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

It’s in the middle of a grassy field, shiny sedans behind gleaming glass walls. Right next door is another luxury car dealership selling a variety of other high-end European rides. It’s as if the sheer magic of wealth has shimmered the glass-and-steel buildings into being.

In fact, expensive cars choke the streets of Râmnicu Vâlcea’s bustling city center—top-of-the-line BMWs, Audis, and Mercedes driven by twenty- and thirtysomething men sporting gold chains and fidgeting at red lights. I ask my cab driver if these men all have high-paying jobs, and he laughs. Then he holds up his hands, palms down, and wiggles his fingers as if typing on a keyboard. “They steal money on the Internet,” he says.

Among law enforcement officials around the world, the city of 120,000 has a nickname: Hackerville. It’s something of a misnomer; the town is indeed full of online crooks, but only a small percentage of them are actual hackers. Most specialize in ecommerce scams and malware attacks on businesses. According to authorities, these schemes have brought tens of millions of dollars into the area over the past decade, fueling the development of new apartment buildings, nightclubs, and shopping centers. Râmnicu Vâlcea is a town whose business is cybercrime, and business is booming.

At a restaurant in a neighborhood of apartment buildings and gated bungalows, I meet Bogdan Stoica and Alexandru Frunza, two of just four local cops on the digital beat. Stoica, 32, is square-shouldered and stocky, with a mustache and prominent stubble. His expression rarely changes. Frunza, 29, is tall and clean shaven. He’s the funny one. “My English will improve after I have a few beers,” he says. We sit at a table on the edge of a big courtyard, piped-in Romanian pop music blaring.

Stoica and Frunza grew up in Râmnicu Vâlcea. “The only cars on the streets were those made by Dacia,” Stoica says, referring to the venerable Romanian carmaker. Access to information was limited, too: Weekday television consisted of two hours of state-run programming, mostly devoted to covering the dictator, Nicolae Ceauşescu. “We had half an hour of cartoons on Sunday,” Stoica says.

In 1989, a revolution that began with anti-government riots ended with the execution of Ceauşescu and his wife, and the country began the switch to a market economy. By 1998, when Stoica finished high school and went off to the police academy in Bucharest, another revolution was beginning: the Internet. Râmnicu Vâlcea was better off than many towns in this relatively poor country—it had a decades-old chemical plant and a modest tourism industry. But many young men and women struggled to find work.

No one really knows how or why those kids started scamming people on the Internet. “If you find out, you let us know,” says Codruţ Olaru, head of Romania’s Directorate for Investigation on Organized Crime and Terrorism. Whatever the reason, online crime was widespread by 2002. Cybercafés offered cheap Internet access, and crooks in Râmnicu Vâlcea got busy posting fake ads on eBay and other auction sites to lure victims into remitting payments by wire transfer. Eventually, FBI agents in the US and Bucharest started to get interested.

In the early days, the perpetrators weren’t exactly geniuses. One of the first cases out of the region involved a team based in the neighboring town of Piteşti. One crook would post ads for cell phones; the other picked up the wired money for orders that would never ship. The two men had made a few hundred dollars from victims in the US, and the guy receiving the cash hadn’t even bothered to use a fake ID. “I found him sitting in an Internet café, chatting online,” says Costel Ion, a Piteşti cop who had been working the cybercrime beat. “He just confessed.”

But as in any business, the scammers innovated and adapted. One early advance was establishing fake escrow services: Victims would be asked to send payments to these supposedly trustworthy third parties, which had websites that made them look like legitimate companies. The scams got better over the years, too. To explain unbelievably low prices for used cars, for example, a crook would pose as a US soldier stationed abroad, with a vehicle in storage back home that he had to sell. (That tale also established a plausible US contact to receive the money, instead of someone in Romania.) In the early years, the thieves would simply ask for advance payment for the nonexistent vehicle. As word of the scam spread, the sellers began offering to send the cars for inspection—asking for no payment except “shipping.”

The con artists got even sneakier. “They learned to create scenarios,” says Michael Eubanks, an FBI agent in Bucharest. “We’ve seen email between criminals with instructions on how to respond to different questions.” The scammers started hiring English speakers to craft emails to US targets. Specialists emerged to occupy niches in the industry, designing fake websites or coordinating low-level confederates.

Internet scammers and their underlings have turned Râmnicu Vâlcea into a hub of international organized crime.
Photo: Nick Waplington

By 2005, Romania had become widely known as a haven for online fraud, and buyers became wary of sending money there. The swindlers adapted again, arranging for payments to be wired to other European countries, where accomplices picked up the cash. A new entry level evolved, people who’d act as couriers and money launderers for a cut of the take. These money mules were called arrows, and their existence elevated Râmnicu Vâlcea to a hub of international organized crime.

Many arrows were Romanians living in Western Europe and the US; some were youngsters from Râmnicu Vâlcea who had moved overseas expressly for the job. They’d go to wire transfer offices to collect remittances from victims, then turn around and wire that money—minus a commission—to Râmnicu Vâlcea or to other arrows in the network. The system served as a kind of firewall, making it much more difficult for law enforcement to track the masterminds.

Back home, the local police were starting to realize they needed people on the cybercrime beat full-time. Frunza, who’d studied informatics in high school before attending the police academy, was working drug cases in Bucharest when he decided to come home. He ended up joining Stoica on the hunt for online con artists. The two learned that suspects expect leniency from the police because their crimes target only foreigners. “The guys will often say, ‘I am not stealing from our countrymen,’” Frunza says. “But a crime is a crime. You have to pay for it.”

Nowadays, Stoica and Frunza occasionally find themselves investigating a childhood acquaintance or, conversely, running into known criminals in social situations. Frunza used to play on the same soccer team as a suspect who was under surveillance. Those connections have helped the two cops pose a formidable challenge to the industry.

A little after 11 pm, Stoica hushes our conversation and tells me to turn around and check out a table across the courtyard, where a small group of flashily dressed young men has just arrived with two blond women who seem barely out of their teens. The men are all under investigation. “It’s a small city,” Stoica says.

The sudden appearance of luxury car dealerships among the grass fields marks the entrance into Râmnicu Vâlcea.
Photo: Nick Waplington

Defining the town center of Râmnicu Vâlcea is a towering shopping mall that looks like a giant glass igloo. The streets are lined with gleaming storefronts—leather accessories, Italian fashions—serving a demand fueled by illegal income. Near the mall is a nightclub, now closed by police because its backers were shady. New construction grinds ahead on nearly every block. But what really stands out in Râmnicu Vâlcea are the money transfer offices. At least two dozen Western Union locations lie within a four-block area downtown, the company’s black-and-yellow signs proliferating like the Starbucks mermaid circa 2003.

Driving past a block of low-rise buildings with neatly trimmed hedges, Stoica notes a couple of apartments owned by people currently under investigation. “I don’t know if the people of Râmnicu Vâlcea are too smart or too stupid,” Stoica says grimly. “They talk a lot to each other. One guy learns the job from another. They ask their high school friends: ‘Hey, do you want to make some money? I want to use you as an arrow.’ Then the arrow learns to do the scams himself.”

It’s not so different from the forces that turn a neighborhood into, say, New York’s fashion district or the aerospace hub in southern California. “To the extent that some expertise is required, friends and family members of the original entrepreneurs are more likely to have access to those resources than would-be criminals in an isolated location,” says Michael Macy, a Cornell University sociologist who studies social networks. “There may also be local political resources that provide a degree of protection.”

Online thievery as a ticket to the good life spread from the early pioneers to scores of young men, infecting Râmnicu Vâlcea’s social fabric. The con artists were the ones with the nice cars and fancy clothes—the local kids made good. And just as in Silicon Valley, the clustering of operations in one place made it that much easier for more to get started. “There’s a high concentration of people offering the kinds of services you need to build a criminal scheme,” says Gary Dickson, an FBI agent who worked in Bucharest from 2005 to 2010. “If your specialty is auction frauds, you can find a money pick-up guy. If you’re a money pick-up guy, you can find a buyer for your services.”

Stoica and Frunza both complain that they’re fighting an unstoppable tide with limited resources. But they haven’t been entirely unsuccessful—in fact, the 2008 case that first revealed the anatomy of Râmnicu Vâlcea’s fraud networks stemmed from Stoica’s investigation of a young entrepreneur named Romeo Chita.

Stoica says Chita started out as an arrow in the UK, and he was good. He moved up the ranks and eventually hired a few friends to establish his own ring. The Romanian authorities began investigating him in 2006, when he started buying new cars every few months and going to clubs every night with no apparent source of legitimate income. Chita launched an Internet service provider called NetOne, which authorities believe he was using as a shelter for fraudulent activity. When cops wanted to identify his customers, Stoica says, Chita usually told them that NetOne didn’t keep records.

Western Union signs have multiplied downtown like the Starbucks mermaid circa 2003.
Photo: Nick Waplington

In January 2008, an informant gave Stoica the cell numbers of two men working for Chita. The police tapped the phones, and the next day one of the men sent Chita a text message with money transfer control numbers—unique numeric sequences required to pick up cash. Stoica and his team followed up with surveillance of Chita and his associates, which established what Stoica calls “the money circuit,” the route through which the funds flowed from victims in the US to Chita and others. Prosecutors now allege that the operation turned into something a little more sophisticated than the usual Râmnicu Vâlcea scam. For example, the case against them details a con known as spear phishing—sending email to US companies that appeared to be from the IRS, the Department of Justice, or some other agency. Through Trojan horses attached to these emails, Chita’s group could obtain the companies’ bank account numbers and passwords. Allegedly, they even hired people in Las Vegas—Stoica says some were homeless—to open fake corporate bank accounts and receive the money.

The same month that Stoica began pursuing Chita, a police officer stopped a car for speeding in the Westlake suburb of Cleveland, Ohio. About to write a ticket, the cop noticed some drug paraphernalia in the car and arrested the two men inside. A further search turned up eight cell phones, two computers, fake IDs, two dozen money transfer receipts, and $63,000 in cash. The pair turned out to be Romanian and eventually confessed to being arrows for an organization authorities traced back to Chita. They had spent most of January driving around the Midwest, picking up money from various Western Union and MoneyGram locations. Their confessions led to more wiretaps and surveillance in the US and Romania over the following months, uncovering a network of at least two dozen accomplices.

That summer, Romanian authorities and FBI agents conducted a series of raids on both sides of the Atlantic. Chita spent 14 months in custody before being granted a provisional release pending the completion of his trial, still pending. On an org chart filed in Stoica’s office, Chita’s photo remains at the top.

Class Café is an inviting coffee shop with a terrace that overlooks a quiet street. It’s nearly empty when I walk in—just the owner behind the counter and a young couple at a corner table.

Stoica discouraged me from attempting this meeting, but I wanted to know what an alleged kingpin looks like. I ask the owner if he knows where Chita is, and he offers to call him. After a brief phone conversation, he hangs up and tells me that Chita is in Bucharest. I remind him that Chita isn’t allowed to leave Râmnicu Vâlcea under the terms of his release, and the owner smiles. He spends a few more minutes on the phone, then hangs up again and asks me to sit. Chita is on his way.

I take a table on the terrace. During our tour of town, Stoica had pointed out Chita’s silver Mercedes on the road, so I ignore the green Jaguar that drives up until a man in Bermuda shorts, canvas shoes, and a white T-shirt climbs out, enters the café, and approaches my table. He introduces himself as Chita’s brother, Marian. He licks his lips nervously and fidgets with an iPhone. “Chita’s coming,” he says after lighting a cigarette and making some phone calls. “But he’s a little drunk.”

A few minutes later, Chita walks around the corner and ambles into the café. Boyish, dressed in shorts, a light-blue polo shirt, and flip-flops, he looks more like a college student than a criminal mastermind. Despite the reputation of Râmnicu Vâlcea’s underworld as relatively free of violence, he has brought along some muscle—a young man in dark glasses with a big tattoo on his arm. The bodyguard slams a beer bottle down on the table and flexes his hand, as if getting ready for a boxing match.

Chita shakes my hand dourly and sits down next to me, looking away. Two other men join us. The young couple from the corner comes over to greet Chita with fawning smiles and handshakes. They clearly recognize him, too. The café owner gets up and leaves. As he walks away, he looks at me gravely and says, “Good luck.”

Râmnicu Vâlcea has become the Silicon Valley of online thievery— a place where the clustering of operations makes boot-strapping a criminal start-up easier.
Photo: Nick Waplington

The tattooed man leans toward me ominously. “Were you sent by Barack Obama?” he asks. I say that I wasn’t, and everyone but me lights cigarettes. Marian, getting increasingly jumpy, demands to know my true agenda. Finally, I spell my name and tell him to search for my stories on his iPhone. He Googles me and shows the screen to his brother. Everybody relaxes a bit, and I silently give thanks for wireless broadband.

Marian asks the young couple to translate for Chita, and they agree to stay. Chita has them tell me to stand, then he pats me down, asking if I’m wearing a wire.

“What do you say to the charges against you?” I ask.

“They are fake,” Chita says, in English.

Marian adds, “It’s all bullshit.” For clarification.

Chita continues with his defense in Romanian, and the couple translates enthusiastically. “He doesn’t even know how to speak English, so it is impossible for him to post ads or exchange email with buyers,” the young woman says. “He doesn’t even have an email address,” she says. “How can he do fraud on the Internet?”

I press Chita about the wiretapped conversations, but his tattooed bodyguard interrupts loudly. “You go back to your hotel room, we send you some nice pussy,” he says, raising his hand for a high five that I feel obligated to meet. The two men beside him laugh, and Chita takes a final drag from his cigarette before rising from his chair. He’s in no mood to discuss the evidence. “This interview is over,” Marian says.

They saunter out of the café and onto the sidewalk, looking surprisingly banal for guys accused of organized cybercrime, enjoying the good life with little effort or risk. Officials have dismantled a few fraud rings in recent years—there were just 188 arrests in all of Romania in 2010—but scores remain in business.

I am left with the friendly couple that helped with the translating. The young man says he’s heard about Chita from his friends and has seen his name in the papers. He tells me he has just received a diploma in engineering from an institution in Bucharest and is now looking for a job here in Râmnicu Vâlcea, his hometown. “I haven’t found anything yet,” he says. Thinking about Marian’s Jag and Chita’s Mercedes, I wonder if he’ll consider a job as an arrow. It’s like Frunza told me at the restaurant: “You arrest two of them and 20 new ones take their place,” he said. “We are two police officers, and they are 2,000.”

Yudhijit Bhattacharjee (yudhijit@gmail.com) is a staff writer at Science. He wrote about decoding a spy’s messages in issue 18.02.

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 British government has been training a Bangladeshi paramilitary force condemned by human rights organisations as a “government death squad”, leaked US embassy cables have revealed.

By Fariha Karim and Ian Cobain for the Guardian

Members of the Rapid Action Battalion (RAB), which has been held responsible for hundreds of extra-judicial killings in recent years and is said to routinely use torture, have received British training in “investigative interviewing techniques” and “rules of engagement”.

Details of the training were revealed in a number of cables, released by WikiLeaks, which address the counter-terrorism objectives of the US and UK governments in Bangladesh. One cable makes clear that the US would not offer any assistance other than human rights training to the RAB – and that it would be illegal under US law to do so – because its members commit gross human rights violations with impunity.

Since the RAB was established six years ago, it is estimated by some human rights activists to have been responsible for more than 1,000 extra-judicial killings, described euphemistically as “crossfire” deaths. In September last year the director general of the RAB said his men had killed 577 people in “crossfire”. In March this year he updated the figure, saying they had killed 622 people.

The RAB’s use of torture has also been exhaustively documented by human rights organisations. In addition, officers from the paramilitary force are alleged to have been involved in kidnap and extortion, and are frequently accused of taking large bribes in return for carrying out crossfire killings.

However, the cables reveal that both the British and the Americans, in their determination to strengthen counter-terrorism operations in Bangladesh, are in favour of bolstering the force, arguing that the “RAB enjoys a great deal of respect and admiration from a population scarred by decreasing law and order over the last decade”. In one cable, the US ambassador to Dhaka, James Moriarty, expresses the view that the RAB is the “enforcement organisation best positioned to one day become a Bangladeshi version of the US Federal Bureau of Investigation”.

In another cable, Moriarty quotes British officials as saying they have been “training RAB for 18 months in areas such as investigative interviewing techniques and rules of engagement”. Asked about the training assistance for the RAB, the Foreign Office said the UK government “provides a range of human rights assistance” in the country. However, the RAB’s head of training, Mejbah Uddin, told the Guardian that he was unaware of any human rights training since he was appointed last summer.

The cables make clear that British training for RAB officers began three years ago under the last Labour government.

However, RAB officials confirmed independently of the cables that they had taken part in a series of courses and workshops as recently as October, five months after the formation of the coalition government. Asked whether ministers had approved the training programme, the Foreign Office said only that William Hague, the foreign secretary, and other ministers, had been briefed on counter-terrorism spending.

The US ambassador explains in the cables that the US government is “constrained by RAB’s alleged human rights violations, which have rendered the organisation ineligible to receive training or assistance” under laws which prohibit American funding or training for overseas military units which abuse human rights with impunity.

Human rights organisations say the RAB cannot be reformed, noting that its human rights record has deterioriated still further in the last 12 months. Human Rights Watch has repeatedly described the RAB as a government death squad.

Brad Adams, the organisation’s Asia director, said: “RAB is a Latin American-style death squad dressed up as an anti-crime force. The British government has let its desire for a functional counter-terrorism partner in Bangladesh blind it to the risks of working with RAB, and the legitimacy that it gives to RAB inside Bangladesh. Furthermore, it is not clear that the British government has ever made it a priority at the highest levels to tell RAB that if it doesn’t change, it will not co-operate with it.”

Amnesty International has also repeatedly condemned the RAB, while the Bangladeshi human rights organisation Odhikar has painstakingly documented the RAB’s involvement in extra-judicial killings and torture since the creation of the force in March 2004.

Asked to comment on the rights groups’ concern about the RAB, the Foreign Office said: “We do not discuss the detail of operational counter-terrorism cooperation. Counter-terrorism assistance is fully in line with our laws and values.” At least some of the British training has been conducted by serving British police officers, working under the auspices of the National Policing Improvement Agency (NPIA), which was established in 2007 to build policing capacity and standards. Recent courses for RAB have been provided by officers from West Mercia and Humberside Police.

Asked whether it believed it was appropriate for British officers to be training members of an organisation condemned as “a government death squad”, and whether courses in investigative interviewing techniques might not render torture more effective, an NPIA spokesman said the courses had been approved by the government and by the Association of Chief Police Officers.

“The NPIA has given limited support to the Bangladeshi Police and the RAB in technical areas of policing such as forensic awareness, management of crime scenes and recovery of evidence. Throughout the training we have emphasised the importance of respecting the human rights of witnesses, suspects and victims.”The purpose of our sanctioned engagement is to support the development and improvement of professional policing that supports democratic, human rights-based practices linked to the rule of law in countries that may have different laws, faiths and policing practices from our own.”

It is understood that there have been disagreements within the Foreign Office about the British government’s involvement with the RAB. Some officials have argued that the partnership with the RAB is an essential component of the UK’s counter-terrorism strategy in the region, while others have expressed concern that the relationship could prove damaging to Britain’s reputation.

Successive Bangladeshi governments have promised to end the RAB’s use of murder. The current government promised in its manifesto that it would end all extra-judicial killings, but they have continued following its election two years ago.In October last year, the shipping minister, Shahjahan Khan, speaking in a discussion organised by the BBC, said: “There are incidents of trials that are not possible under the laws of the land. The government will need to continue with extra-judicial killings, commonly called crossfire, until terrorist activities and extortion are uprooted.”

In December last year the high court in Dhaka ruled that such killings must be brought to a halt following litigation by victims’ familes and human rights groups, but they continue on an almost weekly basis. Most of the victims are young men, some are alleged to be petty criminals or are said to be left-wing activists, and the killings invariably take place in the middle of the night.

In the most recent “crossfire” killings, the RAB reported that it had shot dead Mohammad Mamun, 25, in the town of Tangail, shortly after midnight on Monday, and that 90 minutes later its officers in Dhaka, 50 miles to the south, had shot dead a second man, Taku Alam, 30. Today the RAB announced it had shot dead a 45-year-old man, Anisur Rahman, said to be a member of the Communist party in the west of the country.

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.

See the paper: State and Terrorist Conspiracies

For additional analysis, see here.

By Michel Bauwens for the P2P Foundation

Analysis:

(nearly quoted in full)

“Most of the news media seems to be losing their minds over Wikileaks without actually reading these essays, even though he describes the function and aims of an organization like Wikileaks in pretty straightforward terms. But, to summarize, he begins by describing a state like the US as essentially an authoritarian conspiracy, and then reasons that the practical strategy for combating that conspiracy is to degrade its ability to conspire, to hinder its ability to “think” as a conspiratorial mind. The metaphor of a computing network is mostly implicit, but utterly crucial: he seeks to oppose the power of the state by treating it like a computer and tossing sand in its diodes.

He begins by positing that conspiracy and authoritarianism go hand in hand, arguing that since authoritarianism produces resistance to itself — to the extent that its authoritarianism becomes generally known — it can only continue to exist and function by preventing its intentions (the authorship of its authority?) from being generally known. It inevitably becomes, he argues, a conspiracy:

Authoritarian regimes give rise to forces which oppose them by pushing against the individual and collective will to freedom, truth and self realization. Plans which assist authoritarian rule, once discovered, induce resistance. Hence these plans are concealed by successful authoritarian powers. This is enough to define their behavior as conspiratorial.

The problem this creates for the government conspiracy then becomes the organizational problem it must solve: if the conspiracy must operate in secrecy, how is it to communicate, plan, make decisions, discipline itself, and transform itself to meet new challenges? The answer is: by controlling information flows. After all, if the organization has goals that can be articulated, articulating them openly exposes them to resistance. But at the same time, failing to articulate those goals to itself deprives the organization of its ability to process and advance them. Somewhere in the middle, for the authoritarian conspiracy, is the right balance of authority and conspiracy.

His model for imagining the conspiracy, then, is not at all the cliché that people mean when they sneer at someone for being a “conspiracy theorist.” After all, most the “conspiracies” we’re familiar with are pure fantasies, and because the “Elders of Zion” or James Bond’s SPECTRE have never existed, their nonexistence becomes a cudgel for beating on people that would ever use the term or the concept. For Assange, by contrast, a conspiracy is something fairly banal, simply any network of associates who act in concert by hiding their concerted association from outsiders, an authority that proceeds by preventing its activities from being visible enough to provoke counter-reaction. It might be something as dramatic as a loose coalition of conspirators working to start a war with Iraq/n, or it might simply be the banal, everyday deceptions and conspiracies of normal diplomatic procedure.

He illustrates this theoretical model by the analogy of a board with nails hammered into it and then tied together with twine:

First take some nails (“conspirators”) and hammer them into a board at random. Then take twine (“communication”) and loop it from nail to nail without breaking. Call the twine connecting two nails a link. Unbroken twine means it is possible to travel from any nail to any other nail via twine and intermediary nails…Information flows from conspirator to conspirator. Not every conspirator trusts or knows every other conspirator even though all are connected. Some are on the fringe of the conspiracy, others are central and communicate with many conspirators and others still may know only two conspirators but be a bridge between important sections or groupings of the conspiracy… Conspirators are often discerning, for some trust and depend each other, while others say little. Important information flows frequently through some links, trivial information through others. So we expand our simple connected graph model to include not only links, but their “importance.” … Return to our board-and-nails analogy. Imagine a thick heavy cord between some nails and fine light thread between others. Call the importance, thickness or heaviness of a link its weight. Between conspirators that never communicate the weight is zero. The “importance” of communication passing through a link is difficult to evaluate apriori, since its true value depends on the outcome of the conspiracy. We simply say that the “importance” of communication contributes to the weight of a link in the most obvious way; the weight of a link is proportional to the amount of important communication flowing across it. Questions about conspiracies in general won’t require us to know the weight of any link, since that changes from conspiracy to conspiracy.

Such a network will not be organized by a flow chart, nor would it ever produce a single coherent map of itself (without thereby hastening its own collapse). It is probably fairly acephalous, as a matter of course: if it had a single head (or a singular organizing mind which could survey and map the entirety), then every conspirator would be one step from the boss and a short two steps away from every other member of the conspiracy. A certain amount of centralization is necessary, in other words (otherwise there is no conspiracy), but too much centralization makes the system vulnerable.

To use The Wire as a ready-to-hand example, imagine if Avon Barksdale was communicating directly with Bodie. All you would ever have to do is turn one person — any person — and you would be one step away from the boss, whose direct connection to everyone else in the conspiracy would allow you to sweep them all up at once. Obviously, no effective conspiracy would ever function this way. Remember Stringer Bell’s “is you taking notes on a criminal fucking conspiracy?” To function effectively, the primary authority has to be disassociated from all other members of the conspiracy, layers of mediation which have to be as opaque as possible to everyone concerned (which a paper trail unhelpfully clarifies). But while the complexity of these linkages shield the directing authority from exposure, they also limit Avon Barksdale’s ability to control what’s going on around him. Businesses run on their paperwork! And the more walls you build around him, the less he might be able to trust his lieutenants, and the less they’ll require (or tolerate) him.

This, Assange reasons, is a way to turn a feature into a bug. And his underlying insight is simple and, I think, compelling: while an organization structured by direct and open lines of communication will be much more vulnerable to outside penetration, the more opaque it becomes to itself (as a defense against the outside gaze), the less able it will be to “think” as a system, to communicate with itself. The more conspiratorial it becomes, in a certain sense, the less effective it will be as a conspiracy. The more closed the network is to outside intrusion, the less able it is to engage with that which is outside itself (true hacker theorizing).

His thinking is not quite as abstract as all that, of course; as he quite explicitly notes, he is also understanding the functioning of the US state by analogy with successful terrorist organizations. If you’ve seen The Battle of Algiers, for example, think of how the French counter-terrorist people work to produce an organizational flow chart of the Algerian resistance movement: since they had overwhelming military superiority, their inability to crush the FLN resided in their inability to find it, an inability which the FLN strategically works to impede by decentralizing itself. Cutting off one leg of the octopus, the FLN realized, wouldn’t degrade the system as a whole if the legs all operated independently. The links between the units were the vulnerable spots for the system as a whole, so those were most closely and carefully guarded and most hotly pursued by the French. And while the French won the battle of Algiers, they lost the war, because they adopted the tactics Assange briefly mentions only to put aside:

How can we reduce the ability of a conspiracy to act?…We can split the conspiracy, reduce or eliminating important communication between a few high weight links or many low weight links. Traditional attacks on conspiratorial power groupings, such as assassination, have cut high weight links by killing, kidnapping, blackmailing or otherwise marginalizing or isolating some of the conspirators they were connected to.

This is the US’s counterterrorism strategy — find the men in charge and get ’em — but it’s not what Assange wants to do: such a program would isolate a specific version of the conspiracy and attempt to destroy the form of it that already exists, which he argues will have two important limitations. For one thing, by the time such a conspiracy has a form which can be targeted, its ability to function will be quite advanced. As he notes:

“A man in chains knows he should have acted sooner for his ability to influence the actions of the state is near its end. To deal with powerful conspiratorial actions we must think ahead and attack the process that leads to them since the actions themselves can not be dealt with.”

By the time a cancer has metastasized, in other words, antioxidents are no longer effective, and even violent chemotherapy is difficult. It’s better, then, to think about how conspiracies come into existence so as to prevent them from forming in the first place (whereas if you isolate the carcinogen early enough, you don’t need to remove the tumor after the fact). Instead, he wants to address the aggregative process itself, by impeding the principle of its reproduction: rather than trying to expose and cut particular links between particular conspirators (which does little to prevent new links from forming and may not disturb the actual functioning of the system as a whole), he wants to attack the “total conspiratorial power” of the entire system by figuring out how to reduce its total ability to share and exchange information among itself, in effect, to slow down its processing power. As he puts it:

Conspiracies are cognitive devices. They are able to outthink the same group of individuals acting alone Conspiracies take information about the world in which they operate (the conspiratorial environment), pass through the conspirators and then act on the result. We can see conspiracies as a type of device that has inputs (information about the environment), a computational network (the conspirators and their links to each other) and outputs (actions intending to change or maintain the environment).

Because he thinks of the conspiracy as a computational network, he notes in an aside that one way to weaken its cognitive ability would be to degrade the quality of its information:

Since a conspiracy is a type of cognitive device that acts on information acquired from its environment, distorting or restricting these inputs means acts based on them are likely to be misplaced. Programmers call this effect garbage in, garbage out. Usually the effect runs the other way; it is conspiracy that is the agent of deception and information restriction. In the US, the programmer’s aphorism is sometimes called “the Fox News effect”.

I’m not sure this is what he means, but it’s worth reflecting that the conspiracy’s ability to deceive others through propaganda can also be the conspiracy’s tendency to deceive itself by its own propaganda. So many people genuinely drink the Kool-Aid, after all. Would our super-spies in Afghanistan ever have been so taken in by the imposter Taliban guy if they didn’t, basically, believe their own line of propaganda, if they didn’t convince themselves — even provisionally — that we actually are winning the war against Talibothra? The same is true of WMD; while no one in possession of the facts could rationally conclude that Saddam Hussein then (or Iran now) are actually, positively in pursuit of WMD’s, this doesn’t mean that the people talking about ticking time bombs don’t actually believe that they are. It just means they are operating with bad information about the environment. Sometimes this works in their favor, but sometimes it does not: if Obama thinks Afghanistan is winnable, it may sink his presidency, for example, while the belief of his advisors that the economy would recover if the government rescued only the banks almost certainly lost the midterm elections for the Democrats (and was the death-knell for so many of the Blue Dogs who were driving that particular policy choice). Whether this actually hurts the conspiracy is unclear; those Blue Dogs might have lost their seats, but most of them will retire from public service to cushy jobs supported by the sectors they supported while they were in public service. And lots of successful politicians do nothing but fail.

This is however, not where Assange’s reasoning leads him. He decides, instead, that the most effective way to attack this kind of organization would be to make “leaks” a fundamental part of the conspiracy’s information environment. Which is why the point is not that particular leaks are specifically effective. Wikileaks does not leak something like the “Collateral Murder” video as a way of putting an end to that particular military tactic; that would be to target a specific leg of the hydra even as it grows two more. Instead, the idea is that increasing the porousness of the conspiracy’s information system will impede its functioning, that the conspiracy will turn against itself in self-defense, clamping down on its own information flows in ways that will then impede its own cognitive function. You destroy the conspiracy, in other words, by making it so paranoid of itself that it can no longer conspire:

The more secretive or unjust an organization is, the more leaks induce fear and paranoia in its leadership and planning coterie. This must result in minimization of efficient internal communications mechanisms (an increase in cognitive “secrecy tax”) and consequent system-wide cognitive decline resulting in decreased ability to hold onto power as the environment demands adaption. Hence in a world where leaking is easy, secretive or unjust systems are nonlinearly hit relative to open, just systems. Since unjust systems, by their nature induce opponents, and in many places barely have the upper hand, mass leaking leaves them exquisitely vulnerable to those who seek to replace them with more open forms of governance.

The leak, in other words, is only the catalyst for the desired counter-overreaction; Wikileaks wants to provoke the conspiracy into turning off its own brain in response to the threat. As it tries to plug its own holes and find the leakers, he reasons, its component elements will de-synchronize from and turn against each other, de-link from the central processing network, and come undone. Even if all the elements of the conspiracy still exist, in this sense, depriving themselves of a vigorous flow of information to connect them all together as a conspiracy prevents them from acting as a conspiracy. As he puts it:

If total conspiratorial power is zero, then clearly there is no information flow between the conspirators and hence no conspiracy. A substantial increase or decrease in total conspiratorial power almost always means what we expect it to mean; an increase or decrease in the ability of the conspiracy to think, act and adapt…An authoritarian conspiracy that cannot think is powerless to preserve itself against the opponents it induces.

In this sense, most of the media commentary on the latest round of leaks has totally missed the point. After all, why are diplomatic cables being leaked? These leaks are not specifically about the war(s) at all, and most seem to simply be a broad swath of the everyday normal secrets that a security state keeps from all but its most trusted hundreds of thousands of people who have the right clearance. Which is the point: Assange is completely right that our government has conspiratorial functions. What else would you call the fact that a small percentage of our governing class governs and acts in our name according to information which is freely shared amongst them but which cannot be shared amongst their constituency? And we all probably knew that this was more or less the case; anyone who was surprised that our embassies are doing dirty, secretive, and disingenuous political work as a matter of course is naïve. But Assange is not trying to produce a journalistic scandal which will then provoke red-faced government reforms or something, precisely because no one is all that scandalized by such things any more. Instead, he is trying to strangle the links that make the conspiracy possible, to expose the necessary porousness of the American state’s conspiratorial network in hopes that the security state will then try to shrink its computational network in response, thereby making itself dumber and slower and smaller.

Early responses seem to indicate that Wikileaks is well on its way to accomplishing some of its goals. As Simon Jenkins put it (in a great piece in its own right) “The leaks have blown a hole in the framework by which states guard their secrets.” And if the diplomats quoted by Le Monde are right that, “we will never again be able to practice diplomacy like before,” this is exactly what Wikileaks was trying to do. It’s sort of pathetic hearing diplomats and government shills lament that the normal work of “diplomacy” will now be impossible, like complaining that that the guy boxing you out is making it hard to get rebounds. Poor dears. If Assange is right to point out that his organization has accomplished more state scrutiny than the entire rest of the journalistic apparatus combined, he’s right but he’s also deflecting the issue: if Wikileaks does some of the things that journalists do, it also does some very different things. Assange, as his introductory remarks indicate quite clearly, is in the business of “radically shift[ing] regime behavior.”

If Wikileaks is a different kind of organization than anything we’ve ever seen before, it’s interesting to see him put himself in line with more conventional progressivism. Assange isn’t off base, after all, when he quotes Theodore Roosevelt’s words from his 1912 Progressive party presidential platform as the epigraph to the first essay; Roosevelt realized a hundred years ago that “Behind the ostensible government sits enthroned an invisible government owing no allegiance and acknowledging no responsibility to the people,” and it was true, then too, that “To destroy this invisible government, to befoul this unholy alliance between corrupt business and corrupt politics is the first task of statesmanship.” Assange is trying to shit all over this unholy alliance in ways that the later and more radical Roosevelt would likely have commended.

It’s worth closing, then, by recalling that Roosevelt also coined the term “muckraker,” and that he did so as a term of disparagement. Quoting from Pilgrim’s Progress, he cited the example of the “Muck-Raker” who could only look down, whose perspective was so totally limited to the “muck” that it was his job to rake, he had lost all ability to see anything higher. Roosevelt, as always, is worth quoting:

In Bunyan’s Pilgrim’s Progress you may recall the description of the Man with the Muck-rake, the man who could look no way but downward, with the muckrake in his hand; who was offered a celestial crown for his muck-rake, but who would neither look up nor regard the crown he was offered, but continued to rake to himself the filth of the floor…the Man with the Muck-rake is set forth as the example of him whose vision is fixed on carnal instead of on spiritual things. Yet he also typifies the man who in this life consistently refuses to see aught that is lofty, and fixes his eyes with solemn intentness only on that which is vile and debasing. Now, it is very necessary that we should not flinch from seeing what is s vile and debasing. There is filth on the floor, and it must be scraped up with the muck-rake; and there are times and places where this service is the most needed of all the services that can be performed. But the man who never does anything else, who never thinks or speaks or writes save of his feats with the muck-rake, speedily becomes, not a help to society, not an incitement to good, but one of the most potent forces for evil. There are, in the body politic, economic, and social, many and grave evils, and there is urgent necessity for the sternest war upon them. There should be relentless exposure of and attack upon every evil man, whether politician or business man, every evil practice, whether in politics, in business, or in social life. I hail as a benefactor every writer or speaker, every man who, on the platform, or in book, magazine, or newspaper, with merciless severity makes such attack, provided always that he in his turn remembers that the attack is of use only if it is absolutely truthful…

Roosevelt was many things when he uttered those words, but he was not wrong. There is a certain vicious amorality about the Mark Zuckerberg-ian philosophy that all transparency is always and everywhere a good thing, particularly when it’s uttered by the guy who’s busily monetizing your radical transparency. And the way most journalists “expose” secrets as a professional practice — to the extent that they do — is just as narrowly selfish: because they publicize privacy only when there is profit to be made in doing so, they keep their eyes on the valuable muck they are raking, and learn to pledge their future professional existence on a continuing and steady flow of it. In muck they trust.

According to his essay, Julian Assange is trying to do something else. Because we all basically know that the US state — like all states — is basically doing a lot of basically shady things basically all the time, simply revealing the specific ways they are doing these shady things will not be, in and of itself, a necessarily good thing. In some cases, it may be a bad thing, and in many cases, the provisional good it may do will be limited in scope. The question for an ethical human being — and Assange always emphasizes his ethics — has to be the question of what exposing secrets will actually accomplish, what good it will do, what better state of affairs it will bring about. And whether you buy his argument or not, Assange has a clearly articulated vision for how Wikileaks’ activities will “carry us through the mire of politically distorted language, and into a position of clarity,” a strategy for how exposing secrets will ultimately impede the production of future secrets. The point of Wikileaks — as Assange argues — is simply to make Wikileaks unnecessary”.

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