The War on Drugs has failed. According to all available indices, it is no longer defendable. Vast expenditure on drug law enforcement has resulted in increasing levels of overall drug-use and lowered drug prices. 2011 is the 50th anniversary of the 1961 UN Convention, which lies at the root of the criminalizing approach to drug control. Now is the perfect time to re-evaluate our approach.

Of all regions in the world, Latin America has perhaps been the most affected by the unintended consequences of global prohibition. Huge criminal markets have at times turned countries such as Colombia, Guatemala and Mexico into nigh-on war zones. Drug enforcement and eradication in one Andean country has displaced production into neighboring countries and back in turn, in an ongoing cycle. The criminalization of drug control has seen the numbers of those incarcerated for drug offenses (even the possession of minor amounts for personal consumption) rise to levels that overwhelm judicial systems. Currently there are over 10 million people in prison worldwide.

However, Latin America, as the region that has suffered the most, is now leading the way to an open and frank discussion of drugs. Recent declarations from certain politicians show a much greater understanding of the problems than those coming from some of their Western counterparts. In Peru, former President and current presidential candidate Alejandro Toledo declared himself open to full decriminalization. Whilst he nuanced his argument a few days later, the declaration itself shows that Latin American governments are becoming increasingly progressive in their nature. The Latin American Commission on Drugs and Democracy, led by former presidents of Brazil, Colombia and Mexico, has declared its outright opposition to a “misguided and counter-productive war.”

The most significant declaration of all, however, may well be that of current Colombian President Juan Manuel Santos. Santos is head of a country traditionally felt to be one of the US’ major allies in the War on Drugs. However, President Santos has declared himself open to a discussion on alternative approaches that may reduce both the risks and harms associated with illegal drugs. A recipient of major US aid, Colombia cannot turn away directly from Plan Colombia, but Santos’ comments show that Colombian drug policy may be slowly turning against the whirlpool of US foreign policy.

A fellow Andean country, Bolivia, has recently seen more and more countries support its proposals to reform the international prohibition of chewing the coca leaf. Flexibility and cultural sensitivity are vital within approaches to drug conventions. Drug control regimes should be respectful of human rights and take account of different cultural norms in societies around the world. There must be the freedom for individual countries to work out what is best for them. The one-fit-all model has shown itself to be highly destructive.

Various countries such as Portugal have shown how successful a change in policy can be. They have demonstrated that the decriminalization of use and a commitment to provide health and rehabilitation programs as alternatives to incarceration, together with a sustained educational program, can diminish the harms associated with drug-use. Both Hungary and the Czech Republic criminalized use in 1999. However, studies showed that this policy had been a disaster and brought more social costs than benefits. Consequently, both countries reversed this policy (in 2003 and 2010 respectively). We cannot let such lessons go unheeded. We must learn from these examples.

It is time for a new approach. The 1961 UN Single Convention on Narcotic Drugs, with its zero-tolerance approach, was written in a very different context to today, both socially and politically. A rewriting of the UN Convention would enable us to move forward from the present impasse. Individual countries should have more freedom to be able to decriminalize the personal use of drugs and, should the country so wish, to legally regulate certain substances, such as cannabis, thereby being able to control and label their content, and tax them. This would have the advantage of saving vast sums on the continuation of the coercive approach, as well as raising substantial tax to implement an educational and treatment approach to drug-use. It would also solve the problem of hundreds of billions of dollars going into the hands of criminals each year.

The Beckley Foundation Global Initiative for Drug Policy Reform 2011-2012 is proposing such a model.

2011 is the 50th anniversary of the 1961 UN Convention, the 40th anniversary of the UK Misuse of Drugs Act and the 10th anniversary of the Portuguese drug decriminalisation. There has never been a more appropriate time for change.

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.

From Wired Magazine by Steven Levy

But the warehouses aren’t meant to be understood by humans; they were built for bots. Every day, hundreds of robots course nimbly through the aisles, instantly identifying items and delivering them to flesh-and-blood packers on the periphery. Instead of organizing the warehouse as a human might—by placing like products next to one another, for instance—Diapers.com’s robots stick the items in various aisles throughout the facility. Then, to fill an order, the first available robot simply finds the closest requested item. The storeroom is an ever-shifting mass that adjusts to constantly changing data, like the size and popularity of merchandise, the geography of the warehouse, and the location of each robot. Set up by Kiva Systems, which has outfitted similar facilities for Gap, Staples, and Office Depot, the system can deliver items to packers at the rate of one every six seconds.

The Kiva bots may not seem very smart. They don’t possess anything like human intelligence and certainly couldn’t pass a Turing test. But they represent a new forefront in the field of artificial intelligence. Today’s AI doesn’t try to re-create the brain. Instead, it uses machine learning, massive data sets, sophisticated sensors, and clever algorithms to master discrete tasks. Examples can be found everywhere: The Google global machine uses AI to interpret cryptic human queries. Credit card companies use it to track fraud. Netflix uses it to recommend movies to subscribers. And the financial system uses it to handle billions of trades (with only the occasional meltdown).

This explosion is the ironic payoff of the seemingly fruitless decades-long quest to emulate human intelligence. That goal proved so elusive that some scientists lost heart and many others lost funding. People talked of an AI winter—a barren season in which no vision or project could take root or grow. But even as the traditional dream of AI was freezing over, a new one was being born: machines built to accomplish specific tasks in ways that people never could. At first, there were just a few green shoots pushing up through the frosty ground. But now we’re in full bloom. Welcome to AI summer.

Today’s AI bears little resemblance to its initial conception. The field’s trailblazers in the 1950s and ’60s believed success lay in mimicking the logic-based reasoning that human brains were thought to use. In 1957, the AI crowd confidently predicted that machines would soon be able to replicate all kinds of human mental achievements. But that turned out to be wildly unachievable, in part because we still don’t really understand how the brain works, much less how to re-create it.

So during the ’80s, graduate students began to focus on the kinds of skills for which computers were well-suited and found they could build something like intelligence from groups of systems that operated according to their own kind of reasoning. “The big surprise is that intelligence isn’t a unitary thing,” says Danny Hillis, who cofounded Thinking Machines, a company that made massively parallel supercomputers. “What we’ve learned is that it’s all kinds of different behaviors.”

AI researchers began to devise a raft of new techniques that were decidedly not modeled on human intelligence. By using probability-based algorithms to derive meaning from huge amounts of data, researchers discovered that they didn’t need to teach a computer how to accomplish a task; they could just show it what people did and let the machine figure out how to emulate that behavior under similar circumstances. They used genetic algorithms, which comb through randomly generated chunks of code, skim the highest-performing ones, and splice them together to spawn new code. As the process is repeated, the evolved programs become amazingly effective, often comparable to the output of the most experienced coders.

MIT’s Rodney Brooks also took a biologically inspired approach to robotics. His lab programmed six-legged buglike creatures by breaking down insect behavior into a series of simple commands—for instance, “If you run into an obstacle, lift your legs higher.” When the programmers got the rules right, the gizmos could figure out for themselves how to navigate even complicated terrain. (It’s no coincidence that iRobot, the company Brooks cofounded with his MIT students, produced the Roomba autonomous vacuum cleaner, which doesn’t initially know the location of all the objects in a room or the best way to traverse it but knows how to keep itself moving.)

The fruits of the AI revolution are now all around us. Once researchers were freed from the burden of building a whole mind, they could construct a rich bestiary of digital fauna, which few would dispute possess something approaching intelligence. “If you told somebody in 1978, ‘You’re going to have this machine, and you’ll be able to type a few words and instantly get all of the world’s knowledge on that topic,’ they would probably consider that to be AI,” Google cofounder Larry Page says. “That seems routine now, but it’s a really big deal.”

Even formerly mechanical processes like driving a car have become collaborations with AI systems. “At first it was the automatic braking system,” Brooks says. “The person’s foot was saying, I want to brake this much, and the intelligent system in the middle figured when to actually apply the brakes to make that work. Now you’re starting to get automatic parking and lane-changing.” Indeed, Google has been developing and testing cars that drive themselves with only minimal human involvement; by October, they had already covered 140,000 miles of pavement.

In short, we are engaged in a permanent dance with machines, locked in an increasingly dependent embrace. And yet, because the bots’ behavior isn’t based on human thought processes, we are often powerless to explain their actions. Wolfram Alpha, the website created by scientist Stephen Wolfram, can solve many mathematical problems. It also seems to display how those answers are derived. But the logical steps that humans see are completely different from the website’s actual calculations. “It doesn’t do any of that reasoning,” Wolfram says. “Those steps are pure fake. We thought, how can we explain this to one of those humans out there?”

The lesson is that our computers sometimes have to humor us, or they will freak us out. Eric Horvitz—now a top Microsoft researcher and a former president of the Association for the Advancement of Artificial Intelligence—helped build an AI system in the 1980s to aid pathologists in their studies, analyzing each result and suggesting the next test to perform. There was just one problem—it provided the answers too quickly. “We found that people trusted it more if we added a delay loop with a flashing light, as though it were huffing and puffing to come up with an answer,” Horvitz says.

But we must learn to adapt. AI is so crucial to some systems—like the financial infrastructure—that getting rid of it would be a lot harder than simply disconnecting HAL 9000’s modules. “In some sense, you can argue that the science fiction scenario is already starting to happen,” Thinking Machines’ Hillis says. “The computers are in control, and we just live in their world.” Wolfram says this conundrum will intensify as AI takes on new tasks, spinning further out of human comprehension. “Do you regulate an underlying algorithm?” he asks. “That’s crazy, because you can’t foresee in most cases what consequences that algorithm will have.”

In its earlier days, artificial intelligence was weighted with controversy and grave doubt, as humanists feared the ramifications of thinking machines. Now the machines are embedded in our lives, and those fears seem irrelevant. “I used to have fights about it,” Brooks says. “I’ve stopped having fights. I’m just trying to win.”

Senior writer Steven Levy (steven_levy@wired.com)

What could be more festive than spending a night locked in an art gallery with a dozen reindeer and a fridge full of psychedelic drugs?Soma, Carsten Höller‘s current installation in a former railway station in Berlin, purports to be offering exactly that. A pen running the length of the Hamburger Bahnhof, now the city’s contemparary art museum, contains 12 reindeer, 24 canaries, eight mice and two flies. Giant toadstool sculptures are planted on a mushroom clock that the reindeer can turn with their antlers, and at the centre is a mushroom-shaped “floating hotel” – a bed on a platform complete with minibar, yours for €1,000 a night. (There’s also a raffle giving away free places.)

The twist is that this is meant to be a scientific experiment, in which half the reindeer have been fed “fly agaric” mushrooms, which they consume naturally in the wilds of Siberia. It makes their urine hallucinogenic (some people believe that this is the origin of the story of Santa Claus’s sleigh being pulled by flying, red-nosed reindeers).

The urine is collected by handlers and stored in fridges by the walls, which also hold both dried and fresh fly agaric mushrooms. By day they’re locked, but at night the fridges are opened, allowing people staying over to sample the contents. However, because only half the reindeer are fed the mushrooms, it’s impossible to know which bottles, if any, contain hallucinogenic urine.

Tanja Klein, 28, won a competition to spend the night in the museum with her boyfriend, Sachar Kriwoj, 30. “I wasn’t going to go and drink six bottles of reindeer urine to find out,” says Klein. “I’m not into drugs, I’m into art.”

Höller hasn’t tried the urine, but he has tried the mushrooms. “They’re very unpleasant,” he says, speaking from his home in Stockholm. “And you throw up. The first four times I tried it, I became comatose. Then you wake up, throw up, and you don’t know where you are, or how long you’ve been asleep. The sixth time, I started to chant like a Tibetan monk.”

The title Soma comes from the name of the sacred libation drunk by the Indo-Persian followers of the Vedic religion, Hinduism’s 5,000-year-old parent. Its ancient text, the Rigveda, contains 114 hymns to “creative juice”, supposed to offer immortality. The recipe was lost, but in the 1960s researcher Robert Wasson hypo-thesised that soma was based on the fly agaric mushroom.

Höller’s installation sets out to test this hypothesis – and the possibility that art may change perceptions even more effectively than drugs. It takes the form of an experiment set in a playground: from that giant “double mushroom clock” the reindeer move with their antlers, to the “mice square”, based on an actual playground in Paris designed by sculptor Pierre Székely.

One side of the hall is the “test”, the other the “control”. Reindeer on the test side are fed the mushrooms. (“At least in principle,” says Höller, helpfully.) On each side, the reindeer urine is spread on the food of the other animals. From observation posts, visitors watch the behaviour of the canaries, mice and houseflies for signs of intoxication and form their own conclusions. “The experiment is completed in the minds of the visitors,” says Höller. “It’s very unscientific.” In other words, it’s an open question whether the reindeer are even fed the mushrooms at all: the power of suggestion makes you likely to observe something that may not take place.

Experimentation has been a part of Höller’s work since he began his career as an artist while still an agricultural research scientist in the early 1990s. He went on to install 2006′s Test Site, in Tate Modern’s Turbine Hall, which allowed gallery-goers to throw themselves down double-helix slides.

Overnight visitors to Soma have reported some strange events. Florian Wojnar, a friend of Höller’s, spent the night in the museum with his 11-year-old son. “He was really excited, because at some point, there were seven reindeer on one side and five on the other. In the morning, we counted again and there were six on each. I never saw them move.”

Dorothée Brill, the museum’s lead curator, says: “As far as we can tell, nobody’s done anything they shouldn’t have.” Staff at the restaurant, however, report that some guests “drink the minibar dry”.

It’s hard to resist the suspicion that the exhibition is intended as a microcosm of society, an allegory for democracy, with extra privileges and more fun for those able to pay. And, if this is an experiment, make no mistake: it’s you in the lab. Meanwhile, those tempted to make a Christmas visit should bear in mind that the Hamburger Bahnhof is closed on Christmas Eve. “The reindeer have somewhere else to be that day,” the museum explained.

• Soma is at the Hamburger Bahnhof, Berlin, until 6 February. Details:somainberlin.org

Mirror-Image Cells Could Transform Science — or Kill Us All

Dmitar Sasselov was at the end of a long day of having his mind blown when the really big idea hit him. Sasselov, an astrophysicist and head of the Origins of Life Initiative at Harvard, was sitting in the front row of a packed lecture hall at the university last spring, listening to the famous human genome sequencer J. Craig Venter talk about his efforts to synthesize new forms of life. Sasselov had introduced the bald, perpetually sunburned biotech entrepreneur at another lecture that morning, and he’d spent the day squiring Venter around campus.

By John Bohannon for Wired Magazine

But Sasselov’s thoughts were light-years away. Two months earlier, a Delta II rocket had blasted off into the darkness above Cape Canaveral carrying the Kepler space telescope; Sasselov is on the team using Kepler to hunt for Earth-like planets around the Cygnus constellation—looking, ultimately, for extraterrestrial life. And he was frustrated. Because no matter how much data he and his colleagues collect—gases in the atmosphere, a fingerprint of color on the surface—they’ll never actually see aliens themselves. And that makes it impossible to answer one of the most basic questions of astrobiology: How diverse is life in the universe? If there is life somewhere other than here, does it look like earthly life, with DNA and protein? Or could it run on something else? Venter’s lecture about artisanal bacteria mapped suddenly onto Sasselov’s frustration. Why not just do what Venter was doing? If Sasselov wanted to study aliens, why not just make them himself—or at least the next-best thing? He imagined himself looking at synthetic aliens on a lab bench, “gazing at the other,” as he puts it, “similar to us but not the same.” He uncapped his red pen and scribbled a note: “Arrange a mtg/chat w Jack & GMC,” it read. “Chiral E. coli w GMC and put it into a vesicle w Jack & subject two cultures to planetary environments.”

Translation: Go to the synthetic biologists Jack Szostak and George Church. Ask them to create a life-form that runs on an operating system different from our own, based on mirror-image versions of earthly proteins and DNA. Let these alien cells grow and mutate, and see how they survive. If it worked, those new cells—Church called them “mirror life”—could answer one of the deepest questions about the origin of life, not just here on Earth but everywhere in the universe. They might also open up new avenues of discovery in materials science, fuel synthesis, and pharmaceutical research. On the down side, though, mirror life wouldn’t have any predators or diseases to limit its reproduction. They would have to keep an eye on that.

Four billion years ago was a hellish time on planet Earth. It was the end of the aptly named Hadean eon: Volcanoes spewed lava across rock baked by ultraviolet radiation; asteroids blasted craters into the landscape. But the worst of the bombardment—including the colossal impact that knocked loose the chunk that became our moon—was over. There were oceans of water and plenty of complex organic chemicals. So in some wet place, maybe near an undersea hydrothermal vent, maybe in the clay on the shore of a shallow pond, organic molecules started to replicate. No one knows exactly where or when or how, but life began.

It was nothing fancy at first. But soon those replicating molecules clothed themselves in a skin of fat, a membrane to keep their complex chemistry from diluting away. And with surprising speed, those bubbles of goop gave rise to a living, functioning cell, the Last Universal Common Ancestor of everything alive today—LUCA. Using the genetic differences between today’s living things as a molecular clock, we can calculate when that ancestral cell first emerged: about 3.5 billion years ago.

Since then, life has been busy. At last count, there were as many as 100 million species on the planet, and billions more have gone extinct. And yet, at the most basic level of biochemistry, it has just been more of the same. Every organism runs on the same operating system that LUCA invented. Peel back a cell’s membrane and you’ll find a blur of activity, thousands of chemical reactions taking place all at once. The conductors of this biochemical ballet are the proteins, nano-size building blocks and machines that control the speed and timing of every reaction. From breaking down sugars to clearing waste to repairing the membrane, the unique shape of each protein determines its job, as specifically as a lock to its key.

The LUCA operating system was an ingenious solution to keeping track of all those thousands of proteins. Biochemists call it the central dogma: Genetic material, in the form of a long nucleic acid polymer called DNA, stores a digital record of every protein’s design. Another nucleic acid, RNA, carries the information to a molecular machine called a ribosome, which reads the RNA and strings together amino acids to form the protein. Once the string is complete, the protein snaps itself into the right shape and gets to work.

But there is at least one viable alternative to LUCA: the mirror image of the entire system. Biochemistry is the story of shapes, and this is its strange plot twist. Lots of molecules come in multiple conformations—sticking together the same atoms can sometimes yield different three-dimensional structures that are the mirror images of each other, a property called chirality. Indeed, most of the basic molecules of life—from the nucleic acids of the genome to the amino acids of the proteins—have mirror-image versions. And all cells have enzymes called isomerases, which flip certain molecules into their mirror versions. But for some reason, in the machinery of living things on Earth, one side of the mirror goes almost wholly unused. All of us earthlings, from algae to elephants, have proteins made of left-handed amino acids and a genome of right-handed nucleic acids. (When chemists say handed, they’re generally referring to the direction that polarized light skews when beamed through a pure solution of the molecule.) No one knows why LUCA picked one side of the mirror and not the other.

Theoretically, a cell could be based on “wrong-handed” molecules. Its biochemistry would work just like ours—DNA to RNA to proteins—but it would be completely incompatible with earthly life, its chiral twin. And now, thanks to recent advances in genomics, cell membrane science, and synthetic biology, an ambitious researcher could go beyond theory and build it from the ground up. The tools are here (well, almost here) to make mirror life from scratch.

Photo: Spencer Higgins

Sasselov is the ultimate talent scout for a problem like this. Because of his job at the Origins of Life Initiative, he knew George Church was already trying to build mirror-flipped molecular machines that could translate genes into proteins, and he knew that Church didn’t have anything to put them in. The membranes of earthly cells are built of fat and protein molecules with the wrong chirality. But Sasselov also knew that if there was anyone in the world who could create a membrane that would work, it was Jack Szostak. “They’re both pioneers, but in different ways,” Sasselov says. “They are my favorite people, and my mentors.”

So he brought them both to a café in Cambridge and made his pitch: Build a fully functioning mirror cell made of molecules they themselves would synthesize. Or, to put it another way: Don’t just create new branches on the tree of life, as Venter was doing with his tweaks of existing cells. Instead, create an entirely new tree.

Church went for it immediately. He’d been looking at similar ideas for years. But Szostak didn’t think it would work. “I’m not saying it’s impossible,” he says, sitting in his office at Massachusetts General Hospital a year after that first meeting. “I’m just saying it requires a lot of hard steps.” Nevertheless, he agreed to support the project.

A soft-spoken 58-year-old Canadian with boyish good looks, Szostak won the Nobel Prize last year for his work on telomeres, the protective end caps of chromosomes. He also created the artificial yeast chromosome, critical to advances in DNA cloning and gene mapping. Lately, Szostak has been working on the origin of those membranes that somehow came to enclose and protect LUCA and every cell since. Inside test tubes in his lab float microscopic, hollow spheres of fat—primitive membrane bubbles. Given the right molecular ingredients, they spontaneously self-assemble, grow, and divide, but they’re much simpler than a naturally occurring cell membrane. The fatty acids have no chirality; their mirror image is the same molecule. So if they were injected with, say, the guts of mirror life, there would be no wrong-handedness to get in the way.

And that’s where Church comes in. He’s 6′5″, with a gnarly beard and a science fiction fan’s optimism. It’s his job to build the genome and protein infrastructure for mirror life. But … could mirror cells actually survive on Earth? “Everything I know from chemistry and physics says that this should work,” he says. Then he gets a little silly: “Hey! I know a great shortcut to get our mirror ribosome! I just need a four-dimensional being to pick me up, rotate me in 4-D, and put me back as my mirror self.”

Szostak still says he’d bet against their success. The cautious scientist in him can’t see how the mirror cell, once full of chirally flipped molecular machinery, will come to life. “Forget about all the technical issues of making mirror ribosomes, mirror peptides, and mirror DNA,” he says. “The complexity of reconstituting a normal cell, or even a simplified cell with 1,000 components, is mind-boggling. You don’t just mix these things up and get it to work.” Still, he agreed that if Church got his part figured out, they could use his membranes to keep everything in. Szostak hopes that even attempting to make mirror life could lead to a better understanding of how ribosomes work and cells evolved. He doesn’t mention the possibility that mirror life could earn someone serious money.

The week that Sasselov met with Szostak and Church to discuss mirror life, a catastrophe was under way across the Charles River at Genzyme, one of the largest biotech companies in the world. Two of its top sellers—medicines for treating the rare genetic disorders Gaucher’s disease and Fabry disease—are proteins. In people with these maladies, fats accumulate in the blood, organs, and brain, causing symptoms from burning pain to kidney failure—unless they get the drugs, produced by genetically modified cells suspended in giant nutrient pools called bioreactors. But that week, a virus that disrupts cell reproduction infected one of the bioreactors. The entire plant had to be shut down.

It was a hard summer for Genzyme, as well as for the people who rely on its medications. While the company decontaminated its bioreactors, thousands of patients around the world rationed their drug supplies. Genzyme’s stock price dropped 20 percent.

When Church talks about mirror life’s quirky advantages, invulnerability to this kind of mishap is high on his list. “Viruses can’t touch a mirror cell,” he says. No virus has evolved to infect it. And even if a normal virus did figure out how to get past the membrane of a mirror cell—which usually requires a mechanism that would be thwarted by wrong-handed molecules—the mirror genome would be unreadable to the attacker. Viruses work by hijacking their victims’ genomes, taking over the cellular machinery for making proteins to build more of themselves; a normal virus wouldn’t have any effect on a mirror cell’s factory. This makes mirror life a potential workhorse for biotech.

As it happens, the cell that Sasselov ultimately wants to create—a chiral twin of E. coli—couldn’t make proteins like Genzyme’s cells. It would make the chirally flipped versions, which would almost certainly be useless.

But that’s not the sort of mirror cell Church has in mind. The problem, he says, is that billions of years of evolutionary R&D have made today’s bacterial cells tough, adaptable, and very good at making more of themselves—but inefficient at spitting out designed-to-order molecules in a bioreactor. Church wants a “minimal mirror cell” to produce specific proteins: mirror, normal, and even mixes of the two but far more efficient than a bioreactor full of finicky, genetically engineered cells.

Before she retired in 2007, Kiran Bedi was one of India’s top cops. As the first and highest-ranking female officer in the national police force, she earned a reputation for being tough yet innovative on the job. Her efforts to prevent crime, reform prisons, end drug abuse, and support women’s causes earned her a Roman Magsaysay Award, the Asian equivalent of the Nobel Prize. Bedi also served as a police adviser to the UN Secretary General.

In retirement, Bedi has become one of the most trusted and admired community leaders in India. She advocates for social change and civic responsibility through her books, columns, and a popular reality-TV show. She reaches out to more than 10,000 people daily through her two NGOs, Navjyoti and India Vision Foundation, which provide education, training, counseling and health care to the urban and rural poor. Her latest initiative, Mission Safer India, aims to ensure that police log and address citizen complaints. Her life is the subject of the 2008 documentary Yes, Madam Sir, narrated by Helen Mirren.

By the end of planning her new exhibition, Caroline Fisher had come to an interesting conclusion. “It’s even harder to exhibit rats than drugs,” she says. The Home Office eventually granted her the necessary licences to exhibit a bottle of heroin, a ball of opium, some morphine, a selection of magic mushrooms, a peyote cactus, some hallucinogenic snuff and a variety of Victorian high-street pharmacy favourites including cocaine mouth lozenges and tincture of Indian cannabis – “as many drugs as we could get our hands on”. But Health and Safety weren’t having the rats. “We wanted to recreate a 7m-long Rat Park,” Fisher sighs, referring to the classic 1970s Canadian experiment that showed opiate addiction in rodents was determined not by the drugs they took, but the living conditions they took them in.

By Johnny Davis for the Guardian

Fisher is the co-curator of High Society: Mind-Altering Drugs in History and Culture at the Wellcome Collection in London, and offers a history of narcotics that feels fresh. After all, we hardly need another account of the Romantic poets getting carried away with hashish, or more woolly recollections from acid house revellers who outwitted the police on the M25 while going to Sunrise.

“I don’t think anything similar has been done before,” says Mike Jay, the exhibition’s co-curator and author of an accompanying book. “There’s always been two different discourses, the ‘drug culture underground’ one and a rather more straight-lens way of looking at it, from a medical or political view. It’s the middle ground that feels interesting.”

High Society strives to cover as much of this middle ground as possible. It spans from pre-2000 BC chillum-style pipes fashioned from puma bones, to mephedrone and other internet-distributed synthetic stimulants of the 21st century. Along the way it takes in kava drinking in the South Pacific, betel chewing in Papua New Guinea and cocaine snorting in Weimar Germany. Tea, coffee and sugar also feature (albeit in supporting roles) and there’s plenty on the rise and fall of tobacco.

As such the exhibition is able to make its central premise: very few people live their lives without resorting to some sort of mind-altering substance. Taking drugs, it suggests, is “a universal impulse”. “Drug cultures are endlessly varied, but drugs in general are more or less ubiquitous among our species,” writes Jay. Later he quotes American anthropologist Donald Brown’s celebrated work Human Universals, which lists “mood- or consciousness-altering techniques and/or substances” as one of the essential components of human culture, along with “music, conflict resolution, language and play”. “The public perception is that drugs are this terrible thing that appeared with hippies in the 60s; that they’re a modern disease,” Jay says. “The historicality has been lost.”

The curators are at pains to underline the mutability of culture and society, and how a drug’s definition is determined by non-chemical factors such as intent behind its use, its method of administration and the social class of the user. (Nitrous oxide is a medicine when used by doctors, a drug when used for pleasure.) Even so a pattern soon establishes itself: a new mind-altering substance arrives accompanied by extravagant medical claims and counter-claims, gets enthusiastically taken up by sections of the public (usually the idle rich); then addiction and side-effects make themselves apparent over time.

“It was hard to designate drugs themselves as the problem when they were also being promoted to the public at large as the solution,” writes Jay of the nurses, doctors and military officers who were treating local infections with morphine injections in the 1880s, ushering in the first “morphinomaniacs” in the process. Elsewhere the 18th-century botanist and pioneering drug cataloguer Carl Linnaeus frowned upon coffee – he felt it sapped vitality and brought on early senility – but endorsed tobacco as a means of fighting infection. In a tract published in Leipzig in 1707, we see early adopters of tea being reprimanded for “drinking themselves to death” in the mindless pursuit of fashion. Around the same time the British literary intelligentsia waxed lyrical on the benefits of rounding an evening off with a few pipes of opium, something they believed helped digestion, fortified against fever and improved performance in the bedroom. Only alcohol seems to have maintained a constant reputation, viewed as the boorish vice of the corrupt elite in Roman times, banned across much of the Islamic world and the subject of US prohibition in the 1920s.

Still, High Society remains morally neutral. There won’t be any disclaimers. “We’re not doing, ‘Hey kids, drugs are good’, so ultimately we don’t need to do, ‘Hey kids, drugs are bad,’” reasons Jay. “Since that’s basically the entire popular discourse about drugs, it seems nice to get rid of both of them and take the subject on its own merit.”

High Society has commissioned some interactive artworks to help convey the quixotic effects of drugs on mind and body in the sober medium of an exhibition space. Joshua White was the resident artist at New York’s Fillmore East theatre during the late 60s. Using bottles of coloured liquids, hand-painted slides, lightbulbs on the end of sticks and clock faces, he projected his psychedelic “liquid light shows” on to live performances by Frank Zappa, Janis Joplin and Jefferson Airplane, among others. “Was my work best experienced on drugs? I would say so, yes,” says White, who’ll travel to the UK to install his new show at the Wellcome Collection. “Everybody had a different relationship with drugs back then, just as everybody in my parents’ generation had a different relationship with alcohol. Some people had a nice buzz; some people threw up. We would hire speed freaks for our special projects – get them to stay up all night gluing jewels on to a ball.”

There will also be a recreation of the “dreamachine”, the light-emitting cylinder built by artist Brion Gysin and William Burroughs’s “systems adviser” Ian Sommerville. “You look at it with your eyes shut in a dark room, and it supposedly recreates the hallucinatory experience,” explains Fisher.

Other contemporary artwork includes the video piece Cannabis In the UK, of artist Mark Harris reading Baudelaire’s Les Paradis Artificiels and Walter Benjamin’s Hashish in Marseilles to cannabis plants (“I hope it won’t be taken too seriously,” says Harris. “I just thought, ‘If you’re going to read to plants to make them grow, what better than to read to cannabis plants something about the effects of the drug?’”), and photographer Mark Leffingwell’s “collective intoxication” picture depicting 10,000 people gathered at the University of Colorado for a “smoke-in” to commemorate “420″, an event observed across America every 20 April to promote the legalisation of marijuana.

If none of those do the trick, there are plenty of accounts from the history of self-experimentation. There’s the study on nitrous oxide performed by 18th-century chemist Humphry Davy, who got fed up with testing the gas on rabbits, kittens and fish and took heroic quantities himself, reaching the less than empirical conclusion that “nothing exists but thoughts”. There’s the story of the family who discovered the liberty cap mushroom by accident: cooking some up for a morning broth they developed vertigo, visions and the overwhelming sensation they were dying, only to leave the house for help and forget why they had done so a few hundred metres later. (When a doctor did eventually reach them, the situation was scarcely improved by the family’s eight-year-old, whose symptoms proved unique: bursting into raucous laughter every time his terrified parents opened their mouths.) And there’s French psychiatrist Jacques-Joseph Moreau, who suggested that the low prevalence of insanity in the Arab world was down to a preference for cannabis over alcohol: testing his theory he swallowed three grams before dinner and found himself preparing to fight a duel with a bowl of candied fruit.

From more recent times there’s a photograph of “father of MDMA” and sometime US Drug Enforcement Agency employee Alexander Shulgin. Shulgin’s popularisation of ecstasy eventually gave rise to acid house, the last significant drug-led subculture. High Society largely steers clear of examining the hows and whys of such moments; in fact there’s little on why we might be drawn towards illicit drugs in the first place. “I just think it’s self-evident that people wouldn’t take drugs if they didn’t enjoy them,” Jay shrugs.

The most recent UN figures put the illegal drug trade at $320bn (£200bn) a year – the third biggest international market on the planet, after arms and oil. “2011 is the 50th anniversary of the United Nations Single Convention on Narcotic Drugs,” Jay says. “That’s the 50th anniversary of global prohibition; they’ve been trying for 50 years to achieve that. What’s so ironic is that 1961 was precisely the time when the drug counterculture formed; the point where policing started to fall apart with the surge in demand that was coming. Today our culture has become even more experimental: we regard it as a good thing to try something exotic and different, in a way that it just wasn’t 50 years ago. So it’s very hard to say, ‘That’s the way we are in culture. Oh – except for drugs, which have to be hived off.’”

Given that more people take more drugs than at any other time in history, you might wonder if they’ll ever be part of a counterculture again. At a time when Keith Richards is a bestselling author off the back of his national treasure status as a chemical dustbin, Governor Arnold Schwarzenegger has taken steps to decriminalise marijuana possession in California and Prince Harry is found inhaling “hippy crack”, it’s difficult to see how drugs could be more mainstream. “I wouldn’t be surprised if in five years, marijuana wasn’t fully legalised all over the US,” says Leffingwell. “Most people don’t see it as any more harmful than having a beer.”

Others suggest that the seeds of a new, drug-led counterculture are all around us. “I think smart drugs, things that boost your IQ such as Modafinil, could lend themselves to certain music,” says Jay. “Very techy electronica.”

To return to High Society’s premise, then: the drugs we consume may change – from over-the-counter laudanum in Victorian times, to over-the-internet mephedrone today – but the human relationship with them remains strangely constant. “Nothing’s changed,” says White. “The form changes, the fickleness changes – but our cravings stay the same.”

High Society: Mind-Altering Drugs in History and Culture is at the Wellcome Collection, 183 Euston Road, London NW1 2BE from 11 Nov to 27 Feb. wellcomecollection.org

THE GIST

• Acoustic archaeology is an emerging field that melds acoustical analysis and old-fashioned bone-hunting.
• Ancient people created fun house-like temples that featured scary sound effects.
• Some of the sites were likely built by people who took sensory-altering drugs.

Researchers are uncovering the secrets of ancient civilizations who built fun house-like temples that may have scared the pants off worshipers with scary sound effects, light shows and perhaps drug-induced psychedelic trips.
By Eric Niiler for Discovery News

The emerging field of acoustic archaeology is a marriage of high-tech acoustic analysis and old-fashioned bone-hunting. The results of this scientific collaboration is a new understanding of cultures who used sound effects as entertainment, religion and a form of political control.

Miriam Kolar, a researcher at Stanford University’s Center for Computer Research and Acoustics, has been studying the 3,000 year-old Chavin culture in the high plains of Peru. Kolar and her colleagues have been mapping a maze of underground tunnels, drains and hallways in which echoes don’t sound like echoes.

“The structures could be physically disorienting and the acoustic environment is very different than the natural world,” Kolar said. Ancient drawings from the Chavin culture show a people who were fascinated with sensory experiences — ancient hippies if you will.

“The iconography shows people mixed with animal features in altered states of being,” said Kolar, who is presenting her recent work at a conference in Cancun, Mexico this week. “There is peyote and mucus trails out of the nose indicative of people using psychoactive plant substances. They were taking drugs and having a hallucinogenic experience.”

If that wasn’t enough, the mazes at Chavin de Huantar also include air ducts that use sunlight to produce distorted shadows of the maze’s human participants. And sound waves from giant marine shells found in the maze in 2001 may have produced a frequency that actually rattled the eyeballs of those San Pedro cactus-using ancients, Kolar said.

“We consider sound to be important,” said Kolar. “We’ve gathered a lot of data and we’re finally starting to publish it.”

The Chavin de Huantar site in Peru isn’t the only place where sound played an important role. The Mayan rulers at Chichen Itza in the Yucatan also figured out how to use sound for crowd control. David Lubman, an acoustic engineer who has spent the past 12 years studying the Mayan site, says a strange bird-like echo from the Kukulkan temple was actually constructed on purpose.

“It’s sort of spooky,” Lubman said from Irvine, Calif. “It’s not an ordinary echo.”

Lubman’s analysis compared the acoustic soundprint of the quetzal bird, which was revered by Mayans, to the sound of the echo at Chichen Itza. The two sounds matched.

Lublin said the secret is in the acoustic properties of the steep staircase on the temple’s front.

Other new research presented at this week’s Acoustical Society of America conference in Cancun shows that Mayan rulers figured out how to build a public address system in the site’s giant ball court. That allowed kings to address hundreds of warriors and subjects without screaming.

In England, British researchers are using modern tools of acoustics to figure out what drumming noises may have sounded like to ancient visitors to Stonehenge.