have come from being sexually abused.”

The lady’s son sadly died a few weeks after that, from complications related to his severe substance abuse. For a decade, this poor woman has lived with tremendous fear and guilt, guilt that her son might have been sexually abused, something she didn’t prevent, or even know about. She was anguished that the unknown abuse, and her apparent unknowing neglect, might  have contributed to her son’s tragic life and loss.

I was the first person this woman ever heard, who said that sex addiction was a myth, a moralizing and unsubstantiated label that people throw around callously and casually. I gave her some peace, she told me, because for the first time in a decade, she could see that her son probably hadn’t been abused, and wasn’t addicted to sex. These therapists were merely riding the train of sex addiction, throwing that diagnosis at anything they could lasso with it, regardless of the consequences. If they could convince her son that he wasn’t just an alcoholic, but a sex addict too, what did they get out of it? Who knows? Maybe money. Or maybe they just saw every problem in the young man’s life as a form of addiction, and threw that label around to impress themselves.

A few decades or so ago, therapists believed they could recover memories of abuse, uncover buried memories of sexual, physical and even satanic abuse, in their patients. Because they saw symptoms they thought were related to a history of abuse, it didn’t matter that the patient said “Hey, I wasn’t ever abused.” But it turned out the patients were right and the therapists wrong. Lives were ruined, people went to jail and families were devastated because of the therapist’s well-intended arrogance.

They thought they were helping. But hundreds of lawsuits and settlements have now shown that those therapists hurt people. The myth of sex addiction hurts people too. This is why I’m challenging it every chance I can get. To demand that these therapists be responsible with the power they wield over people’s lives and fears.

David J. Ley is a clinical psychologist in practice in Albuquerque, New Mexico. He provides clinical and consultative services in numerous other states. Dr. Ley currently serves as Executive Director of a large outpatient behavioral health agency in Albuquerque and maintains a current caseload of clients. He is the author of The Myth of Sex Addiction and   Insatiable Wives: Women Who Stray and the Men Who Love Them.

Religious Freedom and the Obama Contraceptive Mandate

By Stephen V. Monsma

An on-going controversy concerns the Obama administration’s attempt to mandate that under the new Affordable Care Act employers’ health insurance plans must include contraceptive coverage.  And contraceptive coverage is defined broadly enough to include sterilization procedures and what some consider abortifacients.  This has aroused the strong opposition of the Catholic Church—which has long opposed artificial birth control as a violation of its religious beliefs—and some evangelical Protestant groups, largely on the basis of the inclusion of what they consider abortifacients. 

Those who oppose the contraceptive mandate are claiming their religious freedom rights are being violated, since the mandate would require them to act in violation of their deeply-held religious beliefs.  Others claim that this a public health issue, not a religious freedom issue, since  assuring that contraceptives are readily available will protect women from unwanted pregnancies and reduce the number of abortions.  As a recent columnist in the New York Times wrote, “[T]he provision of preventive services without a co-pay does not interfere with a religious practice or ceremony.” 

This controversy—which has generated much heat and is likely to continue to do so throughout this election year—largely turns on one’s understanding of what constitutes a religious organization or a religious practice.   We all cringe at the thought of a government edict telling St. Patrick’s Cathedral in New York how it is to celebrate the mass or who may or may not officiate at the mass.  We all recognize this would be a violation of the religious freedom rights we all hold dear.  The organization in this example (St. Patrick’s Cathedral) is clearly accepted by all as a religious organization and the practice (the celebration of the mass) as a religious practice. 

 But this agreement breaks down and the controversy explodes when the organization is not a religious congregation in the traditional sense and the practice does not involve a religious ritual or ceremony.  What about a nonprofit spouse abuse program that was begun by an evangelical Protestant church, is still largely supported by church members, and explicitly states that it is providing services in obedience to Jesus Christ and in his name?  Is it a religious organization?  And are the volunteers and staff who counsel with and offer help to women who have been abused and preyed upon engaging in a religious act? Or what about a Catholic college that takes its religious commitment seriously and seeks to understand the world within the context of historic Catholic thought and reflection?  Is it a religious organization?  And is a professor who seeks to apply Catholic social teaching in her sociology course engaged in a religious act?

As I explain in my book, Pluralism and Freedom: Faith-Based Organizations in a Democratic Society, for historic reasons Americans, and especially the educated elite, tend to exclude as religious organizations and religious practices organizations and practices outside of religious congregations and their core religious rituals and ceremonies.  But such a narrow view of religion is untenable.  It is inaccurate to say that when the Rev. Martin Luther King, Jr., led African American demonstrators out of their churches and into the streets in defense of racial justice he changed from a religious leader to a secular leader.  An official statement the National Association of Evangelicals testifies to its belief that its faith not only encompasses acts of love and mercy but demands them: “Jesus said that those who do not care for the needy and the imprisoned will depart eternally from the living God.”  The nature of religion as extending beyond the confines of church and synagogue was clearly summarized by Robert Bellah and his associates in their classic, Habits of the Heart, when they wrote:  “Yet religion, and certainly biblical religion, is concerned with the whole of life—with social, economic, and political matters as well as with private and personal ones.” 

To me, this means that when a governmental edict clashes with faith-based organizations’ thought-out, long-held, religiously-based beliefs and practices, our public policies should do all they can to accommodate those beliefs and practices.  This is what protects the pluralism and diversity to which we as a society claim to aspire.

Coming back to the current controversy over the contraceptive mandate, this means no church should seek to force its view of contraceptives onto all of society; no government mandate should seek to force faith-based organizations to provide contraceptives in violation of their religious beliefs.  Religious liberty and religious freedom rights are indeed at stake here.  We as a people have long lived together with our deepest differences by each group respecting those with whom it does not agree and allowing them, to the fullest extent possible in keeping with public health and safety, to follow their beliefs.  My book mentioned earlier suggests that we need to renew this commitment and broaden it to include the host of educational, health, and social service faith-based organizations that continue to contribute much to our life together.

 

About the author:

Stephen V. Monsma is a senior research fellow at the Henry Institute at Calvin College and professor of political science emeritus at Pepperdine University. He is the author of numerous works for faith-based organizations and church and state relations, including Faith, Hope, and Jobs and Putting Faith in Partnerships.

DUST: the Inside Story of Its Role in the September 11th Aftermath

By Paul J. Lioy

Memorial Day 2011 has just passed, and during the Spring of 2011 another page in the fight against terrorism and the need to be prepared for the unknown. Tom Kean, who has commented widely about preparedness, is still correct because even with the death of Osama Bin Laden threats remain high against our country’s people and infrastructure, and his words should be a reminder that being prepared for terrorist events is an important part of our country’s responsibility to protect and defend. The 10th Anniversary of the deadly attacks on the WTC, United flight 93, and the Pentagon is also just around the corner. They will be solemn occasions that will provide an opportunity to educate those who were too young to remember or are part of the next generation. Since the publication of Dust: the Inside Story of Its role in Role in the September 11th Aftermath, I have talked to many individuals and groups, and recorded interviews, about the reasons for writing the book. In my discussions, it became clear that people wanted to know how the results of our analyses of the dust were used to understand exposure and health response relationships. In reviewing what has been written since publication of my book, the actual health effects experienced by the workers/volunteers remain highly correlated with the time of a person’s arrival at Ground Zero, and whether or not he or she was wearing a respirator during their completion of Ground Zero related activities over time. Based upon all my conversations with physicians and other environmental health professionals, my hypotheses remain consistent: the unknown or unquantifiable gases released during the jet fuel fires were part of the etiology of the diseases derived from the aerosol that contained the WTC Dust and inhaled by the workers/volunteers during the first days after the collapse of the towers. However, they cannot be realistically reconstructed in toxicological tests because they would have to include both the WTC Dust and combustion gases released by “uncontrolled” fires caused by the burning jet fuel.

The reader response to other important aspects of my story has come as sort of a surprise. Many were associated with the content of Chapter 12 which deals with the lessons learned and the lessons that still need to be learned from 9-11. These are linked specifically to the 5 Rs + 1: Rescue, Re-entry, Recovery, Restoration and Rehabitation. The Plus 1 is Resilience. Because of the natural events that have occurred since 9-11 (e.g. earthquake and Tsunami in Japan), and military actions overseas, I have had opportunities to describe the levels of completion or success using the 5 Rs for some of those incidents. As a member of the general public you can use my 5Rs to grade us all on the actions and the outcomes of those actions that can and do occur in natural and terrorist events.

Paul J. Lioy is a Professor and Vice Chair, Department of Environmental and Occupational Medicine at UMDNJ-Robert Wood Johnson Medical School. He is Deputy Director for Government Relations and Director of Exposure Science at the Environmental and Occupational Health Sciences Institute of Rutgers University and RWJMS-UMDNJ. Dr. Lioy is the author of Dust: The Inside Story of its Role in the September 11th Aftermath.

Relapse Prevention: It’s The “How” That Counts

By Deborah Serani

A recent study from the University of Toronto suggests how you process information determines if you’re at risk for a depressive relapse. More specifically, researchers learned via the use of fMRI technology that how the brain responded to a sad event was a predicting factor.

In this study, depressed participants were shown a series of sad clips of movies. Individuals who ruminated about the sadness they experienced fell into another depressive state as opposed to those who were able to feel and accept their emotional experience. It’s been long-known that patterns of negative thinking put a person’s mental health at risk. Like treading water, negative thinking gets you nowhere fast, leaves you fatigued and overwhelmed. Before you know it, you’re unable to problem-solve, and depression sets in. In this study, individuals who experienced the depth of their sadness and accepted the limits &/or hardships continued with their recovery intact. So, when it comes to keeping your depression from relapsing, it’s all about “how” you move through your experiences.

Taking the “how” to a scientific level, fMRI data showed that frontal brain activity resulted in ruminating behavior whereas brain activity in the rear part of the brain signaled acceptance. This is of great interest not only to researchers, but also to therapists who specialize in depression treatment. This study supports the aims of psychotherapy and medication, where interrupting a negative rumination style is the targeted goal of treatment. For those who live with depression, learning how to problem-solve, visualize and work toward acceptance of what one can change and what one cannot, can help inoculate against relapse.

“Part of what makes depression such a devastating disease is the high rate of relapse,” says Norman Farb, a PhD psychology student and lead researcher. “This study suggests that there are important differences in how formerly depressed people respond to emotional challenges that predict future well-being.”

Reference:

Farb, N.A.; Anderson, A.K.; Bloch, R.T. & Segal, Z.V. (2011). Mood-linked responses in medial prefrontal cortex predict relapse in patients with recurrent unipolar depression. Biological Psychiatry, DOI: 10.1016/j.biopsych.2011.03.009

Deborah Serani is a psychologist in private practice in New York and the author of Living with Depression: Why Biology and Biography Matter along the Path to Hope and Healing.

Shopping for an Organ Transplant?: The Pitfalls of Medical Tourism

By Katrina A. Bramstedt

In the US, thousands of patients are waiting for a kidney or liver transplant. Sometimes, they get so desperate, they contemplate traveling to a foreign country to buy an organ. In their desperation, patients often don’t think about the pitfalls and ethical problems of organ tourism, and there are many. Some organs are known to come from prisoners who did not give informed consent. Some organs are taken from women who are forced by their husbands to “donate” a kidney or liver tissue to pay a debt. Is this the setting for ethical medical care?

Other problems with organ tourism are issues such as the lack of medical records, or records which are written in a foreign language and unhelpful upon return to the US. Organs are sometimes also contaminated with viruses such as HIV and hepatitis. And what about these medical complications? Who pays for the treatment? What if there is malpractice? Can the patient obtain any recourse? The complexity of organ tourism is immense, clinically, ethically, and legally. So is there another option for patients who need a kidney or liver transplant?

Enter the Good Samaritan. These are people, right here in USA, who are ready and willing to give an organ to a stranger. They have no goal other than “to help”. Their organ gifts are “no strings attached” and often, they never even meet the person who receives their organ. For the Good Samaritan, all that matters is that they have something extra and they want to share it with someone who needs it. In the new book, The Organ Donor Experience: Good Samaritans and the Meaning of Altruism, 22 donors were extensively studied to learn their personalities and motivations for organ donation. In general, these givers are normal, everyday folk, of average means, with a genuine desire to serve their community. Often, they have a lengthy history of volunteerism and their parents did as well. They originate from all fields, law, law enforcement, health care, education, you-name-it. A Good Samaritan could be your neighbor down the street, the clerk at the grocery store, a local taxi driver, or even your bank teller. These people want to give, and with medical, surgical, and psychosocial screenings, they can be lifesavers.

References:

• Bramstedt K.A., Xu J. Checklist: passport, plane ticket, organ transplant. Am J Transplant. 2007 Jul;7(7):1698-701.
• Bramstedt K.A. Ethical minefields in medical tourism. Sonoma Medicine 2011.
• Bramstedt K.A. Steering clear of organ tourism. Kidney Review 2007.

Dr. Katrina A. Bramstedt is a noted medical ethicist associated with California Transplant Donor Network in Oakland, California. She also has a private practice in Marin County where she has performed over 800 ethics consultations and published over 75 articles in medical and bioethics journals. She lectures nationally and internationally and has made numerous appearances on television and radio discussing transplantation and donation. She is the co-author of The Organ Donor Experience: Good Samaritans and the Meaning of Altruism.

Vote “YES” on Proposition 1!: Medicinal Marijuana Use on the Ballot in Michigan

By Matt Stolick

Entering the 21st century, the neurological has become central to the treatment of disease. In 1988 neurological receptors activated by THC in marijuana were discovered. Receptor cites for THC are found clustered in the basal ganglia and cerebellum of the brain, likely accounts for its effectiveness in alleviating muscle spasms and symptoms of other body movement disorders as these parts of the brain are associated with these same disorders. Marijuana promises to help reduce if not eliminate seizures, spasticity and bladder control problems. The main experienced and observed effects of marijuana use are relaxation and increased appetite, quite valuable therapeutically for enduring cancer chemotherapy treatments, including regular nausea and vomiting, aversion to food. Almost half of oncologists in 1991 would have prescribed marijuana were they legally able. Today the second largest physicians group in the U.S., the American College of Physicians, has endorsed therapeutic uses of marijuana. This proposal would enable physicians to recommend marijuana where clinically beneficial and thereby providing informed consent to patents.

For many or most of sufferers who find marijuana therapeutically beneficial, no adequate treatments currently exists. Synthetic alternatives in the form of THC pills have failed to provide adequate symptom management for a variety of reasons, including difficulty swallowing, metabolizing, and titrating. From a moral perspective, justice demands a citizen have the right to effective medical treatment. To deny this right, there must be provided very good justification. Society has none to justify wielding justice so as to punish and criminalize citizens merely treating their illnesses in the privacy of their own homes. Medical marijuana users have a valid claim on society, to protect them from government interference with their medical treatment. Rather than protecting medical marijuana users from harming themselves, they are preventing them from healing themselves and creating additional problems in already stress-filled lives.

Laws forbidding effective medical treatment are violent and unjust. Rather than being a matter for retributive justice, medical marijuana has to do with distributive justice, namely of suffering citizens having respected their most basic human right of pain control (a right few if any would forfeit to even live in a society in the first place). By prohibiting medical marijuana use, repugnance develops, one for the aggression of a law that creates criminals out of otherwise law-abiding citizens, and for the law more generally. Voting “Yes” to Proposition 1 demonstrates compassion and a basic sense of justice, as well as the scientific realization that marijuana may actually work to alleviate the pain and suffering associated with a variety of medical conditions.

Matt Stolick, Ph.D. author of forthcoming book, Otherwise Law-Abiding Citizens: A Scientific and Moral Assessment of Cannabis Use (Lexington Books of Rowman and Littlefield, November 2008)