A Kickstarter collaboration with award winning film maker David Malone

Davids Trailer on Youtube

I wrote an article for Brainwaving just over a year ago, ‘Consciousness and the Direction of Structure’. What appeared to be a harsh diagnosis regarding the underlying cause of the obvious insanity that afflicts humanity. Though it accorded well with the Arcadian traditions, modern scientific data and our extremely self destructive behavior, as expected some people found it a little challenging. However the general reaction has been one of relief and in fact even excitement as the nature of the condition outlined implies a relatively easy fix that is well within our reach today.

The next objective is to bring the diagnosis into mainstream culture ASAP in such a way that the rational mind cannot escape the implications despite its phenomenal capacity for delusion and denial. Restoration of the molecular structure and configuration necessary to facilitate sanity as an urgent priority i.e. fixing our brain and its associated state of mind and sense of self. As the very institutions one might expect to address these issues are no less afflicted by the condition, more so in many ways, it will be necessary to throw out the rule book and do whatever is necessary to at least address the question of our neural integrity. Simply asking this question will be enough to initiate a chain reaction that will result in either a clean bill of health, personally I have my doubts, or a massive shift in our collective priority.

We already know our current collective state of mind correlates very well with our current neuro-chemical structure, neuro-chemical fuel and degree of cerebral dominance. We also know that changing those parameters, effectively moving towards their original specifications brings rapid and profound changes including a deep sense of connectedness and empathy, enhanced senses and cognitive ability including an improved capacity to perceive reality. So we can choose more madness, more fear, control and delusion if that is what we want? Such a response would be no more than the continued expression of symptoms typical of serious mental ill health and the inevitable consequences of neural degeneration? Or we could risk a massive improvement that would end the overwhelming symptoms we have created at a causal level.

With this in mind a major Kickstarter project has just gone live and will be launching via media interviews over the next few weeks. It will need a collective effort to network it sufficiently to succeed and is very much a practical first step to initiating a completely new and paradoxically very ancient way of addressing our increasing propensity for industrial scale self harm at its source.

Is it such a great leap from the perspective that ‘humans are mad’ in one way or another, a common view shared by many great philosophers and psychologists and implied in the spiritual and religious traditions to the idea of an underlying neuro-degenerative condition. Its not exactly an uncommon reaction today from a great many people from very diverse cultures and backgrounds.

I invite you to get involved and help unleash a simple idea so powerful that it will eat its way into the hierarchy of madness and change the way we see and eventually experience everything forever.

Links

Molecules of Madness
Beyond Belief

From Wired Magazine by Gary Greenburg

But he recovers quickly, and back in the living room he finishes explaining why he came out of a seemingly contented retirement to launch a bitter and protracted battle with the people, some of them friends, who are creating the next edition of the DSM. And to criticize them not just once, and not in professional mumbo jumbo that would keep the fight inside the professional family, but repeatedly and in plain English, in newspapers and magazines and blogs. And to accuse his colleagues not just of bad science but of bad faith, hubris, and blindness, of making diseases out of everyday suffering and, as a result, padding the bottom lines of drug companies. These aren’t new accusations to level at psychiatry, but Frances used to be their target, not their source. He’s hurling grenades into the bunker where he spent his entire career.

As a practicing psychotherapist myself, I can attest that this is a startling turn. But when Frances tries to explain it, he resists the kinds of reasons that mental health professionals usually give each other, the ones about character traits or personality quirks formed in childhood. He says he doesn’t want to give ammunition to his enemies, who have already shown their willingness to “shoot the messenger.” It’s not an unfounded concern. In its first official response to Frances, the APA diagnosed him with “pride of authorship” and pointed out that his royalty payments would end once the new edition was published—a fact that “should be considered when evaluating his critique and its timing.”

Frances, who claims he doesn’t care about the royalties (which amount, he says, to just 10 grand a year), also claims not to mind if the APA cites his faults. He just wishes they’d go after the right ones—the serious errors in the DSM-IV. “We made mistakes that had terrible consequences,” he says. Diagnoses of autism, attention-deficit hyperactivity disorder, and bipolar disorder skyrocketed, and Frances thinks his manual inadvertently facilitated these epidemics—and, in the bargain, fostered an increasing tendency to chalk up life’s difficulties to mental illness and then treat them with psychiatric drugs.

The insurgency against the DSM-5 (the APA has decided to shed the Roman numerals) has now spread far beyond just Allen Frances. Psychiatrists at the top of their specialties, clinicians at prominent hospitals, and even some contributors to the new edition have expressed deep reservations about it. Dissidents complain that the revision process is in disarray and that the preliminary results, made public for the first time in February 2010, are filled with potential clinical and public relations nightmares. Although most of the dissenters are squeamish about making their concerns public—especially because of a surprisingly restrictive nondisclosure agreement that all insiders were required to sign—they are becoming increasingly restive, and some are beginning to agree with Frances that public pressure may be the only way to derail a train that he fears will “take psychiatry off a cliff.”

At stake in the fight between Frances and the APA is more than professional turf, more than careers and reputations, more than the $6.5 million in sales that the DSM averages each year. The book is the basis of psychiatrists’ authority to pronounce upon our mental health, to command health care dollars from insurance companies for treatment and from government agencies for research. It is as important to psychiatrists as the Constitution is to the US government or the Bible is to Christians. Outside the profession, too, the DSM rules, serving as the authoritative text for psychologists, social workers, and other mental health workers; it is invoked by lawyers in arguing over the culpability of criminal defendants and by parents seeking school services for their children. If, as Frances warns, the new volume is an “absolute disaster,” it could cause a seismic shift in the way mental health care is practiced in this country. It could cause the APA to lose its franchise on our psychic suffering, the naming rights to our pain.

Allen Frances is worried that the DSM-5 will “take psychiatry off a cliff.”
Photo: Susanna Howe; photographed at Café Sabarsky, Neue Galerie, NYC

This is hardly the first time that defining mental illness has led to rancor within the profession. It happened in 1993, when feminists denounced Frances for considering the inclusion of “late luteal phase dysphoric disorder” (formerly known as premenstrual syndrome) as a possible diagnosis for DSM-IV. It happened in 1980, when psychoanalysts objected to the removal of the word neurosis—their bread and butter—from the DSM-III. It happened in 1973, when gay psychiatrists, after years of loud protest, finally forced a reluctant APA to acknowledge that homosexuality was not and never had been an illness. Indeed, it’s been happening since at least 1922, when two prominent psychiatrists warned that a planned change to the nomenclature would be tantamount to declaring that “the whole world is, or has been, insane.”

Some of this disputatiousness is the hazard of any professional specialty. But when psychiatrists say, as they have during each of these fights, that the success or failure of their efforts could sink the whole profession, they aren’t just scoring rhetorical points. The authority of any doctor depends on their ability to name a patient’s suffering. For patients to accept a diagnosis, they must believe that doctors know—in the same way that physicists know about gravity or biologists about mitosis—that their disease exists and that they have it. But this kind of certainty has eluded psychiatry, and every fight over nomenclature threatens to undermine the legitimacy of the profession by revealing its dirty secret: that for all their confident pronouncements, psychiatrists can’t rigorously differentiate illness from everyday suffering. This is why, as one psychiatrist wrote after the APA voted homosexuality out of the DSM, “there is a terrible sense of shame among psychiatrists, always wanting to show that our diagnoses are as good as the scientific ones used in real medicine.”

Since 1980, when the DSM-III was published, psychiatrists have tried to solve this problem by using what is called descriptive diagnosis: a checklist approach, whereby illnesses are defined wholly by the symptoms patients present. The main virtue of descriptive psychiatry is that it doesn’t rely on unprovable notions about the nature and causes of mental illness, as the Freudian theories behind all those “neuroses” had done. Two doctors who observe a patient carefully and consult the DSM’s criteria lists usually won’t disagree on the diagnosis—something that was embarrassingly common before 1980. But descriptive psychiatry also has a major problem: Its diagnoses are nothing more than groupings of symptoms. If, during a two-week period, you have five of the nine symptoms of depression listed in the DSM, then you have “major depression,” no matter your circumstances or your own perception of your troubles. “No one should be proud that we have a descriptive system,” Frances tells me. “The fact that we do only reveals our limitations.” Instead of curing the profession’s own malady, descriptive psychiatry has just covered it up.

The DSM-5 battle comes at a time when psychiatry’s authority seems more tenuous than ever. In terms of both research dollars and public attention, molecular biology—neuroscience and genetics—has come to dominate inquiries into what makes us tick. And indeed, a few tantalizing results from these disciplines have cast serious doubt on long-held psychiatric ideas. Take schizophrenia and bipolar disorder: For more than a century, those two illnesses have occupied separate branches of the psychiatric taxonomy. But research suggests that the same genetic factors predispose people to both illnesses, a discovery that casts doubt on whether this fundamental division exists in nature or only in the minds of psychiatrists. Other results suggest new diagnostic criteria for diseases: Depressed patients, for example, tend to have cell loss in the hippocampal regions, areas normally rich in serotonin. Certain mental illnesses are alleviated by brain therapies, such as transcranial magnetic stimulation, even as the reasons why are not entirely understood.

Some mental health researchers are convinced that the DSM might soon be completely revolutionized or even rendered obsolete. In recent years, the National Institute of Mental Health has launched an effort to transform psychiatry into what its director, Thomas Insel, calls clinical neuroscience. This project will focus on observable ways that brain circuitry affects the functional aspects of mental illness—symptoms, such as anger or anxiety or disordered thinking, that figure in our current diagnoses. The institute says it’s “agnostic” on the subject of whether, or how, this process would create new definitions of illnesses, but it seems poised to abandon the reigning DSM approach. “Our resources are more likely to be invested in a program to transform diagnosis by 2020,” Insel says, “rather than modifying the current paradigm.”

Although the APA doesn’t disagree that a revolution might be on the horizon, the organization doesn’t feel it can wait until 2020, or beyond, to revise the DSM-IV. Its categories line up poorly with the ways people actually suffer, leading to high rates of patients with multiple diagnoses. Neither does the manual help therapists draw on a body of knowledge, developed largely since DSM-IV, about how to match treatments to patients based on the specific features of their disorder. The profession cannot afford to wait for the science to catch up to its needs. Which means that the stakes are higher, the current crisis deeper, and the potential damage to psychiatry greater than ever before.

Allen Frances’ revolt against the DSM-5 was spurred by another unlikely revolutionary: Robert Spitzer, lead editor of the DSM-III and a man believed by many to have saved the profession by spearheading the shift to descriptive psychiatry. As the DSM-5 task force began its work, Spitzer was “dumbfounded” when Darrel Regier, the APA’s director of research and vice chair of the task force, refused his request to see the minutes of its meetings. Soon thereafter, he was appalled, he says, to discover that the APA had required psychiatrists involved with the revision to sign a paper promising they would never talk about what they were doing, except when necessary for their jobs. “The intent seemed to be not to let anyone know what the hell was going on,” Spitzer says.

In July 2008, Spitzer wrote a letter to Psychiatric News, an APA newsletter, complaining that the secrecy was at odds with scientific process, which “benefits from the very exchange of information that is prohibited by the confidentiality agreement.” He asked Frances to sign onto his letter, but Frances declined; a decade into his retirement from Duke University Medical School, he had mostly stayed on the sidelines since planning for the DSM-5 began in 1999, and he intended to keep it that way. “I told him I completely agreed that this was a disastrous way for DSM-5 to start, but I didn’t want to get involved at all. I wished him luck and went back to the beach.”

But that was before Frances found out about a new illness proposed for the DSM-5. In May 2009, during a party at the APA’s annual convention in San Francisco, he struck up a conversation with Will Carpenter, a psychiatrist at the University of Maryland. Carpenter is chair of the Psychotic Disorders work group, one of 13 DSM-5 panels that have been holding meetings since 2008 to consider revisions. These panels, each comprising 10 or so psychiatrists and other mental health professionals, report to the supervising task force, which consists of the work-group chairs and a dozen other experts. The task force will turn the work groups’ proposals into a rough draft to be field-tested, revised, and then ratified—first by the APA’s trustees and then by its 39,000 members.

At the party, Frances and Carpenter began to talk about “psychosis risk syndrome,” a diagnosis that Carpenter’s group was considering for the new edition. It would apply mostly to adolescents who occasionally have jumbled thoughts, hear voices, or experience delusions. Since these kids never fully lose contact with reality, they don’t qualify for any of the existing psychotic disorders. But “throughout medicine, there’s a presumption that early identification and intervention is better than late,” Carpenter says, citing the monitoring of cholesterol as an example. If adolescents on the brink of psychosis can be treated before a full-blown psychosis develops, he adds, “it could make a huge difference in their life story.”

This new disease reminded Frances of one of his keenest regrets about the DSM-IV: its role, as he perceives it, in the epidemic of bipolar diagnoses in children over the past decade. Shortly after the book came out, doctors began to declare children bipolar even if they had never had a manic episode and were too young to have shown the pattern of mood change associated with the disease. Within a dozen years, bipolar diagnoses among children had increased 40-fold. Many of these kids were put on antipsychotic drugs, whose effects on the developing brain are poorly understood but which are known to cause obesity and diabetes. In 2007, a series of investigative reports revealed that an influential advocate for diagnosing bipolar disorder in kids, the Harvard psychiatrist Joseph Biederman, failed to disclose money he’d received from Johnson & Johnson, makers of the bipolar drug Risperdal, or risperidone. (The New York Times reported that Biederman told the company his proposed trial of Risperdal in young children “will support the safety and effectiveness of risperidone in this age group.”) Frances believes this bipolar “fad” would not have occurred had the DSM-IV committee not rejected a move to limit the diagnosis to adults.

Frances found psychosis risk syndrome particularly troubling in light of research suggesting that only about a quarter of its sufferers would go on to develop full-blown psychoses. He worried that those numbers would not stop drug companies from seizing on the new diagnosis and sparking a new treatment fad—a danger that Frances thought Carpenter was grievously underestimating. He already regretted having remained silent when, in the 1980s, he watched the pharmaceutical industry insinuate itself into the APA’s training programs. (Annual drug company contributions to those programs reached as much as $3 million before the organization decided, in 2008, to phase out industry-supported education.) Frances didn’t want to be “a crusader for the world,” he says. But the idea of more “kids getting unneeded antipsychotics that would make them gain 12 pounds in 12 weeks hit me in the gut. It was uniquely my job and my duty to protect them. If not me to correct it, who? I was stuck without an excuse to convince myself.”

At the party, he found Bob Spitzer’s wife and asked her to tell her husband (who had been prevented from traveling due to illness) that he was going to join him in protesting the DSM-5.

Throughout 2009, Spitzer and Frances carried out their assault. That June, Frances published a broadside on the website of Psychiatric Times, an independent industry newsletter. Among the numerous alarms the piece sounded, Frances warned that the new DSM, with its emphasis on early intervention, would cause a “wholesale imperial medicalization of normality” and “a bonanza for the pharmaceutical industry,” for which patients would pay the “high price [of] adverse effects, dollars, and stigma.” Two weeks later, the two men wrote a letter to the APA’s trustees, urging them to consider forming an oversight committee and postponing publication, in order to avoid an “embarrassing DSM-5.” Such a committee was convened, and it did recommend a delay, because—as its chair, a former APA president, later put it—”the revision process hadn’t begun to coalesce as much as it should have.” In December 2009, the APA announced a one-year postponement, pushing publication back to 2013. (The organization insists that Frances “did not have an impact” on the rescheduling of the revision.)

Illustration: Owen Gildersleeve

James Scully, medical director of the APA, fills the big leather chair in his office overlooking the Potomac River and the government buildings beyond. He’s a large, ruddy-faced man with a shock of white hair, and when he leans forward, his monogrammed cuffs perched on his knees, to deliver his assessment of Frances, even though it’s only two words—”he’s wrong”—you can hear his rising gorge and the sense of betrayal that seems to be swelling behind it.

Of all the things that Frances is wrong about—and there are many, Scully says, including his position on psychosis risk syndrome—the confidentiality agreement seems to be the one that really galls. First of all, it’s simply an intellectual property agreement “about who owns the product.” Second, he insists, this is the most open and transparent DSM revision ever, certainly more open than the process that produced Spitzer’s and Frances’ manuals, which were written in the pre-Internet era, before it was possible to field, as the task force has, 8,000 online comments on the proposed changes.

The agreement may well be mere intellectual property boilerplate. But, as I explain to Scully and later to APA research chief Darrel Regier, that hasn’t reassured all the psychiatrists who’ve had to sign it. They fret privately that the DSM-5 will create “monumental screwups” that will turn the field into a “laughingstock.” They accuse the task force of “not knowing where they’re going” and of “not having managed this right from the very beginning.” They worry that the “slipshod nature of the whole process” will lead to a “crappy product” that alienates clinicians even as it makes psychiatry “look capricious and silly.” None of them, however, are willing to go on record, for fear—unfounded or not—of “retaliation” and “reprisal.”

Regier wants to know who said these things.

Not all the dissidents are insisting on anonymity. E. Jane Costello, codirector of the Center for Developmental Epidemiology at Duke Medical School, says she doesn’t mind going on record because she’s “too small a fish” for them to bother with. Costello was one of two psychiatrists who resigned from the Childhood Disorders work group in spring 2009. In her resignation letter, which she subsequently made public, Costello excoriated the DSM committee for refusing to wait for the results of longitudinal studies she was planning and for failing to underwrite adequate research of its own. The proposed revisions, she wrote, “seem to have little basis in new scientific findings or organized clinical or epidemiological studies.” (In a response, the APA cited “several billions of dollars” already spent over the past 40 years on research the revision is drawing upon.)

To critics, the greatest liability of the DSM-5 process is precisely this disconnect between its ambition on one hand and the current state of the science on the other. Of particular concern is a proposal to institute “dimensional assessment” as part of all diagnostic evaluations. In this approach, clinicians would use standardized, diagnostic-specific tests to assign a severity rating to each patient’s illness. Regier hopes that these ratings, tallied against data about the course and outcome of illnesses, will eventually lead to psychiatry’s holy grail: “statistically valid cutpoints between normal and pathological.” Able to reliably rate the clinical significance of a disorder, doctors would finally have a scientific way to separate the sick from the merely suffering.

No one, not even Frances, thinks it’s a bad idea to augment the current binary approach to diagnosis, in which you either have the requisite symptoms or you don’t, with a method for quantifying gradations in illness. Dimensional assessment could provide what Frances calls a “governor” on absurdly high rates of diagnosis—by DSM criteria, epidemiologists have noted, a staggering 30 percent of Americans are mentally ill in any given year—and thereby solve both a public health problem and a public relations problem.

But Michael First, a Columbia University psychiatrist who headed up the DSM-5’s Prelude Project to solicit feedback before the revision, believes that implementing dimensional assessment right now is a tremendous mistake. The tests, he says, are nowhere near ready for use; while some of them have a long track record, “it seems that many of them were made up by the work groups” without any real-world validation. Bad tests could be disastrous not just for the profession, which would erect its diagnostic regime on a shaky foundation, but also for patients: If the tests have been sanctioned in the DSM, insurance companies could use them to cut off coverage for patients deemed not sick enough. “If they really want to do dimensional assessment,” First says, “they should wait the five or 10 years it would take for the scales to be ready.”

Regier won’t say how many of the tests are usable yet. “I don’t think it will be useful to get into this level of detail,” he emails. He acknowledges that dimensional assessment is still evolving, and he says theDSM-5 field trials—studies in which doctors will test the rough draft of the manual with patients—will help refine the tests. But the field trials, too, are bumping up against formidable deadlines. Although trials were scheduled to begin in May 2010, as of October only a pilot study was actually under way—and protocols for the rest of the trials couldn’t be finalized until that study was completed. Meanwhile, Regier has pegged May 2013 as a drop-dead date for publication of the new manual, which means that two sets of field trials and revisions must be completed by September 2012.

The time crunch only gives critics more fuel. Frances, on hearing of the trials’ delay, BlackBerried out a communiqué about the task force’s “Keystone Kops” missteps—the “Rube Goldberg design,” the “numerous measures signifying nothing,” the “criteria sets that are unusable because so poorly written.” All of which, he wrote, will lead to “a mad dash to dreck at the end.”

When the rough draft of the DSM-5 was released, in February 2010, the diagnosis that had galvanized Frances—psychosis risk syndrome—wasn’t included. But another new proposed illness had taken its place: “attenuated psychotic symptoms syndrome,” which has essentially the same symptoms but with a name that no longer implies the patient will eventually develop a psychosis. In principle, Carpenter says, that change “eliminates the false-positive problem.” This is not as cynical as it might sound: Carpenter points out that a kid having even occasional hallucinations, especially one distressed enough to land in a psychiatrist’s office, is probably not entirely well, even if he doesn’t end up psychotic. Currently, a doctor confronted with such a patient has to resort to a diagnosis that doesn’t quite fit, often an anxiety or mood disorder.

But attenuated psychotic symptoms syndrome still creates a mental illness where there previously was none, giving drugmakers a new target for their hard sell and doctors, most of whom see it as part of their job to write prescriptions, more reason to medicate. Even Carpenter worries about this. “I wouldn’t bet a lot of money that clinicians will hold off on antipsychotics until there’s evidence of more severe symptoms,” he says. Nonetheless, he adds, “a diagnostic manual shouldn’t be organized to try to adjust to society’s problems.”

His implication is that the rest of medicine, in all its scientific rigor, doesn’t work that way. But in fact, medicine makes adjustments all the time. As obesity has become more of a social problem, for instance, doctors have created a new disease called metabolic syndrome, and they’re still arguing over the checklist of its definition: the blood pressure required for diagnosis, for example, and whether waist circumference should be a criterion. As Darrel Regier points out, diabetes is defined by a blood-glucose threshold, one that has changed over time. Whether physical or mental, a disease is really a statistical construct, a group of symptoms that afflicts a group of people similarly. We may think our doctors are like Gregory House, relentlessly stalking the biochemical culprits of our suffering, but in real medicine they are more like Darrel Regier, trying to discern the patterns in our distress and quantify them.

The fact that diseases can be invented (or, as with homosexuality, uninvented) and their criteria tweaked in response to social conditions is exactly what worries critics like Frances about some of the disorders proposed for the DSM-5—not only attenuated psychotic symptoms syndrome but also binge eating disorder, temper dysregulation disorder, and other “sub-threshold” diagnoses. To harness the power of medicine in service of kids with hallucinations, or compulsive overeaters, or 8-year-olds who throw frequent tantrums, is to command attention and resources for suffering that is undeniable. But it is also to increase psychiatry’s intrusion into everyday life, even as it gives us tidy names for our eternally messy problems.

I recently asked a former president of the APA how he used the DSM in his daily work. He told me his secretary had just asked him for a diagnosis on a patient he’d been seeing for a couple of months so that she could bill the insurance company. “I hadn’t really formulated it,” he told me. He consulted theDSM-IV and concluded that the patient had obsessive-compulsive disorder.

“Did it change the way you treated her?” I asked, noting that he’d worked with her for quite a while without naming what she had.

“No.”

“So what would you say was the value of the diagnosis?”

“I got paid.”

As scientific understanding of the brain advances, the APA has found itself caught between paradigms, forced to revise a manual that everyone agrees needs to be fixed but with no obvious way forward. Regier says he’s hopeful that “full understanding of the underlying pathophysiology of mental disorders” will someday establish an “absolute threshold between normality and psychopathology.” Realistically, though, a new manual based entirely on neuroscience—with biomarkers for every diagnosis, grave or mild—seems decades away, and perhaps impossible to achieve at all. To account for mental suffering entirely through neuroscience is probably tantamount to explaining the brain in toto,a task to which our scientific tools may never be matched. As Frances points out, a complete elucidation of the complexities of the brain has so far proven to be an “ever-receding target.”

What the battle over DSM-5 should make clear to all of us—professional and layman alike—is that psychiatric diagnosis will probably always be laden with uncertainty, that the labels doctors give us for our suffering will forever be at least as much the product of negotiations around a conference table as investigations at a lab bench. Regier and Scully are more than willing to acknowledge this. As Scully puts it, “The DSM will always be provisional; that’s the best we can do.” Regier, for his part, says, “The DSMis not biblical. It’s not on stone tablets.” The real problem is that insurers, juries, and (yes) patients aren’t ready to accept this fact. Nor are psychiatrists ready to lose the authority they derive from seeming to possess scientific certainty about the diseases they treat. After all, the DSM didn’t save the profession, and become a best seller in the bargain, by claiming to be only provisional.

It’s a problem that bothers Frances, and it even makes him wonder about the wisdom of his crusade against the DSM-5. Diagnosis, he says, is “part of the magic,” part of the power to heal patients—and to convince them to endure the difficulties of treatment. The sun is up now, and Frances is working on his first Diet Coke of the day. “You know those medieval maps?” he says. “In the places where they didn’t know what was going on, they wrote ‘Dragons live here.’”

He went on: “We have a dragon’s world here. But you wouldn’t want to be without that map.”

Gary Greenberg (garygreenbergonline.com) is the author of Manufacturing Depression: The Secret History of a Modern Disease.

“The social, psychological and cognitive sciences remain stuck with pre-scientific words and concepts. For many of us the word ‘soul’ is obsolete as ‘phlogiston,’ but scientists still use such imprecise words as ‘consciousness’, ‘personality’ and ‘ego,’ not to mention ‘mind.’

Perhaps it is time that, in science at least, ‘’imagination’ and ‘introspection’ are remodelled out, or preferably, retired. Artists can have fun with them, but the serious business of the world has moved on.”

It’s hard to know where to begin with a statement like this. Note first the implication that art is not ‘serious business,’ and that science is. The retirement of ‘mentalistic’ terminology has also been enthusiastically advocated by those who think it ‘obvious’ that the mind/consciousness can be easily reduced to the brain; see Pat Churchland’s Neurophilosophy for lengthy expositions of this point of view. Her husband, Paul, wants ‘folk psychological’ words like ‘mind’ retired in favour of more neurologically correct phrases. (The Churchlands are two well known philosophers of mind whose views are highly regarded in the field).

I find this sort of advocacy appalling. One reason is that it is not very clear at all to what extent private experiences, for instance, can be reduced to patterns of neural firing in the brain, even if the correlations are, at times, close. Alternative interpretations remain perfectly viable.

But the main issue here is the proposed abolition of language. Neither Watson nor the Churchlands seem to have read and/or absorbed George Orwell’s 1984. In this novel, the fictional totalitarian government was developing Newspeak, the primary aim of which was to ‘rationalize’ language. One of the reasons they wanted to do this was to control thought, and one of the characters points out that, once the words for rebellion are abolished, then people won’t be able to plot or even think rebellion.

Similarly, if we successfully abolish the language of ‘mind,’ then it is quite possible that alternative, mentalistic ways of looking will also be abolished, because we won’t have the language to talk about them. This has been an utterly standard method of cultural imperialism from the year dot. If you want to subjugate a people and destroy a culture, forbid them to speak their language. It’s a very efficient method of assimilation. And yet these well-intentioned people seem to be unaware that this is precisely what they are proposing.

The abolition of mentalistic terms is often proposed for the best of reasons – these writers honestly believe they’re wanting a desirable and ‘scientifically’ justified thing. But the path to hell is paved with good intentions. My great fear is that they may succeed; that we’ll eventually become so saturated with ‘neuro’ speak, we won’t be able to think in alternative ways — even if such a conversion camouflages and makes inaccessible ways of thinking that have significant benefits in people’s lives. And so an important way of looking at things will be at one with the dodo, like all the other cultures we’ve destroyed in the name of progress.

Finally — we have the subtle but persistent suspicion of the imagination, also evidenced in Richard Dawkins’ statements about fantasies like Harry Potter possibly degrading children’s abilities to reason. We’re not allowed to imagine things that are not so, or couldn’t be, right? Conversely, are we only ‘allowed’ to think in strictly rational-analytical ways?

A strict adherence to rational thought would be a problem even within science. A number of the greatest theories were in some sense day-dreamed or dreamt into existence, the theory of Relativity, Mendeleev’s conception of the periodic table, and Loew’s recognition of the principle of neurotransmitters being examples (Corliss, 2004). And it was Einstein who said that imagination was more important than knowledge. Science is not just about step-by-step reasoning. It’s important, but not really the heart of creation and invention. And the abolition of the imagination would be a positive crime in a culture in which it is already sorely lacking.

References.

Beauregard, M. & O’Leary, D. (2007) The Spiritual Brain. HarperOne.

Corliss, W.R. (2004). Science Frontiers II. Sourcebook Project: Glen Arm, MA.

Watson, P. (2005). Not Written in Stone. New Scientist, Aug 29.

Tan Le is the head of Emotiv Systems, which is developing the next generation of human-machine interface — a headset that takes input directly from the brain.

As founder and publisher of Skeptic Magazine, Michael Shermer has exposed fallacies behind intelligent design, 9/11 conspiracies, the low-carb craze, alien sightings and other popular beliefs and paranoias. But it’s not about debunking for debunking’s sake. Shermer defends the notion that we can understand our world better only by matching good theory with good science. Thus, in order to explore a conspiracy theory that pre-planted explosives caused the World Trade Center towers to fall on 9/11, the magazine called on demolition experts.

Shermer’s work offers cognitive context for our often misguided beliefs: In the absence of sound science, incomplete information can powerfully combine with the power of suggestion (helping us hear Satanic lyrics when “Stairway to Heaven” plays backwards, for example). In fact, a common thread that runs through beliefs of all sorts, he says, is our tendency to convince ourselves: We overvalue the shreds of evidence that support our preferred outcome, and ignore the facts we aren’t looking for.

Yeon-Kyun Shin, professor of biochemistry, biophysics and molecular biology at ISU, has shown that the protein called synaptotagmin1 (Syt1) is the sole trigger for the release of neurotransmitters in the brain.

Prior to this research, Syt1 was thought to be a part of the protein structure (not the sole protein) that triggered the release of neurotransmitters at 10 parts per million of calcium.

Shin’s research is published in the current issue of the journal Science.

“Syt1 was a suspect previously, but people were not able to pinpoint that it’s the real one, even though there were lots and lots of different trials,” said Shin.

“In this case, we are trying to show in the laboratory that it’s the real one. So we excluded everything else, and included SNARE proteins — that’s the machinery of the release, and the Syt1 is a calcium-sensing timer.”

Syt1 senses, at 10 ppm of calcium, and tells the SNARE complex to open the pore to allow the movement of the neurotransmitters.

Brain activity occurs when neurotransmitters move into a fusion pore.

“We are showing that this Syt1 senses the calcium at 10 ppm, and sends the signal to the SNARE complex to open the fusion pore. That is the process that we are showing right now,” Shin said.

Shin and his researchers were able to pinpoint the protein using a new technique called single vesicle fusion method. Using this method, they were able to create and monitor a single fusion event.

Previous research didn’t allow scientists to look at single events, and instead required detecting many events and then taking an average of those events, Shin says.

Shin, who has been looking at this brain activity for 15 years, is happy about the discovery.

“We are quite excited that for the first time we are showing that Syt1 is really what triggers the signal in the brain,” he said. “This is a really important thing in terms of neurosciences. This is the heart of the molecular part of the brain function.”

Shin believes his discovery may be useful in understanding brain malfunctions such as autism, epilepsy and others.

While researching brain function, Shin has previously shown that taking statin drugs to lower cholesterol may actually inhibit some brain function.

I set up the Beckley Foundation in 1998 for the purpose of scientifically studying consciousness and its altered states.

Growing up in an isolated but magical garden on the edge of a marsh in England, I enjoyed several childhood mystical experiences, from which I developed a passionate interest in mysticism, the Sufis and Bhuddism. After my first psychedelic experience with LSD in 1965, I became fascinated by the scientific question: what physiological processes underlie the alteration of consciousness brought about by this miraculous substance? In particular, my explorations led me to wonder whether one of LSD’s principal actions was to increase the blood supply to the brain capillaries, thereby providing extra glucose and oxygen to the brain cells, accelerating brain metabolism, which may in turn be the cause of those experiences that are shared by both psychedelic and mystical states of consciousness.

There is after all, nothing more important to human beings than our consciousness – it is the core of our being, through which all awareness passes. To enhance its function must be to our gain!
The better understanding of what consciousness is, how it works, and what are the changing factors that underlie its full range of states, is centrally important not only to the individual but also to society.
It was to delve into these questions that I set up the Beckley Foundation, realizing that, as a Foundation, I could be much more effective than as a mere person. I invited a distinguished galaxy of scientists, stretching all the way from Albert Hofmann to Sacha Shulgin, to be on the advisory board, giving the Foundation added depth and opening the doors to the world of academia.

From my own experiences with psychedelics, I realized how amazingly and significantly they can
raise ones capacity to perceive and to perform, if used with skill, and in a “responsible” way. With a scientific explanation of how they alter consciousness, one can much more easily use them as valuable tools to expand and explore consciousness.

Between the prohibition of psychedelics in 1970 and the setting up of the Beckley Foundation in 1998, the new technology of brain-imaging had made unbelievable advances. Combined with the catalyst of a psychedelic to alter consciousness, this new technology could now be used to reveal the inner workings of the brain and the mind, at levels not imaginable before – provided, that is, that the state could be persuaded to grant ethical approvals for such research. It is an orchard full of ripe fruit waiting to be picked.

From a combination of my own experiences and many years of studying the science of consciousness, I developed a good idea of what the important questions are that research into the physiology underlying consciousness needs to address and how to set about exploring this subject using psychedelics.

Through the Beckley Foundation I am currently collaborating in over 10 different projects involving psychedelics – particularly LSD, psilocybin and cannabis – at such institutions as, Imperial College London, the Institute of Psychiatry, University College London, Johns Hopkins, Berkeley, Hannover and St. Petersburg.

I would like to give you a very brief overview of a selection of these projects which I hope will be of interest to you:

After years of seeking to open up psychedelic research in the UK, I have at last, with Prof. “Dave” Nutt and Robin Carhart-Harris at Imperial College, started investigating the effects of psilocybin on blood flow and brain activity, using the fMRI techniques of ASL and BOLD. This pioneering study will throw light on the question of if, and how, psilocybin helps in the recall of distant or repressed memories, helping to develop it as an aid in psychotherapy, and also throwing new light on the important and neglected subject of cerebral circulation. We plan that this first Beckley/Imperial study will grow into an ongoing programme of psychedelic research. Robin will be talking about the study in more detail tomorrow.

At Johns Hopkins, I am delighted to be collaborating with Prof. Roland Griffiths and Matt Johnson, in conducting the first study in modern times to harness the profound psychological effects of psilocybin to aid in the treatment of that most intractable addiction, to nicotine in cigarette smoking. Previous research has suggested that the mystical, spiritual experiences that psilocybin can promote might be integral to the efficacy of psychedelic-assisted treatments of addiction. This project has great potential to develop our understanding of psychedelics, their impact on health and well-being, and their therapeutic potential.

In 2005, I suggested to Matt Baggott that we collaborate on an LSD study in California. In April 2007 we received the first full approvals, since prohibition ended all such research over 30 years ago, to use LSD with human participants at Berkeley. This first pilot study, investigates the safety of using LSD in scientific research and, using EEG, explores how changes in consciousness brought about by LSD alter the way in which brain areas communicate with each other, and how LSD may enhance creativity. Most importantly, by obtaining the first approvals it becomes easier for future research to gain such approvals, thereby open up this most important field of research.

In another Beckley Foundation study located in Europe, we are currently applying for approvals to study the effect of LSD on cerebral circulation and brain activity, This study will compliment both the research at Berkeley, and the psilocybin research at Imperial.

Also, working with Profs. Torsten Passie and Matthias Karst at the Hannover Medical School, we are, among other studies, furthering the investigation of the treatment of cluster headaches using a non-psycho-active analogue of LSD, called Bromo-LSD. This study will, we hope, develop our understanding of the underlying causes of cluster headaches, and also refine a treatment-plan, using Bromo-LSD, that would either cure, or reduce the pain and duration of each attack.

We were delighted to be able to make an early contribution to Peter Gasser for the MAPS-sponsored pilot study in Switzerland, which administers LSD, as part of a palliative treatment programme to ease the pain and pre-death anxiety in subjects suffering from terminal illness.

In the field of cannabis research, the Beckley has initiated and is collaborating on a network of projects, including the first investigation, with Prof. Dave Nutt, into what neurophysiological changes underlie the ‘high’ that people experience as beneficial when smoking cannabis. In this pioneering study, the participants are inhaling vapor from the natural plant. We are making use of fMRI to investigate changes in blood flow, and other brain-imaging techniques to investigate the changes in neuro-transmitters and brain activity. Together, these alterations will be correlated with the changes in subjective perception, thereby increasing our understanding of how cannabis alters consciousness

In other research with the Institute of Psychiatry, we are investigating the different effects of THC as opposed to canabidiol or CBD, and the evidence is ever more convincing that CBD might well prove to be a most valuable medication in the treatment of psychosis, stress and a variety of other disorders. In natural cannabis, the ratio of these two compounds is balanced, but in more recent genetically-engineered strains of cannabis the THC ratio becomes ever higher, and the CBD correspondingly lower. A study we have just completed has shown that pure intravenous THC can produce psychotic-like symptoms even in healthy individuals, but that if the subjects are first given CBD, they are much less likely to have those symptoms.

In collaboration with Professor Val Curran and Celia Morgan at University College London, we are investigating four hundred participants smoking their own cannabis; we are taking measures of the ratio of THC to CBD in their cannabis and also collecting data of the participant’s genetic and personality type. With this information we are investigating the propensity of cannabis to stimulate creativity, and also exploring the individual differences which leads to cannabis causing anxiety in some people and pleasure in others. The next stage of this research will use brain imaging technology to investigate the effects of cannabis on creativity.
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Another project which is particularly close to my heart, and is a central piece in the jigsaw of understanding the importance of cerebral circulation in regards to cognitive functioning is my work with Professor Yuri Moskalenko at the Sechenov Institute of Evolutionary Physiology in St Petersburg. Together we are investigating the cerebral-circulatory-systems of blood and cerebrospinal fluid, their changing dynamics, and their effects on cognition and the long-term health of the brain. This research, which has already produced many peer-reviewed papers, is casting important new light on many aspects of the ageing process and dementia, and hints at how changes in blood circulation may provide a unifying thread behind many aspects of consciousness.
The research has also developed a new non-invasive technique to investigate the changes in cerebral dynamics, and further developed the concept of cranial compliance.

It is my hope that as the network of Beckley Foundation studies, progress and produce results, slowly a clearer overview will emerge of how the changing states of consciousness can be understood in terms of changes of blood supply, of chemical and electrical activity and the interaction between different areas of the brain.

To Summarize:
Psychoactive substances have been used since the dawn of human culture as a means of altering consciousness, and to my mind will always be around, as humans have an innate drive to alter their consciousness. That is why a principal aim of the Beckley Foundation is to open the doors to scientific research into these substances, in order to expand our knowledge of how, at a clinical level, their use can help in the treatment of illness and suffering, and at the neuroscientific level, how they can be used as invaluable tools for unlocking the mysteries of consciousness itself.

Of course, there is another aspect of the psychedelics which also merits scientific investigation, and that is to gain a better understanding of how their use can enhance the life of healthy people, by expanding their awareness, deepening their sense of the spiritual, enhancing creativity, adding laughter and vitality and, finally, helping the individual fulfil the Delphic oracle’s message to Know Thyself, which is, by the way, the motto of the Beckley Foundation.

In order for research in psychedelics to fully develop we need to make headway at the political level, of cleansing these substances of their taboos, and at a practical level, of finding the funding to carry out our research programs.

Towards this first aim I would like to briefly mention the Beckley Foundation’s wider efforts in the field of international drug policy research, which is dedicated to providing a rigorous, independent review of global drug policy, aiming at reducing the harms associated with both the misuse of drugs and the policies that aim to control them. The intention of the Foundation is to help develop policies that are evidence-based and rational, rather than those that are ineffectual and harmful, due to being rooted in unsubstantiated ideology.

In conclusion, trying to condense 12 years of Beckley work into 15 minutes is a little like catching lightning in a bottle, but I hope I may have caught a spark or two.

Now is such an exciting time for Psychedelic Research as our toe is in the door, and it is finally beginning to reap real rewards, after having been a sleeping beauty for the last 40 years.

I am very grateful for having the opportunity to meet so many like minded people and I much look forward to widening the network of collaboration over the next few days.

By Paul Devereux www.pauldevereux.co.uk

The Dying of the Light

I learned that macular degeneration is a disease that damages the central portion of the retina known as the “macula”.  This area deals with what is called “fine acuity vision” used in “straight ahead” visual  tasks such as reading, writing, driving, watching television, sewing, and similar activities. The disease produces what is in effect the opposite of tunnel vision. It can occur in two different forms, known as “wet” and “dry”, and though there is as yet no cure for either there are some preventative procedures available in cases where the condition has not progressed too far. Macular degeneration in one eye usually indicates that the other will soon become similarly afflicted. Incidence of the disease becomes more prevalent with age, though it can occur earlier in life, and its first symptoms are easily missed – they are literally overlooked. (Having hypochondriacal tendencies, I made a mental note while Don was talking to have a check-up with my eye doctor within the week.)

With Don the disease had reached a fairly advanced stage and he explained to me how he could no longer read or write as before, or even type. This was because both letters and numbers would vanish suddenly from his sight and then reappear, disrupting any attempt at protracted reading or writing. This still occurred even when he used large print or magnifying glasses, though he had found that leaning down towards a page while wearing a jeweller’s loop enabled him to read and write adequately for short and simple tasks such as completing cheques.

I praised Don for the calm, measured way in which he was dealing with his disability – a particularly distressing one for someone like him who so valued books. He smiled and shrugged, saying it was a matter of getting on with an unavoidable situation. “But it is the visions that take some getting used to,” he muttered, his voice suddenly taking on a darker tone.

Blindsided by Visions

“Visions? What do you mean, Don?” I asked, totally nonplussed. He outlined several forms of hallucination that were plaguing him. The first one to manifest was what Don described as looking like “a ball of string or basketwork, a globular shape with an aperture on one side”.   He would see this image as if projected onto walls or other surfaces. He could sometimes make out a small face inside the aperture, and on the occasions this became particularly evident the basket-like effect  would adjust around it like a bizarre head-dress.  A similar effect was the occurrence of a “pool of pale grey light” which would often appear a few yards in front of him when he was walking along. Faces would also appear within this strange pool of light.

Don explained to me that these visual effects were developing into more complex imagery. When seated at breakfast and looking out of his window into the garden he had on several occasions seen a kind of illumination within which not just one but a number of figures appeared, walking in a column. They were seemingly all male, some wearing hats, others caps. They would silently advance towards the window then turn to the right near the garden shed, but one figure would often break away from the others at this point and come right up to the window as if peering in at Don before it too moved out of sight to one side.

I learned that an even more startling version of this type of vision had occurred shortly before our meeting.  When Don was visiting the graveyard where his wife is buried he sat for a while on a bench. He suddenly saw one end of the church on the far side of the cemetery  become illuminated. Then there appeared “great crowds of figures” of both sexes and in all manner of dresses moving in a stately way towards the church – this time they were not advancing towards him. They entered the large area of illumination and vanished.

A further visual effect which Don considered to be “rather spectacular” was the disappearance of people in front of him, especially presenters on stage in lecture situations. First the person’s head would vanish and then the torso, yet Don would be able to see the background behind where the now invisible figure was standing with perfect, uninterrupted clarity.

I asked Don if he was in a normal state of consciousness when he had all these odd visions and he confirmed that he was. Moreover, he had been talking to another sufferer of macular degeneration who quietly admitted that he, too, was seeing curious visions. I promised my old tutor that I would  research the subject to see what if anything could be found out about these bizarre visual effects.

Enter Charles Bonnet

I read a paper on macular degeneration but it failed to mention anything about visions or hallucinations, so I asked a neuroscientist friend about the matter. He replied at once saying that the effect in visually impaired people was known to medical specialists as the “Charles Bonnet Syndrome”. He directed me to some references on it.

Charles Bonnet was an eighteenth-century Swiss philosopher who was the first person to describe the presence of visual hallucinations in psychologically normal people when he noticed his grandfather who was blinded by cataracts claiming to see birds and buildings that were not there.  It was thought to be a fairly rare condition until as recently as the 1980s when research indicated that its incidence was in fact moderately widespread in elderly and visually handicapped people. One factor that had held up the full appreciation of the situation was that people experiencing the visions were often unwilling to mention them to anyone, especially their doctors, in case they were judged to be going insane.

The research reveals that the hallucinations can last from a few seconds to several hours and can be of many things, both familiar and unfamiliar to the person viewing them. Hallucinatory content can include inanimate objects, people, animals, plants and bunches of flowers, trees, and complete scenes. Some people see strange things such as monsters, shining angels, or transparent figures floating in a ghostly manner through rooms and hallways. A small percentage of reported cases involve visions of  recently deceased people who had been known to the patient. Although most of the content of the hallucinations are life-size, there are also reports of visions of miniature people – for example, one person saw two tiny policemen putting a midget villain into a diminutive prison van! The hallucinated objects can float in the air, but more typically they merge with the physical surroundings – so a visionary person might be seen sitting in a physically real armchair.  In a few instances a person’s whole surroundings can become visually altered, and rooms or even streets can seem to change their shape making it difficult for the person to get around; one extreme case of this in the literature involved a man who when approaching the top of a flight of stairs had the vision of being on top of a mountain, rendering his descent of the staircase somewhat difficult.  Another case study recorded in the literature  reminded me of Don’s experiences: a retired lawyer saw people dressed in soldier-like uniforms putting on street parties outside his house. They were always very busy, he said.

Picture This

The Charles Bonnet Syndrome is merely an observation, not an explanation, so what exactly causes these hallucinations? On that subject the medical literature becomes less helpful, and it is clear, even admitted, that no one really knows.   I could buy the idea that patches of light in the central visual region could be related to pathological conditions in the macula, and could cause people and  writing to apparently disappear intermittently, but faces at the window, and people dressed in various costumes walking toward churches or driving vehicles or holding street parties seem more of a push.  This was especially the case for me in that I was also aware that people claiming to encounter spirits, whether psychic mediums or ordinary individuals in spontaneous cases,  tend to report seeing them in their peripheral vision rather than directly, “head on”. I could not help but wonder with these macular degeneration visions whether we were dealing with hallucinations or spirits or some subtle level of perception between them both.

Although the actual mechanics are currently unknown, the basic official theory explaining the visions associated with visual impairment like macular degeneration is that the brain, on receiving incomplete visual data through the eyes, “fills in” the missing elements as best it can – a  kind of “best fit” process. In fact, there is evidence that  it is only the input of a constant visual stream through our eyes that prevents the brain making up its own imagery in any case. This has been demonstrated in sensory deprivation experiments in which subjects who are placed in total blackout conditions for long periods experience hallucinatory imagery to lighten their darkness. All of us experience this in another form and to a lesser degree when we dream.

If this explanation is true, then a whole host of other implications are raised. If animated figures in costumes, shades of the dead, processions leading to physically real churches, whole landscapes and entire, complex scenes can be rendered in intricate detail by the brain struggling to “fill in” gaps in sensory data, what then is “reality”? Could what we take to be concrete materiality be a kind of hallucination sustained by cultural conditioning, and are paranormal phenomena simply glitches in that illusion? Are the different, spirit-based worldviews held  by tribal societies simply other forms of hallucination no less “real” than our own? Is the Hindu doctrine of apparent reality being but the “Veil of Maya”, of illusion, correct?

Whatever the answers are to such questions, one thing is certain –  we do not see with our eyes alone.

[This article originally appeared in Fortean Times magazine]