Friday, May 25, 2012
Pseudo Research Links Vaccines to Health Problems
A friend sent me a link to a website that spoke of a study that supposedly proves that vaccinated children are more prone to allergies and other health problems than unvaccinated children. This study, known as the Bachmair vaccination study,was not published in a peer-reviewed journal. It compares data drawn from an online survey to data from a different scientific survey of German children and adolescents. The online survey was taken from visitors to an anti-vaccine website. This supposed study includes no methods section and no statistical analysis. Online surveys are notoriously biased and unscientific. An online survey of visitors to an anti-vaccine website will be expected to have results that support an anti-vaccine viewpoint. Vaccines have saved millions of children from the ravages of communicable diseases. Perhaps vaccinated children do actually have more allergies, herpes, seizures, and migraines than unvaccinated children, as this study suggests, but it offers no proof. This pseudo research emphasizes the need for parents and concerned citizens to be critical readers of Internet sites.
Saturday, December 31, 2011
David Brooks on American Politics
David Brooks has an interesting perspective on American politics and public policy. A New York Times Op-Ed columnist, his viewpoint can be described as moderately conservative (a vanishing breed in contemporary American politics). His commentary is informed by a humanities and social sciences perspective that is rare among political analysts today. I earlier blogged about his criticism of the current American meritocracy. I want to talk today about two of his recent columns that provide an interesting perspective on what’s wrong with our political thinking. While he doesn’t provide specific solutions, he talks about some failings among both parties, along with how we need to change our thinking about what we want government to do. As we enter the election year 2012, in which Americans will choose between the same tired and failed alternatives, it’s important to think about our political problems in a different way, as Brooks does.
His first article entitled The Two Moons, is named after Samuel Lubell’s concept of a “political solar system.” Lubell, writing in the 1950’s, proposed the idea that at any moment there’s a Sun Party (the majority party) and a Moon Party (the minority party). The Sun Party drives the agenda, and the Moon Party (which shines by reflecting the Sun’s rays) opposes the Sun Party. During the New Deal, the Democrats were the Sun Party. During the Reagan Revolution, the Republicans were. Between 1996 and 2004, the two parties were tied. This was a transition time, in which from historical experience a Sun Party usually emerges. But no Sun Party emerged. No party was able to take the lead; they both are now Moon Parties. Both Republicans and Democrats have record low approval ratings. “Neither party has been able to rally the country behind its vision of government.”
Having two simultaneous minority parties leads to strange outcomes. Both parties embrace minority mentalities. Democrats feel oppressed by big business and big finance, while Republicans feel oppressed by big government and the big liberal establishment (the media, academics, judges, artists, Hollywood, etc.). Neither side wants to compromise, feeling that the outside world, and especially members of the opposing party, are hostile. They instinctively protect their special interests (labor unions, the poor, the old, and minorities for Democrats; the rich, big business, big finance, and evangelicals for Republicans), and refuse to engage or try to convert outsiders. Neither party engages in serious internal debates, and moderates are no longer welcome.
The Two Moon era is volatile. Voters reject one party, then two years later reject the other party. That happened in the 2008 and 2010 elections, which had a historically large shift from Democrat to Republican. Usually, minority parties suffer a string of election defeats, promoting modernization and revision. The Republicans’ defeats in 2006 and 2008 did help promote internal change via the Tea Party. But rather than owning up to the failures of their neoconservative ideology, and moving more to the center, Tea Party Republicans pushed the party to an extreme libertarian agenda. The Republicans’ 2010 victory encouraged them to act like a Sun Party, trying to force their Tea Party agenda, but were stymied by the fact that they were not a true majority party, and that Democrats controlled the Senate and Presidency. The Democrats’ defeat in 2010, along with subsequent Republican intransigence, is making the Democrats become more extreme. Even if they win big in 2012, however, they do not have the broad-based support to become a Sun Party.
How will the Two Moon era become resolved? Brooks suggests either a third party or a crisis. A third party faces enormous obstacles in the American political context, as discussed in this article. A third-party presidential run has always lost, but sometimes (e.g. Teddy Roosevelt in 1912, or Ross Perot in 1992) can spoil an election. Even in the unlikely event that a third-party candidate can win the election, he’ll have to govern with a Congress in which almost all members are Republicans or Democrats. For a third party to make fundamental changes in government, it needs to control both the executive and legislative branch, which the American political system makes virtually impossible.
This leaves a crisis as a way to break the Two Moon deadlock. It’s possible that a financial panic and/or war will force some major political change. Exactly how the events will unfold and what the responses will be are impossible to determine, but the American political system will have to undergo a radical (and painful) transformation for the Two Moon deadlock to become resolved.
* * *
Brooks’ second article is entitled Midlife Crisis Economics. Brooks criticizes the Obama’s administration’s historical accuracy. When the administration first came to power in 2009, it compared the current situation to the 1930’s, and promoted a second New Deal. Obamacare was a product of this thinking, a successor of ambitious social legislation like Social Security. The problem is that the public’s perception of government has radically changed since the New Deal. “Today, Americans are more likely to fear government than be reassured by it.”
The Obama Administration then switched historical analogies from the New Deal to the progressive era at the beginning of the 20th century (e.g. Obama’s “Roosevelt Speech” in Kansas). There are some similarities between today and a century ago. “Then, as now, we are seeing great concentrations of wealth, especially at the top.” But the differences outweigh the similarities. The economy was much different back then, a vibrant jobs machine at the height of the industrial era. The information age we live in today is not a jobs machine. The industrial decline and elimination of jobs due to outsourcing/offshoring/automation was taking place well before the current recession. Factories that used to employ 1000 workers can now produce more products while employing fewer than 100 workers.
Inequality, while due partially to government policy, has a structural economic component that would be difficult to reverse (short of communism). Inequality is growing in all developed countries, including ones (e.g. Sweden and Germany) that have much more generous welfare states.
Brooks succinctly summarizes the essential differences between today and a century ago: “In the progressive era, the economy was in its adolescence and the task was to control it. Today the economy is middle-aged; the task is to rejuvenate it.” A century ago there were few or no government agencies, institutions, or regulations to protect workers, the sick, the disabled, the old, children, minorities, etc. Today, we have more than enough government; the challenge is to make government more effective. We need to reform existing programs to make them deliver more services at less cost.
Brooks also talks about the moral differences between today and the progressive era. The beginning of the twentieth century was still a time of Victorian culture, with its strict moral code. Individuals and the government taking on debt that they had no hope of repaying would have been considered sinful. Illegitimacy and divorce were culturally prohibited and very rare.
These moral differences have major practical consequences. It’s obvious today what harm the contemporary embracing of public and private debt has caused our economy. Subprime and other risky mortgages led directly to the 2008 financial crisis and subsequent recession. Deficit financing that the American federal government has been doing routinely for decades has led to a buildup of unsustainable debt, and is preventing the government from responding in an appropriate way to the magnitude of the current crisis. The fact that 40% of American children are born out of wedlock leads to a number of social and mental health problems that were unknown a century ago. These problems, including crime, juvenile delinquency, drug abuse, dangerous neighborhoods, failed schools, etc., forces the government to intervene in family life and child upbringing, and spend billions of dollars that it otherwise would not have had to spend.
My favorite quote from this article is the following: “One hundred years ago, we had libertarian economics but conservative values. Today we have oligarchic economics and libertarian moral values — a bad combination.” It’s important to understand that the last (and only) time that libertarian economics was ever practiced, during the late nineteenth and early twentieth centuries in America, Britain, and (to a lesser extent) in other Western European countries, was a time of strict conservative Victorian morality. There is no historical example of a combination of libertarian economics and libertarian morality. There is no contemporary example of libertarian economics. Contemporary countries with strong, rapidly growing, export-oriented economies, e.g. China, are anything but libertarian.
Ron Paul’s fans need to understand that they are advocating an experimental system, something never before tried. They also need to understand that the rise of American government deficit spending, regulation, waste, inefficiency, and all the other things they complain about occurred during a time of increasing libertarian morality. It was the 1960’s embrace of individual social liberty, of personal and sexual freedom from authority, of licentiousness, that represented a cultural revolution, something unique in history. The trend for increasing individual social freedom and autonomy has only increased since the 1960’s. During that period, government deficit spending, regulation, litigation, interference with the economy, waste, fraud, and incompetence has also increased. The two are clearly correlated; it’s impossible to prove whether libertarian morality caused the explosion of government spending and regulation.
Note that Brooks said that we have “oligarchic economics” in America today, not “socialist economics.” The distinction is important. It implies that libertarian ideas did in fact influence not only social and cultural life, but also the economy. Instead of moving toward the libertarian ideal of limited government, however, we moved toward a corrupt, oligarchic form of government, one in which the rich and powerful use a bloated government to become more rich and powerful. The most egregious example is explosion in growth of the financial sector, which occurred after libertarian-inspired deregulation. The investment banks won the freedom to gamble on risky mortgage-based securities, a gamble that led to the 2008 crisis. Unlike in a truly free market, they felt secure enough to make these gambles knowing that the government would bail them out.
As usual, Brooks has no specific solutions to the problems he talks about. “The job is to restore old disciplines, strip away decaying structures and reform the welfare state. The country needs a productive midlife crisis.” I’d agree with that, but how is it going to happen? How can we reform an oligarchic government while maintaining libertarian moral values? How can people from different socioeconomic status, intelligence, race, age, ethnicity, culture, sexual orientation, political beliefs, religious beliefs, etc. come together and agree on anything, when libertarian morality tells them to pursue their own self interest no matter the social cost? Will they be willing to make sacrifices for the common good, whether it take the form of accepting fewer government benefits, more taxation, or a combination of the two? I doubt it. My view is that the “productive midlife crisis” our country needs must include a serious re-evaluation of the permissive morality that has been dominant since the 1960’s.
His first article entitled The Two Moons, is named after Samuel Lubell’s concept of a “political solar system.” Lubell, writing in the 1950’s, proposed the idea that at any moment there’s a Sun Party (the majority party) and a Moon Party (the minority party). The Sun Party drives the agenda, and the Moon Party (which shines by reflecting the Sun’s rays) opposes the Sun Party. During the New Deal, the Democrats were the Sun Party. During the Reagan Revolution, the Republicans were. Between 1996 and 2004, the two parties were tied. This was a transition time, in which from historical experience a Sun Party usually emerges. But no Sun Party emerged. No party was able to take the lead; they both are now Moon Parties. Both Republicans and Democrats have record low approval ratings. “Neither party has been able to rally the country behind its vision of government.”
Having two simultaneous minority parties leads to strange outcomes. Both parties embrace minority mentalities. Democrats feel oppressed by big business and big finance, while Republicans feel oppressed by big government and the big liberal establishment (the media, academics, judges, artists, Hollywood, etc.). Neither side wants to compromise, feeling that the outside world, and especially members of the opposing party, are hostile. They instinctively protect their special interests (labor unions, the poor, the old, and minorities for Democrats; the rich, big business, big finance, and evangelicals for Republicans), and refuse to engage or try to convert outsiders. Neither party engages in serious internal debates, and moderates are no longer welcome.
The Two Moon era is volatile. Voters reject one party, then two years later reject the other party. That happened in the 2008 and 2010 elections, which had a historically large shift from Democrat to Republican. Usually, minority parties suffer a string of election defeats, promoting modernization and revision. The Republicans’ defeats in 2006 and 2008 did help promote internal change via the Tea Party. But rather than owning up to the failures of their neoconservative ideology, and moving more to the center, Tea Party Republicans pushed the party to an extreme libertarian agenda. The Republicans’ 2010 victory encouraged them to act like a Sun Party, trying to force their Tea Party agenda, but were stymied by the fact that they were not a true majority party, and that Democrats controlled the Senate and Presidency. The Democrats’ defeat in 2010, along with subsequent Republican intransigence, is making the Democrats become more extreme. Even if they win big in 2012, however, they do not have the broad-based support to become a Sun Party.
How will the Two Moon era become resolved? Brooks suggests either a third party or a crisis. A third party faces enormous obstacles in the American political context, as discussed in this article. A third-party presidential run has always lost, but sometimes (e.g. Teddy Roosevelt in 1912, or Ross Perot in 1992) can spoil an election. Even in the unlikely event that a third-party candidate can win the election, he’ll have to govern with a Congress in which almost all members are Republicans or Democrats. For a third party to make fundamental changes in government, it needs to control both the executive and legislative branch, which the American political system makes virtually impossible.
This leaves a crisis as a way to break the Two Moon deadlock. It’s possible that a financial panic and/or war will force some major political change. Exactly how the events will unfold and what the responses will be are impossible to determine, but the American political system will have to undergo a radical (and painful) transformation for the Two Moon deadlock to become resolved.
* * *
Brooks’ second article is entitled Midlife Crisis Economics. Brooks criticizes the Obama’s administration’s historical accuracy. When the administration first came to power in 2009, it compared the current situation to the 1930’s, and promoted a second New Deal. Obamacare was a product of this thinking, a successor of ambitious social legislation like Social Security. The problem is that the public’s perception of government has radically changed since the New Deal. “Today, Americans are more likely to fear government than be reassured by it.”
The Obama Administration then switched historical analogies from the New Deal to the progressive era at the beginning of the 20th century (e.g. Obama’s “Roosevelt Speech” in Kansas). There are some similarities between today and a century ago. “Then, as now, we are seeing great concentrations of wealth, especially at the top.” But the differences outweigh the similarities. The economy was much different back then, a vibrant jobs machine at the height of the industrial era. The information age we live in today is not a jobs machine. The industrial decline and elimination of jobs due to outsourcing/offshoring/automation was taking place well before the current recession. Factories that used to employ 1000 workers can now produce more products while employing fewer than 100 workers.
Inequality, while due partially to government policy, has a structural economic component that would be difficult to reverse (short of communism). Inequality is growing in all developed countries, including ones (e.g. Sweden and Germany) that have much more generous welfare states.
Brooks succinctly summarizes the essential differences between today and a century ago: “In the progressive era, the economy was in its adolescence and the task was to control it. Today the economy is middle-aged; the task is to rejuvenate it.” A century ago there were few or no government agencies, institutions, or regulations to protect workers, the sick, the disabled, the old, children, minorities, etc. Today, we have more than enough government; the challenge is to make government more effective. We need to reform existing programs to make them deliver more services at less cost.
Brooks also talks about the moral differences between today and the progressive era. The beginning of the twentieth century was still a time of Victorian culture, with its strict moral code. Individuals and the government taking on debt that they had no hope of repaying would have been considered sinful. Illegitimacy and divorce were culturally prohibited and very rare.
These moral differences have major practical consequences. It’s obvious today what harm the contemporary embracing of public and private debt has caused our economy. Subprime and other risky mortgages led directly to the 2008 financial crisis and subsequent recession. Deficit financing that the American federal government has been doing routinely for decades has led to a buildup of unsustainable debt, and is preventing the government from responding in an appropriate way to the magnitude of the current crisis. The fact that 40% of American children are born out of wedlock leads to a number of social and mental health problems that were unknown a century ago. These problems, including crime, juvenile delinquency, drug abuse, dangerous neighborhoods, failed schools, etc., forces the government to intervene in family life and child upbringing, and spend billions of dollars that it otherwise would not have had to spend.
My favorite quote from this article is the following: “One hundred years ago, we had libertarian economics but conservative values. Today we have oligarchic economics and libertarian moral values — a bad combination.” It’s important to understand that the last (and only) time that libertarian economics was ever practiced, during the late nineteenth and early twentieth centuries in America, Britain, and (to a lesser extent) in other Western European countries, was a time of strict conservative Victorian morality. There is no historical example of a combination of libertarian economics and libertarian morality. There is no contemporary example of libertarian economics. Contemporary countries with strong, rapidly growing, export-oriented economies, e.g. China, are anything but libertarian.
Ron Paul’s fans need to understand that they are advocating an experimental system, something never before tried. They also need to understand that the rise of American government deficit spending, regulation, waste, inefficiency, and all the other things they complain about occurred during a time of increasing libertarian morality. It was the 1960’s embrace of individual social liberty, of personal and sexual freedom from authority, of licentiousness, that represented a cultural revolution, something unique in history. The trend for increasing individual social freedom and autonomy has only increased since the 1960’s. During that period, government deficit spending, regulation, litigation, interference with the economy, waste, fraud, and incompetence has also increased. The two are clearly correlated; it’s impossible to prove whether libertarian morality caused the explosion of government spending and regulation.
Note that Brooks said that we have “oligarchic economics” in America today, not “socialist economics.” The distinction is important. It implies that libertarian ideas did in fact influence not only social and cultural life, but also the economy. Instead of moving toward the libertarian ideal of limited government, however, we moved toward a corrupt, oligarchic form of government, one in which the rich and powerful use a bloated government to become more rich and powerful. The most egregious example is explosion in growth of the financial sector, which occurred after libertarian-inspired deregulation. The investment banks won the freedom to gamble on risky mortgage-based securities, a gamble that led to the 2008 crisis. Unlike in a truly free market, they felt secure enough to make these gambles knowing that the government would bail them out.
As usual, Brooks has no specific solutions to the problems he talks about. “The job is to restore old disciplines, strip away decaying structures and reform the welfare state. The country needs a productive midlife crisis.” I’d agree with that, but how is it going to happen? How can we reform an oligarchic government while maintaining libertarian moral values? How can people from different socioeconomic status, intelligence, race, age, ethnicity, culture, sexual orientation, political beliefs, religious beliefs, etc. come together and agree on anything, when libertarian morality tells them to pursue their own self interest no matter the social cost? Will they be willing to make sacrifices for the common good, whether it take the form of accepting fewer government benefits, more taxation, or a combination of the two? I doubt it. My view is that the “productive midlife crisis” our country needs must include a serious re-evaluation of the permissive morality that has been dominant since the 1960’s.
Monday, November 7, 2011
Daylight Saving Time Change = Mood Change?
I’ve updated my Are You Sensitive page to include two additional tests of possible sensitivity to the Earth’s magnetic field. One is any mood change from the daylight saving time change. In the U.S., we set our clocks back an hour yesterday (Sunday, November 6). I noticed a mood change this morning. I also have a mood change when the spring ahead time change happens in March. Why does the daylight saving time change cause a mood change in magnetoreceptive people? It has to do with circadian rhythms, internal rhythms that are approximately one day in length. I’ve found that circadian rhythm affects both my mood and my ability to locate my magnetic home. When we shift our clocks forward or backward, one of my circadian rhythms changes, and this change causes symptoms. I’ve found ways to compensate, including going to bed earlier in the fall, and later in the spring.
The second additional test is the presence of seasonal changes in symptoms. Although the daylight saving time change is associated with seasonal changes, I have something different in mind here. Winter depression is an example of a seasonal change in symptoms. Unlike the daylight saving time change, which happens once in the fall and once in the late winter, seasonal depression and other seasonal symptoms are more gradual. They get progressively worse before the solstice and better after the solstice. Magnetoreceptive people can have seasonal symptoms when the location they’re living in is far enough north or south of where they grew up. During childhood, seasonal changes in day length are “programmed in”, and your body expects similar seasonal changes throughout your life. If you live far enough north or south of where you grew up, day length around the solstices can be different enough for your body to notice it. For example, if you live in New York and grew up in Florida, in New York you’ll have fewer hours of daylight in December than you did when living in Florida. Your body reacts to this difference, causing symptoms. I don’t think that the symptoms are caused, as commonly believed, to it being too dark in the winter. I had winter and summer seasonal symptoms when I lived in North Carolina, which was about 600 km (370 miles) south of where I grew up (New Jersey). These symptoms consisted of sleep problems, anxiety, tics, and agitation. I didn’t have seasonal symptoms when I lived in Salt Lake City, Utah, which, while being far west of New Jersey, is close in north-south distance to it. The best way to compensate for seasonal symptoms is to move away from the place that is causing symptoms. If that’s not possible, then temporarily increasing dosage of medication to get through the tough times, or using a bright light box can be helpful for some people.
The second additional test is the presence of seasonal changes in symptoms. Although the daylight saving time change is associated with seasonal changes, I have something different in mind here. Winter depression is an example of a seasonal change in symptoms. Unlike the daylight saving time change, which happens once in the fall and once in the late winter, seasonal depression and other seasonal symptoms are more gradual. They get progressively worse before the solstice and better after the solstice. Magnetoreceptive people can have seasonal symptoms when the location they’re living in is far enough north or south of where they grew up. During childhood, seasonal changes in day length are “programmed in”, and your body expects similar seasonal changes throughout your life. If you live far enough north or south of where you grew up, day length around the solstices can be different enough for your body to notice it. For example, if you live in New York and grew up in Florida, in New York you’ll have fewer hours of daylight in December than you did when living in Florida. Your body reacts to this difference, causing symptoms. I don’t think that the symptoms are caused, as commonly believed, to it being too dark in the winter. I had winter and summer seasonal symptoms when I lived in North Carolina, which was about 600 km (370 miles) south of where I grew up (New Jersey). These symptoms consisted of sleep problems, anxiety, tics, and agitation. I didn’t have seasonal symptoms when I lived in Salt Lake City, Utah, which, while being far west of New Jersey, is close in north-south distance to it. The best way to compensate for seasonal symptoms is to move away from the place that is causing symptoms. If that’s not possible, then temporarily increasing dosage of medication to get through the tough times, or using a bright light box can be helpful for some people.
Saturday, September 24, 2011
A Psychiatrist Criticizes His Own Profession: A Review of “Unhinged” by Daniel Carlat
It’s not news that the profession of psychiatry is in a crisis state. I’ve talked about problems with psychiatry on this blog, and there have been many books, articles, and blogs written criticizing psychiatry. There’s no shortage of things to criticize. The fact that there is little understanding of the neurobiology of psychopathology, that there are no diagnostic tests for psychiatric disorders, that drugs have become widely prescribed with little evidence supporting their long-term efficacy, that most psychiatrists have become exclusively pill pushers, eschewing the need to understand and connect to their patients beyond a 15 minute med check, and that many psychiatrists have allowed themselves to be corrupted by drug money, are some of the problems with contemporary psychiatry.
Daniel Carlat, in his book Unhinged: The Trouble with Psychiatry—A Doctor’s Revelations about a Profession in Crisis, provides an insider’s look at the problems with psychiatry. Carlat was motivated to pursue a career in psychiatry because of his depressed mother’s suicide. He begins his book by giving an account of his medical training. Much of what he learned from the medical school curriculum and clinical rotations was useless in his later practice. Psychiatrists don’t perform surgeries, don’t order lab tests (except to rule out rare physical problems), and (usually) don’t order brain scans. They diagnose based on symptoms, which is what all doctors used to do before the twentieth century, but which is only a minor part of medical diagnosis today. Psychiatrists, like other doctors, prescribe drugs, so they need to understand psychopharmacology, but as Carlat describes in his book their decisions about medications are usually subjective.
Carlat did his residency at Massachusetts General Hospital (MGH), beginning in 1992, after the introduction of second generation antidepressants like Prozac. Although his supervisors were divided between therapy and drug advocates, Carlat admits that “the main thing you learn in a psychiatric residency, then or now, is how to write prescriptions” (p. 34). After completing his residency, Carlat, like most psychiatrists of his generation, specialized in psychopharmacology, i.e. prescribing drugs. He saw patients for 15 to 20 minute medication visits. The reason why he and other psychiatrists did this was that it was more profitable. Seeing three patients an hour for med checks allowed him to make about $180 an hour minus expenses. Seeing one patient an hour for therapy allowed him to make between $80 to $100 an hour, which is about 50% less. Carlat blames managed care companies for forcing psychiatrists into becoming pill pushers. But managed care companies can’t force psychiatrists to do something that they don’t believe in. The “key opinion leaders” in psychiatry, those leading academic psychiatrists who set the direction of their profession via their research and publications, are fanatical advocates of the biochemical/drug paradigm. This advocacy is quite profitable for them, as Carlat describes in his book.
Carlat talks about his experiences as a “hired gun,” someone who is paid (i.e. bought out) by drug companies. Carlat worked for Wyeth Pharmaceuticals to promote the antidepressant drug Effexor to primary care doctors. He made $750 per talk. He describes that although he was officially an “expert consultant,” in reality he was basically a highly-credentialed salesman. Sales reps attended his talks, and they communicated to him via body language and other feedback whether he was doing what they expected of him, i.e. to promote their product. When he tried to be more balanced and neutral, they criticized him. He eventually gave up his hired gun position.
Although Carlat was a minor figure among the drug company hired guns, he assumes that the same thought processes and corruption happened among the more famous and successful psychiatrists. He discusses the Senator Grassley investigations of several key opinion leaders in psychiatry, including:
Carlat describes his own experiences with the pharmaceutical marketing machine. One experience was a lavish party put on by Janssen, the manufacturer of the antipsychotic drug Risperdal, during the 1999 American Psychiatric Association annual meeting. Janssen rented the entire Smithsonian Air and Space Museum, with live jazz band, buffet food, and free drinks, all for the benefit of psychiatrists whom they wanted to prescribe Risperdal.
Another experience was with Valerie, his Ambien rep. Ambien, marketed by Sanofi-Aventis, was the first in a new category of non-benzodiazepine sleeping pill. Since Ambien was going off patent soon, Valerie tried to sell him Ambien CR (“Controlled Release”), a longer-acting drug than the original. Carlat was skeptical of the science behind the new pill. Valerie knew that he wasn’t prescribing much Ambien CR. She had access to this information since pharmacies have been selling their prescribing data to drug companies since the 1990’s. Valerie was persistent, offering a free medical textbook as a gift. Carlat prescribed Ambien CR to a patient, subconsciously or consciously reciprocating Valerie’s gift. The patient didn’t like the drug due to a hangover side effect. Carlat didn’t tell his patient that he prescribed Ambien CR as a favor to a drug rep.
Carlat criticizes the chemical imbalance theory. This theory, i.e. that depression is caused by a deficiency of the neurotransmitters serotonin and norepinephrine, and that schizophrenia is caused by too much dopamine, came about from discoveries of the pharmacology of antidepressant and antipsychotic drugs. It’s now known that antidepressant drugs block the reuptake of serotonin and/or norepinephrine (thus increasing the amount of these neurotransmitters in the synapse). Antipsychotic drugs block dopamine receptors. The chemical imbalance theory took as a given that the drugs were effective, and that they were not just treating symptoms, but treating the biochemical cause of mental disorders.
There has been no direct evidence in favor of the chemical imbalance theory. Part of the problem with verifying the theory is that scientists can only indirectly measure neurotransmitters via breakdown products in the blood, urine, or cerebrospinal fluid, or post-mortem exams. The studies utilizing these techniques have been inconclusive for both depression and schizophrenia. The result is that since virtually all biological psychiatric research in the past several decades has been based on the chemical imbalance theory, “the shadow of our ignorance [of psychiatric disorders] overwhelms the few dim lights of our knowledge” (p. 80). Carlat admits that with the lack of a scientific basis for drug choice, prescribing is more of an art than a science. “To a remarkable degree, our choice of medications is subjective, even random. Perhaps your psychiatrist is in a Lexapro mood this morning, because he was just visited by an attractive Lexapro drug rep” (p. 83).
Carlat talks about the overdiagnosis of psychiatric disorders, which is caused by a combination of lack of scientific understanding of mental disorders, and greed. The DSM-IV, the “bible” of psychiatry, classifies mental disorders based on a list of symptoms. If you have five of the symptoms it mentions, you have depression. If you only have four, you don’t have depression. Since this symptom-based diagnosis is ultimately based on subjective or arbitrary factors, there is no way to prevent multiplication or redefinition of disorders. One of the criticisms of the upcoming revision (entitled “DSM-V”), is that new definitions of disorders would make it too easy to diagnose patients. An example is the proposed “prepsychotic” category, attempting to identify individuals who might in the future develop schizophrenia. In the words of Allen Frances, who was the chair of the DSM-IV committee, these broadened categories “would be a wholesale imperial medicalization of normality that will trivialize mental disorder and lead to a deluge of unneeded medication treatment” (p. 65).
The problems with the DSM also affect clinical practice. For example, bipolar disorder is a diagnosis in the DSM based on symptoms such as alternating manic and depressive episodes. This diagnosis was intended for adults, although sometimes older teenagers have these symptoms. Joseph Biederman and his colleagues at MGH decided to expand the diagnosis of bipolar disorder to toddlers. In 1996, Biederman published a paper reporting that nearly a quarter of children he was treating for ADHD also met his criteria for bipolar disorder. Since preschool children don’t have mania or depression, how could they have bipolar disorder? Biederman decided that irritability was a defining attribute for mania in young children, even in the absence of euphoria or grandiosity. How could he make this diagnostic change? It wasn’t based on science, since the neurobiology of bipolar disorder in adults or children is unknown. Biederman was able to do this, and get a lot of other psychiatrists to follow his lead, because he was a full professor at Harvard, next to God, in his own words, on the psychiatric prestige scale. His diagnostic change led to a forty-fold increase in the number of children and adolescents treated for bipolar disorder. These children have been prescribed powerful drug cocktails, including antipsychotic drugs. The antipsychotic drugs have side effects such as sedation and weight gain that are much more harmful to children than adults. As I mentioned above, Biederman and colleagues received over $4 million dollars from drug companies, which was certainly a powerful incentive to expand diagnosis (and drug treatment) of bipolar disorder to children.
What is Carlat’s prescription for change in his broken profession? Carlat wants psychiatrists to go back to providing therapy, which can be balanced with medications. 15 minute medication checks are not sufficient to get to know a patient, to know what makes him tick. Sometimes changes in symptoms are not due to medications but life changes or stresses. Since most psychiatrists don’t have time to inquire about anything other than symptoms and medications, they are blind to what is going on in their patients’ lives. Carlat changed his own practice from exclusively 15-20 minute med checks, to somewhat longer medication sessions (20- 25 minutes), alternating with 45 minute therapy visits. He doesn’t use traditional psychodynamic therapy, but instead “a version of supportive therapy that I now try to weave into the fabric of all my sessions with patients, whether they are seeing me primarily for medications or for therapy” (p. 199).
Carlat also wants to see an alternative to medical school for training psychiatrists. He feels that medical school, in addition to be largely useless to future psychiatrists, indoctrinates these students into an excessively biomedical viewpoint. It also makes them feel inferior to other doctors, since psychiatry is in such a primitive state compared to the rest of medicine, and makes them feel superior to other mental health professionals, since psychiatrists have a medical degree. Carlat would like to see a new training program modeled on the “Doctorate in Mental Health” experiment in San Francisco in the 1970’s and 1980’s. This program combined two years of medical and psychological classes with three years of on-the-job training similar to a psychiatric residency. This shaved three years from the standard medical training, but unfortunately fizzled when psychiatrists successfully lobbied to prevent its graduates from being licensed. This program can be revived, and serve as a way to train new practitioners who would be better able to integrate drugs and therapy.
Carlat assumes that drugs are effective. In his book, he gives a number of case examples of patients who he says were helped by medications he prescribed. But how does he know that? His conclusions about drug effectiveness are based on his own clinical observations, which derive from 15 to 25 minute appointments. How can he, or any other psychiatrist, make any conclusion about effectiveness based on such short patient visits, and in the absence of any objective lab tests? Many people with mental disorders are in a complete state of denial about their condition. They are unable to recognize when they’re behaving strangely or irrationally. Family members and friends can usually notice changes, but they don’t always accompany a patient to a psychiatrist doctor visit. Even if they do, they may not speak up.
I have a personal example to support this. I have a relative who for years has been in denial about his depression, anxiety, paranoia, and OCD. When he went for his 10 minute medication visits (which was every month or every other month), he would tell his psychiatrist that everything was fine. His psychiatrist didn’t have time to ask probing questions or to try to make some independent observations. My relative's wife, who would drive him to the appointment and usually not go into the doctor’s office, was afraid to speak up. She was afraid because if she did speak up, my relative would become extremely angry, paranoid, and hostile, and blame her for triggering his bad mood, which would persist sometimes for days. So in the absence of any contradicting information, the doctor would usually tell him that he was doing great, and refill his prescriptions. This is pill pushing, not medicine. But it is the current standard of care in psychiatry.
I can give an example of where a 15 minute appointment would represent quality medical care. Let’s take a hypothetical example of Mary, who has diabetes. She is in denial about her condition. When she goes to the doctor, she tells him that she feels fine. He looks at her lab tests, however, and sees that her blood sugar is elevated. He tells her that she’s not fine, and then discusses possible causes for the elevated blood sugar, and prescribes a treatment plan. The doctor has an independent, objective source of information to balance Mary’s account of how she feels.
A psychiatrist doesn’t have any objective lab tests to balance a patient’s testimony. He needs more time to make an accurate diagnosis of the patient’s current state of mind. I think that an hour a patient is a bare minimum, even if the psychiatrist is only prescribing drugs, and not doing any therapy. In an hour, the psychiatrist has more time to observe and hear the patient, and ask questions. While it’s easy for a disturbed patient to put on an act for 15 minutes, it’s a lot harder do maintain this for 50 minutes. If a family member is present, it would also give the psychiatrist time to interview the family member away from the patient.
Psychiatrists, including Carlat, blame managed care companies for forcing them to have such short patient visits. But it is psychiatrists who set the standard of care for their profession. If leading psychiatrists said that they needed to see patients for a longer time, that 15 minute visits represented poor patient care and shouldn’t be reimbursed at all, and they lobbied the government, Medicare, and managed care companies to reimburse them at a higher rate for longer visits, then these changes would get made. Psychiatrists are not helpless pawns in the face of powerful entities, they have significant power themselves and can use that power to improve patient care.
Carlat doesn’t question the basic effectiveness of psychiatric drugs. His prescribing habits seem conventional, including prescribing drug cocktails. He gives an example of James, whom he calls a “typical success story of modern psychopharmacology” (p. 70). Carlat prescribed James five different medications, including Celexa for depression, Ativan for anxiety, Ambien for insomnia, Provigil for fatigue (a side effect of Celexa), and Viagra for erectile dysfunction (another side effect of Celexa). Is this a success story, even if James reported feeling happier? Carlat compares James to an old pickup truck, held together with baling wire and duck tape. Is turning patients into fragile jalopies a good thing?
Drug cocktails make it impossible to identify what drug is responsible for what side effect or reaction. How does one know if the patient’s fatigue or agitation is due to Drug A, Drug B, Drug C, the interaction between Drug A and Drug B, the interaction between Drug B and Drug C, or the interaction between Drug A and Drug C? This is for only 3 drugs. If a patient is on 5 drugs, as is James in the case mentioned above, then there are 10 possible interactions to consider. (The number of drug interactions can be expressed as [{n*(n-1)}/2], where n is the number of different drugs).
Drug interactions aren’t the only thing to worry about. There is also the question of dose sizes. Maybe Drug A is causing problems because it’s at too high a dose. But with the drug interactions and the effects of Drugs B and C, it’s not easy to identify Drug A’s dose as the problem. Also, drugs have different long-term effects from short-term effects. If a patient is on three different drugs, and suddenly develops severe anxiety, how does one know if this anxiety is due to the long-term effect of a drug? More likely, the doctor will add another drug to the regimen, or increase the dose of the anti-anxiety pill. But the better solution would have been to reduce or eliminate the drug that is causing the reaction, a drug that is impossible to ascertain because the patient is on too many drugs.
I emphasize these problems with drug cocktails because of my own personal experience with psychiatric drugs. I avoided drug cocktails, usually talking no more than two drugs at a time. With two drugs, there is only one interaction to worry about. For a period of time, the two drugs I took were the antidepressants Anafranil and Zoloft. After two years on this combination, I had an attack of severe anxiety. Rather than allowing my psychiatrist to prescribe an anti-anxiety drug, which would have been the typical response to this problem, I discontinued taking Zoloft. I had been on Anafranil for 3 years before I started Zoloft, and I didn’t think that Anafranil was the problem. The anxiety abated, and never returned to the level it was. If I were taking three or more medications, it would have been harder to identify the drug that was the problem.
Psychiatrists, including Carlat, have a knee-jerk reaction to add more drugs when there is a problem, rather than take drugs away. This is how drug cocktails come into being. Drug cocktails represent a type of off-label prescribing, because the individual drugs in the cocktail were never clinically tested or approved as part of a cocktail, only when taken individually. They are part of what’s wrong with psychiatry today, something that Carlat doesn’t acknowledge.
It’s unlikely that Carlat would accept Irving Kirsch’s thesis in his book The Emperor’s New Drugs (which I review here) that antidepressants are no better than placebos, or Robert Whitaker’s more radical thesis in his book Anatomy of an Epidemic (which I review here) that psychiatric drugs do more long-term harm than good. The reason for this is that Carlat has spent his entire career prescribing drugs. For him to acknowledge that they are placebos with dangerous side effects, or that they harm patients long-term, would be for him to admit that his life’s work was a failure. It’s similar to getting a district attorney who, after years of prosecuting and convicting an innocent man, to admit that he made a terrible error. There are not many district attorneys who can make this admission. In the case of psychiatrists like Carlat, most will not admit that they have made a terrible error and harmed patients by prescribing drugs. Thus Unhinged, while a call for change in psychiatry, doesn’t go far enough in questioning the efficacy of drugs. Such questioning usually comes from people outside the profession, such as a clinical psychologist (Irving Kirsh) who treats patients via psychotherapy, and a journalist (Robert Whitaker) who isn’t a mental health practitioner.
In conclusion, Unhinged is a well-written, honest account of systemic problems in psychiatry written by someone with an insider’s perspective on the profession. Carlat does an excellent job describing the drug money corruption in psychiatry, in the overmedicalized view of a complicated phenomenon such as mental illness, and in the need for psychiatrists to better know their patients and provide some of them with therapy. He fails, however, to go far enough in questioning drug (and drug cocktail) efficacy.
Daniel Carlat, in his book Unhinged: The Trouble with Psychiatry—A Doctor’s Revelations about a Profession in Crisis, provides an insider’s look at the problems with psychiatry. Carlat was motivated to pursue a career in psychiatry because of his depressed mother’s suicide. He begins his book by giving an account of his medical training. Much of what he learned from the medical school curriculum and clinical rotations was useless in his later practice. Psychiatrists don’t perform surgeries, don’t order lab tests (except to rule out rare physical problems), and (usually) don’t order brain scans. They diagnose based on symptoms, which is what all doctors used to do before the twentieth century, but which is only a minor part of medical diagnosis today. Psychiatrists, like other doctors, prescribe drugs, so they need to understand psychopharmacology, but as Carlat describes in his book their decisions about medications are usually subjective.
Carlat did his residency at Massachusetts General Hospital (MGH), beginning in 1992, after the introduction of second generation antidepressants like Prozac. Although his supervisors were divided between therapy and drug advocates, Carlat admits that “the main thing you learn in a psychiatric residency, then or now, is how to write prescriptions” (p. 34). After completing his residency, Carlat, like most psychiatrists of his generation, specialized in psychopharmacology, i.e. prescribing drugs. He saw patients for 15 to 20 minute medication visits. The reason why he and other psychiatrists did this was that it was more profitable. Seeing three patients an hour for med checks allowed him to make about $180 an hour minus expenses. Seeing one patient an hour for therapy allowed him to make between $80 to $100 an hour, which is about 50% less. Carlat blames managed care companies for forcing psychiatrists into becoming pill pushers. But managed care companies can’t force psychiatrists to do something that they don’t believe in. The “key opinion leaders” in psychiatry, those leading academic psychiatrists who set the direction of their profession via their research and publications, are fanatical advocates of the biochemical/drug paradigm. This advocacy is quite profitable for them, as Carlat describes in his book.
Carlat talks about his experiences as a “hired gun,” someone who is paid (i.e. bought out) by drug companies. Carlat worked for Wyeth Pharmaceuticals to promote the antidepressant drug Effexor to primary care doctors. He made $750 per talk. He describes that although he was officially an “expert consultant,” in reality he was basically a highly-credentialed salesman. Sales reps attended his talks, and they communicated to him via body language and other feedback whether he was doing what they expected of him, i.e. to promote their product. When he tried to be more balanced and neutral, they criticized him. He eventually gave up his hired gun position.
Although Carlat was a minor figure among the drug company hired guns, he assumes that the same thought processes and corruption happened among the more famous and successful psychiatrists. He discusses the Senator Grassley investigations of several key opinion leaders in psychiatry, including:
- Melissa DelBello, a researcher who was paid $180,000 by AstraZeneca to promote the antipsychotic drug Seroquel.
- Joseph Biederman, Timothy Wilens, and Thomas Spencer of MGH, who were paid a combined $4.2 million by drug companies over a 7 year period. These men also received taxpayer money in the form of NIH research grants, which explicitly disallows such large drug company income. Biederman and colleagues pioneered the diagnosis of bipolar disorder in toddlers, which has led to thousands of preschool children receiving drug cocktails including powerful antipsychotics.
- Alan Schatzberg of Stanford, president of the American Psychiatric Association, controlled more than $4.8 million of stock in Corcept Therapeutics, a company he cofounded to test a drug to treat psychotic depression. He was also the principal investigator of a huge NIH study to test the same drug. This combination represented a major conflict of interest.
- Charles Nemeroff, chairman of the department of psychiatry at Emory University, earned $2.8 million from consulting arrangements, but failed to disclose at least $1.2 million. Some of this money was from the drug company GlaxoSmithKline, whose drugs Nemeroff was studying with $3.9 million of taxpayer money.
Carlat describes his own experiences with the pharmaceutical marketing machine. One experience was a lavish party put on by Janssen, the manufacturer of the antipsychotic drug Risperdal, during the 1999 American Psychiatric Association annual meeting. Janssen rented the entire Smithsonian Air and Space Museum, with live jazz band, buffet food, and free drinks, all for the benefit of psychiatrists whom they wanted to prescribe Risperdal.
Another experience was with Valerie, his Ambien rep. Ambien, marketed by Sanofi-Aventis, was the first in a new category of non-benzodiazepine sleeping pill. Since Ambien was going off patent soon, Valerie tried to sell him Ambien CR (“Controlled Release”), a longer-acting drug than the original. Carlat was skeptical of the science behind the new pill. Valerie knew that he wasn’t prescribing much Ambien CR. She had access to this information since pharmacies have been selling their prescribing data to drug companies since the 1990’s. Valerie was persistent, offering a free medical textbook as a gift. Carlat prescribed Ambien CR to a patient, subconsciously or consciously reciprocating Valerie’s gift. The patient didn’t like the drug due to a hangover side effect. Carlat didn’t tell his patient that he prescribed Ambien CR as a favor to a drug rep.
Carlat criticizes the chemical imbalance theory. This theory, i.e. that depression is caused by a deficiency of the neurotransmitters serotonin and norepinephrine, and that schizophrenia is caused by too much dopamine, came about from discoveries of the pharmacology of antidepressant and antipsychotic drugs. It’s now known that antidepressant drugs block the reuptake of serotonin and/or norepinephrine (thus increasing the amount of these neurotransmitters in the synapse). Antipsychotic drugs block dopamine receptors. The chemical imbalance theory took as a given that the drugs were effective, and that they were not just treating symptoms, but treating the biochemical cause of mental disorders.
There has been no direct evidence in favor of the chemical imbalance theory. Part of the problem with verifying the theory is that scientists can only indirectly measure neurotransmitters via breakdown products in the blood, urine, or cerebrospinal fluid, or post-mortem exams. The studies utilizing these techniques have been inconclusive for both depression and schizophrenia. The result is that since virtually all biological psychiatric research in the past several decades has been based on the chemical imbalance theory, “the shadow of our ignorance [of psychiatric disorders] overwhelms the few dim lights of our knowledge” (p. 80). Carlat admits that with the lack of a scientific basis for drug choice, prescribing is more of an art than a science. “To a remarkable degree, our choice of medications is subjective, even random. Perhaps your psychiatrist is in a Lexapro mood this morning, because he was just visited by an attractive Lexapro drug rep” (p. 83).
Carlat talks about the overdiagnosis of psychiatric disorders, which is caused by a combination of lack of scientific understanding of mental disorders, and greed. The DSM-IV, the “bible” of psychiatry, classifies mental disorders based on a list of symptoms. If you have five of the symptoms it mentions, you have depression. If you only have four, you don’t have depression. Since this symptom-based diagnosis is ultimately based on subjective or arbitrary factors, there is no way to prevent multiplication or redefinition of disorders. One of the criticisms of the upcoming revision (entitled “DSM-V”), is that new definitions of disorders would make it too easy to diagnose patients. An example is the proposed “prepsychotic” category, attempting to identify individuals who might in the future develop schizophrenia. In the words of Allen Frances, who was the chair of the DSM-IV committee, these broadened categories “would be a wholesale imperial medicalization of normality that will trivialize mental disorder and lead to a deluge of unneeded medication treatment” (p. 65).
The problems with the DSM also affect clinical practice. For example, bipolar disorder is a diagnosis in the DSM based on symptoms such as alternating manic and depressive episodes. This diagnosis was intended for adults, although sometimes older teenagers have these symptoms. Joseph Biederman and his colleagues at MGH decided to expand the diagnosis of bipolar disorder to toddlers. In 1996, Biederman published a paper reporting that nearly a quarter of children he was treating for ADHD also met his criteria for bipolar disorder. Since preschool children don’t have mania or depression, how could they have bipolar disorder? Biederman decided that irritability was a defining attribute for mania in young children, even in the absence of euphoria or grandiosity. How could he make this diagnostic change? It wasn’t based on science, since the neurobiology of bipolar disorder in adults or children is unknown. Biederman was able to do this, and get a lot of other psychiatrists to follow his lead, because he was a full professor at Harvard, next to God, in his own words, on the psychiatric prestige scale. His diagnostic change led to a forty-fold increase in the number of children and adolescents treated for bipolar disorder. These children have been prescribed powerful drug cocktails, including antipsychotic drugs. The antipsychotic drugs have side effects such as sedation and weight gain that are much more harmful to children than adults. As I mentioned above, Biederman and colleagues received over $4 million dollars from drug companies, which was certainly a powerful incentive to expand diagnosis (and drug treatment) of bipolar disorder to children.
What is Carlat’s prescription for change in his broken profession? Carlat wants psychiatrists to go back to providing therapy, which can be balanced with medications. 15 minute medication checks are not sufficient to get to know a patient, to know what makes him tick. Sometimes changes in symptoms are not due to medications but life changes or stresses. Since most psychiatrists don’t have time to inquire about anything other than symptoms and medications, they are blind to what is going on in their patients’ lives. Carlat changed his own practice from exclusively 15-20 minute med checks, to somewhat longer medication sessions (20- 25 minutes), alternating with 45 minute therapy visits. He doesn’t use traditional psychodynamic therapy, but instead “a version of supportive therapy that I now try to weave into the fabric of all my sessions with patients, whether they are seeing me primarily for medications or for therapy” (p. 199).
Carlat also wants to see an alternative to medical school for training psychiatrists. He feels that medical school, in addition to be largely useless to future psychiatrists, indoctrinates these students into an excessively biomedical viewpoint. It also makes them feel inferior to other doctors, since psychiatry is in such a primitive state compared to the rest of medicine, and makes them feel superior to other mental health professionals, since psychiatrists have a medical degree. Carlat would like to see a new training program modeled on the “Doctorate in Mental Health” experiment in San Francisco in the 1970’s and 1980’s. This program combined two years of medical and psychological classes with three years of on-the-job training similar to a psychiatric residency. This shaved three years from the standard medical training, but unfortunately fizzled when psychiatrists successfully lobbied to prevent its graduates from being licensed. This program can be revived, and serve as a way to train new practitioners who would be better able to integrate drugs and therapy.
Carlat assumes that drugs are effective. In his book, he gives a number of case examples of patients who he says were helped by medications he prescribed. But how does he know that? His conclusions about drug effectiveness are based on his own clinical observations, which derive from 15 to 25 minute appointments. How can he, or any other psychiatrist, make any conclusion about effectiveness based on such short patient visits, and in the absence of any objective lab tests? Many people with mental disorders are in a complete state of denial about their condition. They are unable to recognize when they’re behaving strangely or irrationally. Family members and friends can usually notice changes, but they don’t always accompany a patient to a psychiatrist doctor visit. Even if they do, they may not speak up.
I have a personal example to support this. I have a relative who for years has been in denial about his depression, anxiety, paranoia, and OCD. When he went for his 10 minute medication visits (which was every month or every other month), he would tell his psychiatrist that everything was fine. His psychiatrist didn’t have time to ask probing questions or to try to make some independent observations. My relative's wife, who would drive him to the appointment and usually not go into the doctor’s office, was afraid to speak up. She was afraid because if she did speak up, my relative would become extremely angry, paranoid, and hostile, and blame her for triggering his bad mood, which would persist sometimes for days. So in the absence of any contradicting information, the doctor would usually tell him that he was doing great, and refill his prescriptions. This is pill pushing, not medicine. But it is the current standard of care in psychiatry.
I can give an example of where a 15 minute appointment would represent quality medical care. Let’s take a hypothetical example of Mary, who has diabetes. She is in denial about her condition. When she goes to the doctor, she tells him that she feels fine. He looks at her lab tests, however, and sees that her blood sugar is elevated. He tells her that she’s not fine, and then discusses possible causes for the elevated blood sugar, and prescribes a treatment plan. The doctor has an independent, objective source of information to balance Mary’s account of how she feels.
A psychiatrist doesn’t have any objective lab tests to balance a patient’s testimony. He needs more time to make an accurate diagnosis of the patient’s current state of mind. I think that an hour a patient is a bare minimum, even if the psychiatrist is only prescribing drugs, and not doing any therapy. In an hour, the psychiatrist has more time to observe and hear the patient, and ask questions. While it’s easy for a disturbed patient to put on an act for 15 minutes, it’s a lot harder do maintain this for 50 minutes. If a family member is present, it would also give the psychiatrist time to interview the family member away from the patient.
Psychiatrists, including Carlat, blame managed care companies for forcing them to have such short patient visits. But it is psychiatrists who set the standard of care for their profession. If leading psychiatrists said that they needed to see patients for a longer time, that 15 minute visits represented poor patient care and shouldn’t be reimbursed at all, and they lobbied the government, Medicare, and managed care companies to reimburse them at a higher rate for longer visits, then these changes would get made. Psychiatrists are not helpless pawns in the face of powerful entities, they have significant power themselves and can use that power to improve patient care.
Carlat doesn’t question the basic effectiveness of psychiatric drugs. His prescribing habits seem conventional, including prescribing drug cocktails. He gives an example of James, whom he calls a “typical success story of modern psychopharmacology” (p. 70). Carlat prescribed James five different medications, including Celexa for depression, Ativan for anxiety, Ambien for insomnia, Provigil for fatigue (a side effect of Celexa), and Viagra for erectile dysfunction (another side effect of Celexa). Is this a success story, even if James reported feeling happier? Carlat compares James to an old pickup truck, held together with baling wire and duck tape. Is turning patients into fragile jalopies a good thing?
Drug cocktails make it impossible to identify what drug is responsible for what side effect or reaction. How does one know if the patient’s fatigue or agitation is due to Drug A, Drug B, Drug C, the interaction between Drug A and Drug B, the interaction between Drug B and Drug C, or the interaction between Drug A and Drug C? This is for only 3 drugs. If a patient is on 5 drugs, as is James in the case mentioned above, then there are 10 possible interactions to consider. (The number of drug interactions can be expressed as [{n*(n-1)}/2], where n is the number of different drugs).
Drug interactions aren’t the only thing to worry about. There is also the question of dose sizes. Maybe Drug A is causing problems because it’s at too high a dose. But with the drug interactions and the effects of Drugs B and C, it’s not easy to identify Drug A’s dose as the problem. Also, drugs have different long-term effects from short-term effects. If a patient is on three different drugs, and suddenly develops severe anxiety, how does one know if this anxiety is due to the long-term effect of a drug? More likely, the doctor will add another drug to the regimen, or increase the dose of the anti-anxiety pill. But the better solution would have been to reduce or eliminate the drug that is causing the reaction, a drug that is impossible to ascertain because the patient is on too many drugs.
I emphasize these problems with drug cocktails because of my own personal experience with psychiatric drugs. I avoided drug cocktails, usually talking no more than two drugs at a time. With two drugs, there is only one interaction to worry about. For a period of time, the two drugs I took were the antidepressants Anafranil and Zoloft. After two years on this combination, I had an attack of severe anxiety. Rather than allowing my psychiatrist to prescribe an anti-anxiety drug, which would have been the typical response to this problem, I discontinued taking Zoloft. I had been on Anafranil for 3 years before I started Zoloft, and I didn’t think that Anafranil was the problem. The anxiety abated, and never returned to the level it was. If I were taking three or more medications, it would have been harder to identify the drug that was the problem.
Psychiatrists, including Carlat, have a knee-jerk reaction to add more drugs when there is a problem, rather than take drugs away. This is how drug cocktails come into being. Drug cocktails represent a type of off-label prescribing, because the individual drugs in the cocktail were never clinically tested or approved as part of a cocktail, only when taken individually. They are part of what’s wrong with psychiatry today, something that Carlat doesn’t acknowledge.
It’s unlikely that Carlat would accept Irving Kirsch’s thesis in his book The Emperor’s New Drugs (which I review here) that antidepressants are no better than placebos, or Robert Whitaker’s more radical thesis in his book Anatomy of an Epidemic (which I review here) that psychiatric drugs do more long-term harm than good. The reason for this is that Carlat has spent his entire career prescribing drugs. For him to acknowledge that they are placebos with dangerous side effects, or that they harm patients long-term, would be for him to admit that his life’s work was a failure. It’s similar to getting a district attorney who, after years of prosecuting and convicting an innocent man, to admit that he made a terrible error. There are not many district attorneys who can make this admission. In the case of psychiatrists like Carlat, most will not admit that they have made a terrible error and harmed patients by prescribing drugs. Thus Unhinged, while a call for change in psychiatry, doesn’t go far enough in questioning the efficacy of drugs. Such questioning usually comes from people outside the profession, such as a clinical psychologist (Irving Kirsh) who treats patients via psychotherapy, and a journalist (Robert Whitaker) who isn’t a mental health practitioner.
In conclusion, Unhinged is a well-written, honest account of systemic problems in psychiatry written by someone with an insider’s perspective on the profession. Carlat does an excellent job describing the drug money corruption in psychiatry, in the overmedicalized view of a complicated phenomenon such as mental illness, and in the need for psychiatrists to better know their patients and provide some of them with therapy. He fails, however, to go far enough in questioning drug (and drug cocktail) efficacy.
Monday, July 18, 2011
Are Tea Party Republicans Anarchists?
NY Times columnist Timothy Egan’s recent article describes radical Republicans as anarchists, seeking to destroy the U.S. government. Their refusal to raise the debt limit, and refusal to deal at all with Obama and Democrats, threatens America with another financial crash and economic catastrophe. This “burn-it-all-down position” indicates that the Tea Party Republicans “didn’t go to Washington to find solutions; they went there to destroy the place.” Is Egan being fair in his description of radical Republicans?
Anarchy is the absence of government, a condition of complete freedom from government coercion. Anarchists are people who want to bring about this utopian condition. Tea Party republicans claim to want to reduce the size of government, not eliminate it entirely. So by the strict dictionary definition, radical Republicans aren’t anarchists. They are extremists, however, and this extremism threatens the stability and health of our government and society. It also threatens to bring about a condition of anarchy.
Extremists share some common attributes, whether they are anarchists, libertarians, communists, Nazis, sixties radicals, or religious zealots:
I’ll go over these attributes and see if the Tea Party Republicans fit these characteristics.
While it’s possible that the crisis can be solved peacefully, I wouldn’t bet on it. Historically, economic crises have sometimes led to violent revolutions in other countries. The French Revolution and subsequent reign of terror was a product of a financial crisis. The Bolsheviks came to power in the context of the economic and political chaos of World War I.
A revolution can sometimes be a good thing, right? What about the American Revolution? The Tea Party Republicans may claim to be intellectual heirs of the American Revolution, but in reality they are far apart ideologically. Compared to other revolutions, the American Revolution was moderate. Before the revolution and after, Americans enjoyed the privileges of a representative government, freedom of expression and religion, a capitalistic economic system, and the absence of any hereditary aristocracy. The biggest change was the withdrawal from the British Empire and the establishment of a new republican political system. While this was a substantial change, it didn’t affect the daily life of most people. There was no widespread expropriation of property or political murders that characterized the contemporaneous French Revolution.
The Tea Party Republicans may not provoke a revolution at all. Since their dominant ideology is anti-government, if they succeed in bringing the economy and the federal government to their knees, we may end up with a condition of anarchy. The best contemporary example is Iraq after the 2003 invasion. Like the Iraqi government, the American government may become so weakened and ineffective that terrorists and criminals will basically take over the country. Anarchy is an unstable condition, so it won’t last forever, but as we’ve seen in some countries (e.g. Somalia) this could last for years and possibly decades.
I think that America has too much going for it (i.e. its wealth, history, political system, social structures) that we will become another Iraq or Somalia. But there’s a real chance of some major political and economic disruption that will affect the lives of millions. If the Tea Party Republicans get their way, this disruption will happen soon.
Anarchy is the absence of government, a condition of complete freedom from government coercion. Anarchists are people who want to bring about this utopian condition. Tea Party republicans claim to want to reduce the size of government, not eliminate it entirely. So by the strict dictionary definition, radical Republicans aren’t anarchists. They are extremists, however, and this extremism threatens the stability and health of our government and society. It also threatens to bring about a condition of anarchy.
Extremists share some common attributes, whether they are anarchists, libertarians, communists, Nazis, sixties radicals, or religious zealots:
- Promoting extreme change
- Wanting the extreme change now
- Being unwilling to compromise
- Promoting violence
I’ll go over these attributes and see if the Tea Party Republicans fit these characteristics.
- Extreme change: The Tea Party Republicans claim to be conservative, wanting the federal government to return to its small pre-Great Deal size. But since so many people have become dependent on government programs, and we’ve had for decades a large military, progressive income tax, and widespread regulation of industry, a return to the way things were 80 or more years ago is an extreme change from the status quo. Thus I can conclude that radical Republicans promote extreme change.
- Wanting the extreme change now: Paul Ryan’s plan to overhaul Medicare doesn't take effect until 2022, exempting people 55 and older from the change. Although it proposes a radical change to Medicare, it’s not extremist in the sense of wanting the change now. The refusal to extend the debt limit in the absence of an immediate agreement to major cuts in government spending is, however, extremist. It threatens economic catastrophe unless changes are made now. While it’s true that changes are badly needed in Washington, threatening an economic crisis unless changes happen immediately is extremist and very dangerous. So I conclude that in the context of the debt crisis radical Republicans want extreme change now.
- Being unwilling to compromise: Tea Party Republicans are refusing to compromise with Obama and the Democrats on the issue of tax increases. They will not accept any deal that involves tax increases, even if the spending cuts vastly outnumber the tax increases, as is the case in the Obama plan. This “my way or the highway” attitude is definitely extremist. Tea Party Republicans have exuded this type of extremism since they began their term in office.
- Promoting violence: Tea party advocates and representatives so far haven’t advocated violence or committed any violent acts. But the other three extremist characteristics that describe Tea Party Republicans make it highly likely that violence will eventually happen. If one of the two major American political parties wants extreme change, wants it now, and is unwilling to compromise, then the legislative process will grind to a halt. We can see that happening already. If legislators cannot accomplish anything, then the government won’t be do anything, even to pay its bills. This will provoke a crisis.
While it’s possible that the crisis can be solved peacefully, I wouldn’t bet on it. Historically, economic crises have sometimes led to violent revolutions in other countries. The French Revolution and subsequent reign of terror was a product of a financial crisis. The Bolsheviks came to power in the context of the economic and political chaos of World War I.
A revolution can sometimes be a good thing, right? What about the American Revolution? The Tea Party Republicans may claim to be intellectual heirs of the American Revolution, but in reality they are far apart ideologically. Compared to other revolutions, the American Revolution was moderate. Before the revolution and after, Americans enjoyed the privileges of a representative government, freedom of expression and religion, a capitalistic economic system, and the absence of any hereditary aristocracy. The biggest change was the withdrawal from the British Empire and the establishment of a new republican political system. While this was a substantial change, it didn’t affect the daily life of most people. There was no widespread expropriation of property or political murders that characterized the contemporaneous French Revolution.
The Tea Party Republicans may not provoke a revolution at all. Since their dominant ideology is anti-government, if they succeed in bringing the economy and the federal government to their knees, we may end up with a condition of anarchy. The best contemporary example is Iraq after the 2003 invasion. Like the Iraqi government, the American government may become so weakened and ineffective that terrorists and criminals will basically take over the country. Anarchy is an unstable condition, so it won’t last forever, but as we’ve seen in some countries (e.g. Somalia) this could last for years and possibly decades.
I think that America has too much going for it (i.e. its wealth, history, political system, social structures) that we will become another Iraq or Somalia. But there’s a real chance of some major political and economic disruption that will affect the lives of millions. If the Tea Party Republicans get their way, this disruption will happen soon.
Thursday, June 23, 2011
Genetically-Engineered Flies Prove That a Human Eye Protein Has Magnetoreceptive Characteristics
The journal Nature Communications published an article this week that supports the hypothesis of human magnetoreception. Steven Reppert and colleagues at the University of Massachusetts Medical School did a study in which they genetically engineered fruit flies (Drosophila) to produce a human eye protein called cryptochrome. This protein is known to be important in circadian clock regulation along with light-dependent magnetoreception. Normal Drosophilia flies have magnetoreceptive ability that can be behaviorally tested in a lab. Flies that are genetically engineered not to produce cryptochrome lose their magnetoreceptive ability. In this experiment, flies that were genetically engineered to produce the human (not fly) version of cryptochrome had magnetoreceptive ability similar to normal flies.
It’s important not to get too excited about this experiment. The study did not show that humans have magnetoreceptive ability. It only showed that human cryptochrome can give magnetoreceptive ability to Drosophilia. The fact that humans have this magnetoreceptive protein doesn’t imply that any people actually use it for navigational purposes. It could be a vestigial protein, an evolutionary leftover that has no function, like the tailbone or appendix.
The authors of this study suggest that “[a]dditional research on magnetosensitivity in humans at the behavioural level. . .would be informative.” I agree, and point to my paper as something I hope to guide future research.
Here are some links to nontechnical articles that talk about this experiment:
http://www.bbc.co.uk/news/science-environment-13809144
http://www.redorbit.com/news/science/2068170/human_retina_can_sense_earths_magnetism/
http://www.geekosystem.com/flies-magnetic-fields-protein/
http://www.nytimes.com/2011/06/28/science/28magnet.html?_r=1
Thursday, June 16, 2011
Can Creative Genius Be Scientifically Studied? A Review of “Origins of Genius” by Dean Keith Simonton
It’s common to think of the genius of men like Shakespeare, Darwin, and Einstein as something impossible to understand or study, kind of like a miracle. But psychologists consider all facets of human behavior to be fair game for research, no matter how strange or unusual. The geniuses who wrote Hamlet, who painted the Sistine Chapel, and who discovered the theory of relativity are extreme examples of personality traits like creativity, intelligence, and literary/artistic/scientific ability that all people posses to some extent. Dean Keith Simonton is a psychologist who specializes in studying creativity and genius. In his book Origins of Genius: Darwinian Perspectives on Creativity, Simonton applies Darwin’s theory of evolution to the study of creative achievement.
Simonton begins by defining “genius”. A genius isn’t someone with a high IQ, although most people we consider geniuses were very intelligent. A genius is someone who accomplishes something that sets him apart from everyone else, i.e. someone who has achieved eminence. Beethoven is a musical genius because of his symphonies, piano concertos, and other works that continue to be performed almost two centuries after his death. If Beethoven hadn’t composed any music, he wouldn’t be considered a genius, no matter how much intelligence or ability he possessed. “The phrase unrecognized genius becomes an oxymoron” (p. 5).
A “creative genius” is someone who invents or discovers an original, adaptive idea or product. Originality is required because mere imitation isn’t creative. Adaptiveness is required because if the new mousetrap doesn’t work, it isn’t any better than what we have now. If the new theory doesn’t fit the facts, or has internal contradictions, it won’t help advance science. If no one wants to listen to the new symphony, then no matter how original it is, it won’t be considered a great musical composition.
Given these definitions, Simonton goes on to present the research, theories, and biographical information that have advanced our understanding of creative genius. He begins by examining the thought processes of geniuses. To understand how Darwinism can be applied to this thought process, Simonton mentions Donald Campbell’s theory. This theory states that creative thinking involves 3 conditions:
The more ideas, the greater chance that one or more of them will become a masterpiece. The most successful geniuses are also the most prolific. Shakespeare, Beethoven, Newton and others created (or discovered) many things that are now forgotten. The few things for which they are remembered are only a fraction of their total output.
How do creative people think? Like other people, they use imagery, intuition, and insight, along with analytical thinking. The main difference between creative and ordinary people is that creative people utilize remote association and divergent thinking. Remote association is making connections between separate ideas. A historical example of remote association is Einstein’s connecting relative space and time with the constancy of the speed of light. Before Einstein, scientists had considered these separate subjects.
Divergent thinking is the ability to come up with original ideas, solutions, and responses to questions. It is distinguished from convergent thinking, which is the coming up with the expected solution or response, e.g. the correct answer on a standardized test. Some fields require more divergent thinking than others. For example, artists, composers, and creative writers usually think more divergently than scientists.
Creative people also have different personalities than most other people. They have broad interests, they’re open to novel and ambiguous stimuli, they have trouble focusing on any one thing, they are flexible cognitively and behaviorally, they are more likely to be introverted, and are nonconformists. While not all creative geniuses fit this personality profile exactly, most exhibit at least some of these traits.
Creative people are also more likely to have psychiatric problems than the average person. There are many examples of depressed, bipolar, alcoholic, suicidal, and psychotic creative geniuses. Famous names with severe disorders include Vincent Van Gogh, Robert Schumann, Ernest Hemingway, Peter Tchaikovsky, and Charles Darwin. It’s important to understand, however, that most creative geniuses don’t exhibit high levels of psychopathology, or they would never have been able to create anything. Their symptoms tend to be midway between normal and abnormal.
Not surprisingly, geniuses usually grow up in enriched family environments. Their parents tend to have higher-than-average levels of formal education, with at least one parent working at an intellectual profession. Their parents value learning and supply their children with an ample supply of books, magazines, games. Visits to museums, exhibits, galleries, libraries and other places that stimulate intellectual development are common.
What’s unusual about geniuses’ childhood experiences is that they frequently face adversity. Geniuses often have physical or sensory disabilities, or chronic childhood illnesses. Sometimes their parents become bankrupt or impoverished. Many geniuses have experienced the death of one or both parents at an early age. These adverse experiences may set the young future genius on a developmental path different from most of his peers.
While geniuses are all highly intelligent, many of them lack advanced degrees or do poorly in school. Artistic creators generally have less schooling than scientific creators. Formal schooling suppresses creativity in favor of memorization and conformity. So it makes sense that many geniuses would dislike school. Since education and training is required for acquiring the necessary expertise in one’s profession, creators who drop out of school always are autodidacts. Many geniuses have one or more mentors who help compensate for the lack of formal education.
Like all complex human behaviors, creative achievement is a product of both nature and nurture. On the nurture side, as I mentioned above, creative people tend to grow up in enriched home environments, and also experience more traumatic childhood experiences than usual. But many people grow up in enriched environments and have adverse childhood experiences. Only a tiny fraction become geniuses. So there must be a unique genetic predisposition that interacts with these experiences to produce a genius. The technical term for this is “emergenesis”, or a combination of multiple genetic components, each of which must be inherited for the trait to appear. An emergenic trait is shared but identical twins, but doesn’t run in families. Evidence that creative genius is emergenic comes from family studies of geniuses. Many of the greatest geniuses in history, including Newton, Shakespeare, Beethoven, and Michelangelo, have no relatives of distinction.
Unlike intelligence, which is normally distributed in the population (i.e. having a bell-shaped curve), creative achievement is highly skewed. There are two mathematical laws describing this skewed distribution. The Price law states that if k represents the number of active creators in a field, then √k of these creators contribute about half of the products in the field. For example, assuming that there are 100 total architects, then 10 out of 100 architects are responsible for half of all building designs. The Lotka law states that the number of creators who contribute n products is inversely proportional to n squared. For example, the number of creators who contribute 10 products is c/100, where c is a constant. The number of creators who contribute 20 products (twice the number) is c/400, only 1/4 of who contribute 10 products. If you go up to 50 products (five times the original number), then the number is c/2500, or 1/25 of who contribute 10 products.
These laws hold whether one is considering all works created, or just works that have stood the test of time. For example, all of the works that make up the standard repertoire of classical music (i.e. works that are still performed today) were composed by about 250 composers. The square root of this number is about 16, which is the number of composers accounting for half of all the pieces performed today. Mozart alone composed 6.1% of the standard repertoire, which is slightly greater than the sum total of the bottom 150 composers!
The level of creative achievement varies across a creator’s career. At the beginning of his career, his output gradually increases. At some point he reaches a peak, after which his output declines. This trajectory is based on career age rather than chronological age. Late bloomers will have a later peak. Some disciplines, such as mathematics and poetry, have a much earlier peak than other disciplines, such as geology and philosophy.
One of the most interesting and difficult-to-explain aspects of creative genius is that achievement isn’t constant over place and time. Genius tends to cluster in some places at certain times. When these places experience a burst of creative achievement, they are said to have experienced a “golden age”. Eventually, and for reasons not fully understood, these golden ages decline to silver ages, and finally to dark ages. Examples of golden ages of achievement include Ancient Greece, the European Renaissance and Scientific Revolution, and similar (but less golden) ages in China, Japan, and other places.
It’s easy to understand how the presence of genius in one’s time can help spur additional genius. This can occur by means of immediate predecessors and contemporaries. “[T]he number of eminent creators in one generation is a positive function of the number in the preceding generation who are active in the same or affiliated domains” (p. 206). These eminent predecessors serve both as role models and mentors. Charles Darwin had Alexander Monro and Adam Sedgwick as his teachers, and was influenced by Hutton, Lamarck, Sprengel, Malthus, Lyell, and others. Beethoven studied under Haydn, and was influenced by Mozart.
Eminent scientists and artists are more likely to occur during eras in which they can form relationships with contemporaries in their fields. These contemporaries don’t have to be at the same level that the geniuses are. “No matter what the domain of achievement, genius of the highest quality tends to be contemporaneous with genius of a lesser rank, and even with the more obscure also-rans and nonentities” (p. 208). Geniuses need audiences, professional contacts, and social networks to help motivate them to create. The idea of the lone-wolf genius, like Howard Roark in the novel The Fountainhead, doesn’t correspond to historical fact. While there were likely potential geniuses during the European Dark Ages, the barren cultural milieu prevented them from achieving anything.
Geniuses tend to live during eras of high intellectual receptiveness, ethnic diversity, and political openness. Some level of basic political freedom and economic prosperity is required for creative flourishing. It must be noted, however, that most creative achievement occurred under regimes which by today’s standards would be considered autocratic and unfree. Remember that Socrates, who lived during the Athenian creative golden age, was executed for his beliefs. Galileo, who lived during the European scientific revolution, was persecuted by the Catholic Church.
The division of labor is an important sociological factor that contributed to the emergence of creative genius. If every person in a society is engaged in physical labor such as hunting, gathering, homemaking, or farming, no one will have any time to create. With increased population comes specialization and division of labor, including jobs for creative people such as painters, sculptors, architects, musicians, and engineers. The European scientific revolution gave birth to another profession that gave men opportunity for creative achievement. Population size is a necessary, but not sufficient factor for the emergence of creative genius, as there were many large societies (e.g. Europe during the dark ages) that had very little creative achievement, and smaller societies (e.g. classical Athens) that had a great deal of achievement.
Origins of Genius is strong in its understanding and analysis of individual genius. Simonton does an excellent job explaining creative thought processes, in presenting what personality characteristics distinguish geniuses from everyone else, in explaining how developmentally and genetically they are different, and in describing the mathematical laws that show the skewed output of creative achievement.
The book’s main weaknesses have to do with group phenomena, including clustering of genius, and gender differences in genius. While Simonton can explain why having creative achievers in one’s own and preceding generations can help spur geniuses to accomplishment, he can’t explain what starts and ends this process. Since genius occurs in golden ages that come and go, something must occur to start the process of creative achievement, and something must end it. Simonton has little to offer to explain this.
Another problem is that Simonton completely ignores the cultural and creative dark ages we are currently living in. As I explain in an earlier blog post, dullness has become triumphant in our times. In the arts, modernism has completely destroyed all the great European traditions, and we have a reign of mediocrity. This isn’t just my personal opinion. I can prove this by asking who are the great contemporary artists, writers, and composers. Various people will provide different responses, but none of the names mentioned will have the recognition that the great artists of the past have. As Simonton mentions in his book, an unrecognized genius is an oxymoron. A genius who is unrecognized in his own time will most likely remain unrecognized in future generations.
In the sciences, there is some low-level creative group achievement, but no individual geniuses on the level of Newton, Darwin, or Einstein. As proof, I’ll offer the same name recognition test that I did for artists. While every year a handful of scientists win Nobel Prizes, they are always people no one (outside their fields) has heard of. These people, while accomplished, are not geniuses.
One of the problems with both the arts and sciences is that both have become so highly professionalized and esoteric that people can gain distinction in a field, but be unknown outside the field. This is partly due to the disintegration and balkanization of our culture, which has various causes, including modernism (in the arts) and technology (e.g. the Internet). But it is partly due to declining accomplishment. If someone accomplished something at the level of Einstein, Michelangelo, or Beethoven, most educated people would have heard of him. This is as true today as it would have been true centuries ago.
One historical fact that Simonton tries unsuccessfully to explain on environmental grounds is the almost complete lack of female creative geniuses. “In Western civilization, for example, women make up only around 3% of the most illustrious figures of history. And many of these females [e.g. monarchs] entered the records in part by birthright or marriage. (p. 215)” Almost all geniuses in history have been male. Some fields, such as mathematics, physics, and music composition, are completely dominated by men. The one field where women have a minor presence is literature.
Simonton rejects biological explanations such as lower IQ, less variable IQ, and biologically-based personality differences. He provides more conventional environmental explanations such as child-rearing practices, the costs of marriage and family to female achievement, sex discrimination, and philosophical/cultural hostility to female employment and achievement. He claims that female achievement in literature is due solely to the fact that creative writing requires little start-up cost or overhead. But he ignores that publication (including book marketing) does require overhead. Many women had access to musical instruments in their home. Why didn’t they use these instruments to compose music, as men did? Why is the female lack of creative achievement universal across societies, including cultures that had little interaction with each other (e.g. Eastern and Western societies before the modern era). Why, in contemporary America and Europe, when all these environmental hindrances to female creative achievement have been removed, do we still see so little female achievement?
In conclusion, Origins of Genius is an excellent summary of scientific knowledge about creative genius at the beginning of the new millennium. It provides a wealth of detailed facts and analyses that illuminate our understanding of this strange and wondrous phenomenon. Its main weakness is a lack of understanding of what environmental factors bring about creative golden ages and dark ages. This weakness makes it unhelpful in trying to engender new works of genius, i.e. helping bring about a new golden age of creativity.
Simonton begins by defining “genius”. A genius isn’t someone with a high IQ, although most people we consider geniuses were very intelligent. A genius is someone who accomplishes something that sets him apart from everyone else, i.e. someone who has achieved eminence. Beethoven is a musical genius because of his symphonies, piano concertos, and other works that continue to be performed almost two centuries after his death. If Beethoven hadn’t composed any music, he wouldn’t be considered a genius, no matter how much intelligence or ability he possessed. “The phrase unrecognized genius becomes an oxymoron” (p. 5).
A “creative genius” is someone who invents or discovers an original, adaptive idea or product. Originality is required because mere imitation isn’t creative. Adaptiveness is required because if the new mousetrap doesn’t work, it isn’t any better than what we have now. If the new theory doesn’t fit the facts, or has internal contradictions, it won’t help advance science. If no one wants to listen to the new symphony, then no matter how original it is, it won’t be considered a great musical composition.
Given these definitions, Simonton goes on to present the research, theories, and biographical information that have advanced our understanding of creative genius. He begins by examining the thought processes of geniuses. To understand how Darwinism can be applied to this thought process, Simonton mentions Donald Campbell’s theory. This theory states that creative thinking involves 3 conditions:
- There exists some process that generates ideational variations, similar to genetic recombinations and mutations.
- These variations are subjected to a selection mechanism, similar to natural selection, but more cognitive or cultural in nature.
- There is some retention procedure that preserves and reproduces creative ideas, similar to genetic retention.
The more ideas, the greater chance that one or more of them will become a masterpiece. The most successful geniuses are also the most prolific. Shakespeare, Beethoven, Newton and others created (or discovered) many things that are now forgotten. The few things for which they are remembered are only a fraction of their total output.
How do creative people think? Like other people, they use imagery, intuition, and insight, along with analytical thinking. The main difference between creative and ordinary people is that creative people utilize remote association and divergent thinking. Remote association is making connections between separate ideas. A historical example of remote association is Einstein’s connecting relative space and time with the constancy of the speed of light. Before Einstein, scientists had considered these separate subjects.
Divergent thinking is the ability to come up with original ideas, solutions, and responses to questions. It is distinguished from convergent thinking, which is the coming up with the expected solution or response, e.g. the correct answer on a standardized test. Some fields require more divergent thinking than others. For example, artists, composers, and creative writers usually think more divergently than scientists.
Creative people also have different personalities than most other people. They have broad interests, they’re open to novel and ambiguous stimuli, they have trouble focusing on any one thing, they are flexible cognitively and behaviorally, they are more likely to be introverted, and are nonconformists. While not all creative geniuses fit this personality profile exactly, most exhibit at least some of these traits.
Creative people are also more likely to have psychiatric problems than the average person. There are many examples of depressed, bipolar, alcoholic, suicidal, and psychotic creative geniuses. Famous names with severe disorders include Vincent Van Gogh, Robert Schumann, Ernest Hemingway, Peter Tchaikovsky, and Charles Darwin. It’s important to understand, however, that most creative geniuses don’t exhibit high levels of psychopathology, or they would never have been able to create anything. Their symptoms tend to be midway between normal and abnormal.
Not surprisingly, geniuses usually grow up in enriched family environments. Their parents tend to have higher-than-average levels of formal education, with at least one parent working at an intellectual profession. Their parents value learning and supply their children with an ample supply of books, magazines, games. Visits to museums, exhibits, galleries, libraries and other places that stimulate intellectual development are common.
What’s unusual about geniuses’ childhood experiences is that they frequently face adversity. Geniuses often have physical or sensory disabilities, or chronic childhood illnesses. Sometimes their parents become bankrupt or impoverished. Many geniuses have experienced the death of one or both parents at an early age. These adverse experiences may set the young future genius on a developmental path different from most of his peers.
While geniuses are all highly intelligent, many of them lack advanced degrees or do poorly in school. Artistic creators generally have less schooling than scientific creators. Formal schooling suppresses creativity in favor of memorization and conformity. So it makes sense that many geniuses would dislike school. Since education and training is required for acquiring the necessary expertise in one’s profession, creators who drop out of school always are autodidacts. Many geniuses have one or more mentors who help compensate for the lack of formal education.
Like all complex human behaviors, creative achievement is a product of both nature and nurture. On the nurture side, as I mentioned above, creative people tend to grow up in enriched home environments, and also experience more traumatic childhood experiences than usual. But many people grow up in enriched environments and have adverse childhood experiences. Only a tiny fraction become geniuses. So there must be a unique genetic predisposition that interacts with these experiences to produce a genius. The technical term for this is “emergenesis”, or a combination of multiple genetic components, each of which must be inherited for the trait to appear. An emergenic trait is shared but identical twins, but doesn’t run in families. Evidence that creative genius is emergenic comes from family studies of geniuses. Many of the greatest geniuses in history, including Newton, Shakespeare, Beethoven, and Michelangelo, have no relatives of distinction.
Unlike intelligence, which is normally distributed in the population (i.e. having a bell-shaped curve), creative achievement is highly skewed. There are two mathematical laws describing this skewed distribution. The Price law states that if k represents the number of active creators in a field, then √k of these creators contribute about half of the products in the field. For example, assuming that there are 100 total architects, then 10 out of 100 architects are responsible for half of all building designs. The Lotka law states that the number of creators who contribute n products is inversely proportional to n squared. For example, the number of creators who contribute 10 products is c/100, where c is a constant. The number of creators who contribute 20 products (twice the number) is c/400, only 1/4 of who contribute 10 products. If you go up to 50 products (five times the original number), then the number is c/2500, or 1/25 of who contribute 10 products.
These laws hold whether one is considering all works created, or just works that have stood the test of time. For example, all of the works that make up the standard repertoire of classical music (i.e. works that are still performed today) were composed by about 250 composers. The square root of this number is about 16, which is the number of composers accounting for half of all the pieces performed today. Mozart alone composed 6.1% of the standard repertoire, which is slightly greater than the sum total of the bottom 150 composers!
The level of creative achievement varies across a creator’s career. At the beginning of his career, his output gradually increases. At some point he reaches a peak, after which his output declines. This trajectory is based on career age rather than chronological age. Late bloomers will have a later peak. Some disciplines, such as mathematics and poetry, have a much earlier peak than other disciplines, such as geology and philosophy.
One of the most interesting and difficult-to-explain aspects of creative genius is that achievement isn’t constant over place and time. Genius tends to cluster in some places at certain times. When these places experience a burst of creative achievement, they are said to have experienced a “golden age”. Eventually, and for reasons not fully understood, these golden ages decline to silver ages, and finally to dark ages. Examples of golden ages of achievement include Ancient Greece, the European Renaissance and Scientific Revolution, and similar (but less golden) ages in China, Japan, and other places.
It’s easy to understand how the presence of genius in one’s time can help spur additional genius. This can occur by means of immediate predecessors and contemporaries. “[T]he number of eminent creators in one generation is a positive function of the number in the preceding generation who are active in the same or affiliated domains” (p. 206). These eminent predecessors serve both as role models and mentors. Charles Darwin had Alexander Monro and Adam Sedgwick as his teachers, and was influenced by Hutton, Lamarck, Sprengel, Malthus, Lyell, and others. Beethoven studied under Haydn, and was influenced by Mozart.
Eminent scientists and artists are more likely to occur during eras in which they can form relationships with contemporaries in their fields. These contemporaries don’t have to be at the same level that the geniuses are. “No matter what the domain of achievement, genius of the highest quality tends to be contemporaneous with genius of a lesser rank, and even with the more obscure also-rans and nonentities” (p. 208). Geniuses need audiences, professional contacts, and social networks to help motivate them to create. The idea of the lone-wolf genius, like Howard Roark in the novel The Fountainhead, doesn’t correspond to historical fact. While there were likely potential geniuses during the European Dark Ages, the barren cultural milieu prevented them from achieving anything.
Geniuses tend to live during eras of high intellectual receptiveness, ethnic diversity, and political openness. Some level of basic political freedom and economic prosperity is required for creative flourishing. It must be noted, however, that most creative achievement occurred under regimes which by today’s standards would be considered autocratic and unfree. Remember that Socrates, who lived during the Athenian creative golden age, was executed for his beliefs. Galileo, who lived during the European scientific revolution, was persecuted by the Catholic Church.
The division of labor is an important sociological factor that contributed to the emergence of creative genius. If every person in a society is engaged in physical labor such as hunting, gathering, homemaking, or farming, no one will have any time to create. With increased population comes specialization and division of labor, including jobs for creative people such as painters, sculptors, architects, musicians, and engineers. The European scientific revolution gave birth to another profession that gave men opportunity for creative achievement. Population size is a necessary, but not sufficient factor for the emergence of creative genius, as there were many large societies (e.g. Europe during the dark ages) that had very little creative achievement, and smaller societies (e.g. classical Athens) that had a great deal of achievement.
Origins of Genius is strong in its understanding and analysis of individual genius. Simonton does an excellent job explaining creative thought processes, in presenting what personality characteristics distinguish geniuses from everyone else, in explaining how developmentally and genetically they are different, and in describing the mathematical laws that show the skewed output of creative achievement.
The book’s main weaknesses have to do with group phenomena, including clustering of genius, and gender differences in genius. While Simonton can explain why having creative achievers in one’s own and preceding generations can help spur geniuses to accomplishment, he can’t explain what starts and ends this process. Since genius occurs in golden ages that come and go, something must occur to start the process of creative achievement, and something must end it. Simonton has little to offer to explain this.
Another problem is that Simonton completely ignores the cultural and creative dark ages we are currently living in. As I explain in an earlier blog post, dullness has become triumphant in our times. In the arts, modernism has completely destroyed all the great European traditions, and we have a reign of mediocrity. This isn’t just my personal opinion. I can prove this by asking who are the great contemporary artists, writers, and composers. Various people will provide different responses, but none of the names mentioned will have the recognition that the great artists of the past have. As Simonton mentions in his book, an unrecognized genius is an oxymoron. A genius who is unrecognized in his own time will most likely remain unrecognized in future generations.
In the sciences, there is some low-level creative group achievement, but no individual geniuses on the level of Newton, Darwin, or Einstein. As proof, I’ll offer the same name recognition test that I did for artists. While every year a handful of scientists win Nobel Prizes, they are always people no one (outside their fields) has heard of. These people, while accomplished, are not geniuses.
One of the problems with both the arts and sciences is that both have become so highly professionalized and esoteric that people can gain distinction in a field, but be unknown outside the field. This is partly due to the disintegration and balkanization of our culture, which has various causes, including modernism (in the arts) and technology (e.g. the Internet). But it is partly due to declining accomplishment. If someone accomplished something at the level of Einstein, Michelangelo, or Beethoven, most educated people would have heard of him. This is as true today as it would have been true centuries ago.
One historical fact that Simonton tries unsuccessfully to explain on environmental grounds is the almost complete lack of female creative geniuses. “In Western civilization, for example, women make up only around 3% of the most illustrious figures of history. And many of these females [e.g. monarchs] entered the records in part by birthright or marriage. (p. 215)” Almost all geniuses in history have been male. Some fields, such as mathematics, physics, and music composition, are completely dominated by men. The one field where women have a minor presence is literature.
Simonton rejects biological explanations such as lower IQ, less variable IQ, and biologically-based personality differences. He provides more conventional environmental explanations such as child-rearing practices, the costs of marriage and family to female achievement, sex discrimination, and philosophical/cultural hostility to female employment and achievement. He claims that female achievement in literature is due solely to the fact that creative writing requires little start-up cost or overhead. But he ignores that publication (including book marketing) does require overhead. Many women had access to musical instruments in their home. Why didn’t they use these instruments to compose music, as men did? Why is the female lack of creative achievement universal across societies, including cultures that had little interaction with each other (e.g. Eastern and Western societies before the modern era). Why, in contemporary America and Europe, when all these environmental hindrances to female creative achievement have been removed, do we still see so little female achievement?
In conclusion, Origins of Genius is an excellent summary of scientific knowledge about creative genius at the beginning of the new millennium. It provides a wealth of detailed facts and analyses that illuminate our understanding of this strange and wondrous phenomenon. Its main weakness is a lack of understanding of what environmental factors bring about creative golden ages and dark ages. This weakness makes it unhelpful in trying to engender new works of genius, i.e. helping bring about a new golden age of creativity.
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