Jun 13 2013

The Problem of Addiction

The central nervous system evolved as a tool for rapidly dealing with and adapting to the environment. If we strip down the nervous system’s function to its essential core, it functions as a tool for sensing the surrounding environment and responding with either reward or aversion. As vertebrates evolved this function became increasingly sophisticated, but the essence remains.

Even in the human brain there remain reward circuits that respond to thoughts and sensations by creating a good feeling, and others that respond with an emotionally negative experience. Despite our incredible neurological sophistication, humans are still powerfully motivated by this simple binary system. We seek out pleasant experiences and avoid negative ones. Psychologists have identified a number of cognitive biases, such as cognitive dissonance, that essentially follow this paradigm.

Building a nervous system around reward/aversion circuits is apparently evolutionarily successful, but comes with a significant vulnerability – what if the system can be “hacked”? What if a creature hits upon a behavior that is not advantageous to its survival or propagation, but stimulates the reward circuits? A little bit of this is probably inevitable – incidental behaviors around the edges of those that are truly adaptive. But what if such behaviors take over one’s existence?

That is essentially what addiction is. Addiction can be behavioral, such as gambling or a particular fetish. They can also bypass thoughts and behavior by directly stimulating reward circuits pharmacologically – drug addiction.

I don’t think we are evolutionarily prepared for drug addiction. Animals may encounter edible items in their environment that contain addictive substances, but are unlikely to have access to sufficient amounts that it can be a constant long term behavior. Humans, on the other hand, have figured out how to manufacture large quantities of purified drugs, tweaked to produce a maximal direct stimulation of our reward circuits.

It’s even worse than that, however. A recent study looked at cocaine addiction in a rat model. They found that not only does cocaine use activate reward circuits, driving drug-seeking behavior in the rats, after the rats become addicted the circuits involving negative emotions (involving the central amygdala) become active. Use of cocaine is then necessary to suppress the negative feelings of this circuit.

This study mirrors observations in humans. For many addictive drugs, use creates euphoria and intensely positive experiences. Users are then motivated to seek out this positive experience. Once addicted, however, withdrawal from the substance creates a powerful dysphoria, and users seek out drug use in order to reduce this extremely negative experience. This leads to not just addiction but dependence.

The question is – what are the ethical implications of this research (and yes, this does overlap with the whole free will debate). Can anyone really be blamed because their brains are vulnerable to addiction and dependence? More to the point – neuroscientific research into addiction seems like a powerful argument against legalizing recreational drugs.

At least, it seems to refute the argument that people should be free to choose for themselves if they want to use recreational drugs, because by the very nature of those drugs and brain function, they take away that freedom. Are people who are addicted to a drug really free to choose if they want to keep using that drug? Is it unfair to legalize a pharmacological trap waiting to ensnare the naive, uninformed, or unfortunate?

I know there are potentially practical arguments to be made for legalization, but that is a debate I am not addressing here. I simply don’t buy arguments for drug legalization premised on liberty and freedom, when those drugs by their very nature take away liberty and freedom.

It also seems inevitable that new ways to hack this reward/aversion system are coming. It has already been 50 years since the famous James Olds rat experiment in which an implanted wire stimulating the “pleasure center” of the brain caused the rat to seek out that stimulation to the exclusion of all else, even to the point of starvation.

Direct electrical stimulation may prove more powerful than pharmacological stimulation – and more addictive.

There are more subtle problems coming also. Video game addiction may be a harbinger of more extreme problems to come. What will happen when we can live our lives in a fully immersive virtual reality – when we can create our own reality to maximally cater to our reward centers? Will this be the ultimate trap of our neurobiology?

The deeper conflict here is between living in harsh reality, and making the best of it, vs bypassing the adaptive nature of the reward/aversion circuits in our brain in order to escape to a pharmacologically/electrically/virtually induced fantasy euphoria.

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173 responses so far

173 Responses to “The Problem of Addiction”

  1. Insomniacon 13 Jun 2013 at 9:00 am

    Steven,

    What about marijuana ? My understanding was that it did not cause any direct physical dependance, although its use does stimulate reward circuits.

    And you said :
    “those drugs by their very nature take away liberty and freedom”

    I don’t know if there is the hidden assumption here that we possess any form of free will. I’d like to know where you stand in the free will debate, because although I looked into compatibilist arguments, it seems to me that there is no strong case possible for free will in a naturalistic worldview.

  2. praktikon 13 Jun 2013 at 9:52 am

    Steven,

    Studies have shown that people who try hard drugs end up dependent (following cohorts over the years after their first experience) at roughly the 5-12% level.

    If many individuals are then able to sample – even hard drugs – without developing dependency, then I think there is still some element of freedom and liberty that is a valid argument for the legalization of drugs.

    A useful example is alcohol, where dependent alcoholics ruin lives and families – yet many people enjoy the freedom of being able to indulge in this drug in social venues where it performs the function of “social glue”.

    Now this may be a cultural bridge too far from the world you inhabit Steven, but in the circles I’ve travelled many illegal drugs (most prominently marijuana – but including hallucinogens, ecstasy and even cocaine) perform these same functions. As with alcohol I have seen people develop problems. But also with alcohol, I’ve personally used all the substances I’ve listed in the same social way that others do with alcohol (they are ingrained in the night-life subculture I inhabit).

    You may be overgeneralizing from a rather mechanical view of the way drug use works on the brain – leaving out the statistics showing that dependency is still something that happens to a minority and the socio-cultural milieus in which these drugs are taken.

    Furthermore, when it comes to worry about the harm from drug use and our legal rubric – I think there is a strong case to be made that prohibition exacerbates and multiplies these harms. Too much to list here, but I find this site to be a very worthwhile compendium of research and studies across a variety of aspects of drugs and prohibition: http://www.countthecosts.org

  3. ccbowerson 13 Jun 2013 at 9:53 am

    “More to the point – neuroscientific research into addiction seems like a powerful argument again legalizing recreational drugs…
    I know there are potentially practical arguments to be made for legalization, but that is a debate I am not addressing here. I simply don’t buy arguments for drug legalization premised on liberty and freedom.”

    I think the first sentence is way too strong a statement, because there is far too much to unpack here. Your next paragraph is a bit better, but I don’t see how this neuroscience research is ” a powerful argument again (sic) legalizing recreational drugs.” It adds to our understanding of addiction, but it does not tell us what to do about our laws. There are too many specifics that matter much more than this general understanding. We would need to evaluate the effects of various controlled substance laws to know what is best. This is basic research, and you are extrapolating that research beyond what it tells us when you say it is a powerful argument against legalization.

    Also, I am not sure what precisely you mean by “practical arguments.” What becomes law must also be practical, or you have lost me. I know you must mean you are excluding arguments based upon practicality, but then what arguments are you talking about? Just freedom arguments?

    The practical arguments are critical to know what to do with our laws: What impact do our laws regarding controlled substances have on the use of those substances and the citizens more generally? In which ways do they help, and in which ways do they hurt. How are they different between substances? Are the laws on specific substance proportionate to their harm? Do the punishments help or hurt? etc

    I agree that arguments solely based upon liberties and freedoms are not good ones, which you get to in this post, but those are only a small part of the arguments. Also, I think in order to have disussions about addiction and recreational drugs, we actually need to speak about specifics, since by lumping them into one category very few conclusions can be drawn. Not all recreational substance have them same addictive properties, and some substances cause addiction in a minority of the population (e.g. marijuana, alcohol) while others cause addiction in close to 100% (heroin, cigarettes).

    To be clear, I am not necessarily a legalization advocate, I just disagree with your argument.

  4. cannotsay2013on 13 Jun 2013 at 10:32 am

    Steven,

    “At least, it seems to refute the argument that people should be free to choose for themselves if they want to use recreational drugs, because by the very nature of those drugs and brain function, they take away that freedom.”

    Only for those who have already dogmatically concluded that,

    - A experiment about behavior in rats extrapolates to humans completely

    - Humans do not have “free will”

    Even you admit that the second point is a contentious point. I side with “humans’ free will” over “rat experiments that provide insight about human behavior” any time, but again, my thinking is not corrupted with so called “skeptic dogma” :D .

  5. Steven Novellaon 13 Jun 2013 at 10:46 am

    cc – I specifically did not get into the question of whether or not specific recreational drugs should be legal. That’s what I meant when I wrote, “that is not a debate I am addressing here.”

    Regarding the research, I said it “seems” like an argument against legalization, then immediately clarified that by stating that it removes the argument based upon liberty and free choice because the very nature of addiction removes free choice.

    I could have explicitly added that this is also a matter of degree and different substances have different addictive potentials. Different people also have different susceptibility to addiction to different substances.

  6. Steven Novellaon 13 Jun 2013 at 10:49 am

    There is a great deal of clinical addiction research on humans. Rat studies are helpful to sort out the neuroanatomical correlates because we can do things like slice up their brains. But there is plenty of human clinical research.

    There is no such thing as “skeptic dogma” – only cranks who don’t understand scientific skepticism.

  7. cannotsay2013on 13 Jun 2013 at 10:55 am

    Steven Novella,

    Actually the two threads in which psychiatry has been duly deconstructed (it was about time) show very convincingly that there is plenty of dogmatism in your movement. You have written in the past several posts that after May 2013′s crisis in psychiatry look ridiculous (they were ridiculous back then, only now authoritative figures in psychiatry have refuted many of your points). The post called “Responding to a Szaszian” is the poster example of the type of canards the so called “skeptic movement” dogmatically beliefs such as,

    “ADHD is demonstrably a brain disorder and fits well into our current models of brain function, specifically the role of executive function in guiding our attention and behavior”

    Well, no, as Insel said ADHD (like other DSM labels) is just a label created by “consensus” of DSM committee members about a pattern of behavior that has a low reliability measure (0.6) and for which some time in the future some think there will be a “biological biomarker” but nobody has demonstrated in a way that passes any reasonable test that it is a “brain disorder” :D .

  8. Steven Novellaon 13 Jun 2013 at 11:21 am

    I am not the skeptical movement. There is actually quite a diversity of opinion among skeptics on this topic, and I am the only skeptic of note that I know of who writes regularly on this topic.

    Second – a science-based and rational argument for a position does not equal “dogma.” It if very telling that you cannot tell the difference, or that you don’t care about the difference.

    Regarding ADHD, your simplistic quoting out of context of one individual is also very revealing. Meanwhile, and actual scientific discussion on the nuances of validity and reliability are happening within psychiatry.

    Here is one review that takes a frank and honest look at the current state of the evidence. They acknowledge the limitations of the diagnosis, but also note: http://psych.colorado.edu/~willcutt/pdfs/Willcutt_Carlson_2005.pdf

    “This paper summarizes the results of a comprehensive review of the internal and external validity of ADHD as defined in the fourth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV). Results indicate that for most individuals DSM-IV ADHD is a valid disorder in the sense that it is associated with significant impairment in social, academic, and occupational functioning and increased risk of accidental injury across the life span.”

    About the notion of validity of mental disorders more broadly, they write:

    “As described in more detail elsewhere in this special issue, the criteria, which must be met for a mental
    disorder to be considered valid, have been the focus of considerable discussion. These authors have
    considered an extensive range of important issues, including the role of theory in the development of diagnostic criteria, the utility of a dimensional versus categorical conceptualization of mental disorders, the extent to which the definition of a mental disorder is influenced by social values, and the potential usefulness of evolutionary theory to identify mental processes that have gone awry.”

    Here’s also a more recent 2012 review: http://www.ncbi.nlm.nih.gov/pubmed/22612200

    “Results indicated that DSM-IV criteria identify individuals with significant and persistent impairment in social, academic, occupational, and adaptive functioning when intelligence, demographic factors, and concurrent psychopathology are controlled. Available data overwhelmingly support the concurrent, predictive, and discriminant validity of the distinction between inattention and hyperactivity-impulsivity symptoms, and indicate that nearly all differences among the nominal subtypes are consistent with the relative levels of inattention and hyperactivity-impulsivity symptoms that define the subtypes.”

    But they go on to conclude that the DSM IV subtypes are not sufficiently supported by evidence, and perhaps we should rethink (more dimensional, less categorical) how subtypes of ADHD are defined.

    Contrast this to your simplistic cartoon. Where’s the dogma?

  9. LittleBoyBrewon 13 Jun 2013 at 11:29 am

    Your statement

    “I simply don’t buy arguments for drug legalization premised on liberty and freedom, when those drugs by their very nature take away liberty and freedom.”

    seems to be an backhanded slap at the libertarian viewpoint. Whether you did that with intent I do not know. I once heard Penn Jillette (a big libertarian, for those who do not know) say that when considering potential solutions to a problem, one should consider whether increasing liberty and freedom is a better solution than decreasing it. In the case of addiction you seem to be limiting the discussion of freedom and liberty to the person consuming the drug. What about the liberty and freedom of a person who lives in a neighborhood that is unsafe due to crime, crime that is related to the sale and distribution of illegal drugs? If you are afraid to leave your house because you might be robbed or shot, I would say your freedom has been taken away to a degree.

    I understand your premise, the irony that the freedom to take a drug results in a certain loss of freedom. And that irony should be considered as a part of any smart drug policy. But there is a much larger picture to consider.

  10. ConspicuousCarlon 13 Jun 2013 at 11:34 am

    Steve Novella said
    I simply don’t buy
    arguments for drug legalization premised on
    liberty and freedom,

    Someone else already mentioned that the loss of freedom from addiction is far from universal, so I will deal with the first half of the sentence.

    I get the impression that you think drugs ought to all be illegal unless someone argues for “legalization”. But these drugs weren’t found in the woods wrapped up in prohibition laws. Prohibition was implimented without much more than political hatred, and I can dismiss the blanket “lock you up for your own good” brutality just as easily as you dismiss freedom.

    The difference is that you are, by phrasing it as “legalization”, supporting a system which actively affirms the paternalistic basis for criminal prosecution as a default. I don’t ask for “legalization”, which implies that I am asking for a thing to be done, I ask that the government stop actively imprisoning people who haven’t harmed anyone.

    I’m sure you want to respond with a claim to want to avoid making political assertions, but you have already made one.

  11. ccbowerson 13 Jun 2013 at 11:35 am

    “Regarding the research, I said it ‘seems’ like an argument against legalization, then immediately clarified that by stating that it removes the argument based upon liberty and free choice because the very nature of addiction removes free choice.
    I could have explicitly added that this is also a matter of degree and different substances have different addictive potentials. Different people also have different susceptibility to addiction to different substances.”

    I agree with all of your follow up, but your post implies something different. I assume that this post is a continuation of previous conversations that you have had with others with a libertarian/legalization perspective, but without this context it is misleading. I agree that the freedom of choice argument alone is not a good one, but there is much more to this conversation.

    “Contrast this to your simplistic cartoon. Where’s the dogma?”

    Apparently he thinks that if he repeats the word dogma in different forms, it becomes more true. He has used it dozens of times, and keeps using it despite the fact that I have demonstrated that he doesn’t know what the word means or is at least misusing the term.
    Dogma is really argument from authority, and the skeptical movement is not heirarchically structured- there is no built in authority. It’s one of his weasel words of choice.

  12. Bruce Woodwardon 13 Jun 2013 at 12:00 pm

    If illegalization of drugs was to be done on addiction alone, surely nicotine should be added to the list?

    Personally, I think (note think, this is not based on facts) that making recreational drugs legal would solve more problems than it causes and would open the door for taxation and regulation.

  13. dawso007on 13 Jun 2013 at 12:03 pm

    You are correct about the low probability of encountering a foodstuff that will contain an addictive compound that will hijack your brain. There are currently 322 addictive drugs and precursors on the DEA list of controlled substances compared with a total of 34 million compounds in Chem Abstracts. George Koob has defined addiction as a disorder that moves from an impulse control disorder involving positive reinforcement to compulsive disorder involving negative reinforcement. In clinical work with addicts this is commonly observed as “chasing the high”. With chronic use it is rare to talk with anyone who is getting high anymore and the bulk of their behavior is focused on avoiding withdrawal symptoms. I also agree with your observations that legalization of drugs doesn’t make any sense from the standpoint of neurobiology. Historically we have already done these experiments and they have failed. That does not mean that addicts need to be criminalized and treatment is an option. Musto does a good job of documenting what he describes as oscillations between periods of tolerance of drug use to periods of disapproval and demarcating three temperance movements so far in the US.

    Reality is not as harsh as being stuck on the compulsive negative reinforcing side of an addiction. The reward system operates well in response to the less intense biological reinforcers like social affiliation, more intimate relationships, and hedonic activities that activate the reward system in more predictable ways. Those same activities can be a pathway to sobriety for anyone who is experiencing an addiction.

  14. cannotsay2013on 13 Jun 2013 at 12:42 pm

    Steven Novella,

    First, I must note that this is your first non condescending answer to me that goes to address the meat of the matter.

    Let’s see where now it seems there is agreement: the issue of whether DSM “labels” are genuine brain disorders is controversial. If this is the case, then what you said that “ADHD is demonstrably a brain disorder” cannot be true at the same time.

    So admitting that there is controversy on this matter is a perfectly valid position. Calling “denialist” somebody who has your opposite point of view on the controversy, controversy that exists because the issue has not been given a scientifically valid answer, not only is not scientific but is counterproductive.

    In other areas of science, there are controversies and arguments being made about which position is true. For instance, on the https://en.wikipedia.org/wiki/P_versus_NP_problem , most top notch computer scientists and mathematicians are in agreement that it is very likely that P is not NP. There is anecdotal evidence that it is the case. However, nobody, to my knowledge, has called “denialist” to those who take the opposite position because the history of science is full of instances of controversies where the “mainstream thinking” was proven wrong.

    But here is the thing, when it comes to psychiatry- June 2013 which is after both those studies you have mentioned-, the mainstream thinking is that “there are no biomakers for DSM mental disorders” and as a result the validity of “DSM labels” has not been established with the same criteria that HIV has been shown to be the VALID cause of AIDS. This takes me to the next point, from one of the studies you refer,

    “Results indicate that for most individuals DSM-IV ADHD is a valid disorder in the sense that it is associated with significant impairment in social, academic, and occupational functioning and increased risk of accidental injury across the life span.”

    This was something that another commenter already addressed (I think it was BO but I could be wrong). With that notion of validity, homosexuality is a genuine and valid “mental illness” in homophobic societies. So a country like Iran is its perfect right to “quarantine” homosexuals that pose a danger to the “public health”. Since I can only assume that you find this proposition preposterous, then you’ll have to agree that this notion of validity is BS and it’s the type of fallacious thinking that psychiatry needs to engage in to justify itself.

    Instead, the scientifically honest position to take is to say that to this day none of the DSM labels has been shown to have a valid biological cause in the sense HIV has been shown to be the cause of AIDS. It might be a “simple statement” but it also happens to be scientifically true.

    That statement, as sonic also pointed out, is perfectly consistent with admitting that a) I could be wrong and that this time’s promise that “biomarkers are around the corner” will not be empty, and b) I could still be true that Insel’s program will fail miserably.

    Whether a) or b) is true is a matter of controversy. What is not controversial in June 2013 is the statement: “DSM disorders lack scientific validity with the criteria of validity that HIV causes AIDS”. So to put somebody like me in the company of AIDS denialists is offensive.

    Now, to support b) what I have said (since it is impossible to prove the negative) is that most of the evidence provided by those who “believe” in a) is “correlates of brain physiology with behavior” of the kind that support that dead fishes respond to human emotion or that Internet Explorer usage is the cause of crime in the US. Really, none of your arguments is stronger than the arguments that could be made to support either statement.

    If you “believe” that biomarkers will eventually found, as Tom Insel does, fine, but state it as such, don’t give the false idea to your readers that those biomarkers have been found because that is categorically false as of June 2013.

    Now, the reason this matters is because you have a following and you could be a great influence to fix the current system that results, more often than not, in blunt human right abuses, like those 10000 British citizens who had their civil liberties restricted gratuitously, or that guy who was until last year forcibly ECT-ed in New York, or that woman who is now facing criminal charges because the state wanted to force anti psychotics on her daughter against the woman’s judgement. This type of human rights abuses are specific to psychiatry, which is ironically the only branch of “medicine” that has not had any of its invented labels scientifically validated. These are the lives of individual people, like mine, that have been ruined by a quackery.

  15. steve12on 13 Jun 2013 at 12:44 pm

    “I know there are potentially practical arguments to be made for legalization, but that is a debate I am not addressing here. I simply don’t buy arguments for drug legalization premised on liberty and freedom, when those drugs by their very nature take away liberty and freedom.”

    I would tend to agree that this liberty argument is naive considering the data (though marijuana is an exception to this), but I think the practical argument that you’re not addressing trumps this argument re: legalization.

    The current model doesn’t stop drug use in any way. Anyone can get any drug whenever they want – and driving up the cost doesn’t lead to ess use as much as it leads to crime. So now, we have all of the drug use + the cost of a drug war, which is substantial.

    I think we need a treatment regime – in some cases forced treatment, especially when a crime is committed. If someone were to apply the libertarian argument at this point I woud indeed reject it for the reasons that you site.

  16. chrisjon 13 Jun 2013 at 12:45 pm

    “Once addicted, however, withdrawal from the substance creates a powerful dysphoria, and users seek out drug use in order to reduce this extremely negative experience. This leads to not just addiction but dependence.”

    Steve, this is not the same thing as there being no choice whether to seek out the drug. As you said the human brain is much more sophisticated than other animals. While I do not dispute the idea that humans work on a reward/aversion model, we should not think about this in overly simple terms. A lot of cognition occurs between the feeling dysphoria and seeking out drugs as a means of stopping the dysphoria. In other words, the reward/aversion system is not the only system in operation here. If it is possible for a one of those cognitive processes to override drug seeking behavior, then the person does have a choice in the relevant sense for this question. I think it is clearly the case that this is possible for some people at the very least. If it weren’t, its hard to see how people who overcame their addiction did so.

  17. Steven Novellaon 13 Jun 2013 at 12:59 pm

    Chris – the vast majority of people cannot simply override their addiction by making a choice. It’s not a matter of will power. Those that can beat their addiction mostly have help, whether counseling or otherwise. I agree with the consensus of opinion among addiction experts that framing addiction as a matter of choice or will power does not fit the evidence and is counterproductive.

  18. starikon 13 Jun 2013 at 1:14 pm

    “The deeper conflict here is between living in harsh reality, and making the best of it, vs bypassing the adaptive nature of the reward/aversion circuits in our brain in order to escape to a pharmacologically/electrically/virtually induced fantasy euphoria.”

    Once we’re able to do this without harm, plus immortality, it would be hard to convince anyone to opt out. Maybe this is why haven’t seen any evidence of advanced alien civilizations.

  19. Steven Novellaon 13 Jun 2013 at 1:17 pm

    cannotsay – I characterize your style of argument as that of denial. You continue to display this pattern, and have been called on it my numerous other commenters without acknowledging or countering their arguments, or changing your behavior.

    There is no significant controversy among actual neuroscientists about whether or not ADHD is a brain disorder. You keep quoting one person’s statement out of context, while I provide systematic reviews. This body of evidence did not change when Insel made his comment.

    You keep falsely stating that there are not biomarkers for any mental illness when this is demonstrably not true – and copious evidence has been provided to you. You keep confusing the existence of biomarkers useful in diagnosis with those useful in characterizing underlying neurophysiology.

    You ignore the point that mental illnesses lack classical pathology (like infection) but are based in brain function determined by the pattern of neuronal connections and regulations of these circuits.

    Further to the extent that brain function can be imaged for this, researchers are finding physiological correlates of the main mental illnesses. To keep with ADHD – there are several genetic correlates (http://www.ncbi.nlm.nih.gov/pubmed/21409419)

    The neuroanatomical correlates of ADHD are even more well established -http://www.ncbi.nlm.nih.gov/pubmed/20546170. In short, ADHD is primarily a disorder of executive function, with reduced activity in those parts of the frontal lobes that are responsible for executive function.

    Finally, you keep doing the denialist shuffle – attempting to refute one valid point with another unrelated point. Your homosexuality point is an example of this. You claim that mental disorders do not have validity. I provide evidence that ADHD diagnosis has validity. You do not acknowledge this, you simply argue that validity is pointless because of the example of homosexuality. But this does not dispute validity, merely the implications of specific diagnoses in a social/cultural context. Some diagnoses are more culturally subjective than others, and you keep choosing a historical diagnosis (homosexuality) that is among the most sensitive to cultural context – and one that has already been dealt with within psychiatry (making its relevance even more dubious).

    It is for all these reasons that I argue your style of argument fits cleanly into what has been identified as a denialist strategy. This is not dismissive or unfair – it is an accurate portrayal of your illogic. Continuing to demonstrate that poor logic is making my case, not yours.

  20. cannotsay2013on 13 Jun 2013 at 1:48 pm

    Steven Novella,

    Again, insulting and “strawmanning” will not take you very far. You’ve made only one valid admission and now you are back to your insults.

    “I characterize your style of argument as that of denial. You continue to display this pattern, and have been called on it my numerous other commenters without acknowledging or countering their arguments, or changing your behavior. ”

    WOW, now it’s not that I have not addressed arguments (to the opinion of several commenters I have perfectly addressed the arguments put forward by people like you), it’s that I “exhibit a denialist behavior” or something. Glad you didn’t have a say in any DSM discussions :D .

    More seriously,

    “There is no significant controversy among actual neuroscientists about whether or not ADHD is a brain disorder. You keep quoting one person’s statement out of context, while I provide systematic reviews. This body of evidence did not change when Insel made his comment. ”

    I remind you that the two studies you have provided are very clear that their “notion” of validity is,

    “in the sense that it is associated with significant impairment in social, academic, and occupational functioning and increased risk of accidental injury across the life span”

    That is not what Insel or anybody who takes medicine seriously thinks that “validity is”. Your counter argument is just a Clintonian answer, known in your circles as a “semantics fallacy”.
    So, don’t pile sh%@#$%#$ on you because you were doing just fine with the previous post admitting that there is a controversy.

    “You keep falsely stating that there are not biomarkers for any mental illness when this is demonstrably not true – and copious evidence has been provided to you. You keep confusing the existence of biomarkers useful in diagnosis with those useful in characterizing underlying neurophysiology.”

    “Further to the extent that brain function can be imaged for this, researchers are finding physiological correlates of the main mental illnesses. To keep with ADHD – there are several genetic correlates (http://www.ncbi.nlm.nih.gov/pubmed/21409419)”

    As for the study which you fail to put the tile on, I’ll put it:

    “Neuroanatomical correlates of attention-deficit-hyperactivity disorder accounting for comorbid oppositional defiant disorder and conduct disorder.”

    Again, none of the so called “evidence” provided is stronger than the evidence that can be provided to show that dead fishes respond to human emotion: it has a name: confusing correlation with causation in a situation where there are with many hypothesis at play, scenarios in which anything can be shown to be correlated with almost anything.

    I do not dispute that somebody with your point of view takes this so called “evidence” as something that puts your position on the “brink of being finally established” but for those of us for whom science matters and who cannot afford to make unscientific statements in our lines of work, we’ll take it as some studies that you use to confirm your own bias and beliefs but that actually accomplish nothing with respect to the matter at hand.

    Regarding you straman tendency, here is a perfect example,

    “Your homosexuality point is an example of this. You claim that mental disorders do not have validity. I provide evidence that ADHD diagnosis has validity. You do not acknowledge this, you simply argue that validity is pointless because of the example of homosexuality. But this does not dispute validity, merely the implications of specific diagnoses in a social/cultural context.”

    YOU ARE THE ONE who have as notion of validity adaptation with society. No real biological disorder has that notion of validity. In order to accept ADHD as valid, you need to accept that canard, to which I add, if you accept that, homosexuality is also a valid disorder in homophobic societies. After all, in Iran, being homosexual results in “impairment in social, academic, and occupational functioning”. So indeed, it seems to me that this is a cheap attempt on your side at double backing by introducing a strawman (your specialty, like that nonsense that I was denying the existence of extremes in a continuum). You cannot have it both ways. If “impairment in social, academic, and occupational functioning” is VALID as a criteria to establish scientific validity, then homosexuality is also a valid “mental illness” in most non Western societies. Similarly, graduating from Yale might not be a desired outcome in societies where he/she (normally he) who owns most land is the most powerful, so something as what is labelled as “ADHD” might prevent that somebody from going to Yale, but it will give that somebody the skills required to become very successful in that other society. So no pal, you cannot have it both ways no matter how many strawmen you introduce in your reasoning.

    “It is for all these reasons that I argue your style of argument fits cleanly into what has been identified as a denialist strategy. This is not dismissive or unfair – it is an accurate portrayal of your illogic. Continuing to demonstrate that poor logic is making my case, not yours.”

    Just as for all the reasons I have described I claim that you lack critical thinking skills and that you argue from the point of view of “skeptic dogmatism” -you are even on record now admitting that this is a matter of controversy in scientific circles, but you still insist on showing as “proof” something that shows “correlation” at best. Again, “not dismissive or unfair-it is an accurate portrayal of your illogic. Continuing to demonstrate that poor logic is making my case, not yours.” :D .

  21. ConspicuousCarlon 13 Jun 2013 at 1:50 pm

    Little boy Brewers,
    ” What about the liberty and freedom of a
    person who lives in a neighborhood that is
    unsafe due to crime, crime that is related
    to the sale and distribution of illegal drugs?”

    “Related to” is a pretty loose legal standard. It sounds like you want the person you sympathize with to be treated as an individual with rights, but anyone who uses drugs is part of some inhuman conglomerate.

    And I feel for my fellow non-drug users. I hate stoned dipshits who can’t hold jobs and alcoholics who lie to get money for vodka. But not everyone who has snorted coke, smoked weed, or drinks alcohol is like that. A lot of the pot prohibitionists drink alcohol, which kills 10k people on the road every year, and yet they don’t expect to be locked up simply for consuming beer at home.

  22. DOYLEon 13 Jun 2013 at 1:56 pm

    Here is something I have wondered about.With the exponential progress of human endeavor(tech,science,medicine)are we getting over on evolution.Are we antagonizing our biology that evolution has selected for.

  23. ccbowerson 13 Jun 2013 at 2:01 pm

    Cannotsay- I guess this post is an example of skeptical dogma in action, right? Of course, Steve is well known person in skepticism, but that does not stop others from from being critical of his posts, even when there is mostly agreement. Skepticism requires a rigorous process for evaluating claims so often that results in similar conclusions, but note that this is not a top-down process.

    PTSD is another diagnosis that had been ignored during this discussion. The increase in recognition of this disorder has increased access to treatment. In the past, problems after tramatic experiences like war or assault were more likely to be framed as character or morality issues, which caused many people to go untreated/ unhelped. . You fail to acknowledge these obvious benefits that have come from attempts to categorize mental illness by focusing on the difficulties. This is another denialist strategy, to add to the ones others have mentioned.

  24. cannotsay2013on 13 Jun 2013 at 2:12 pm

    ccbowers,

    With respect to Steven Novella, he is making no favors to the “skeptic movement”, when he claims that “impairment in social, academic, and occupational functioning” is a valid criteria to establish scientific validity of a “mental illness” (something that BTW will gain him a lot of enemies even among those who believe that psychiatry has scientific validity) and then reject that standard applied to homosexuality or other invented DSM disorders. He cannot have it both ways. What he is doing is digging deeper into the hole just when he was about to start climbing out of the hole he has dug over the years. I expect that at least some of the readers are smart to see that he has written two entries in this blog entry that are utterly contradictory, first admitting to a controversy, then going back to his nonsense to claim that there is no controversy.

    I am not very familiar with PTSD, but here is the historical fact that cannot be denied. Even in the context of American history alone, many more million people went to war and died in war than those who have gone to war or died in the wars of Afghanistan and Iraq. Many veterans came back, had some issues adjusting back to civil society but they eventually did, to the point that many WWII, Korea and Vietnam veterans are among our most successful members of society. I don’t think that the veterans of those wars had an experience any less traumatizing than the average experience of today’s veteran. What the historical context of those wars didn’t have was an unholy alliance between Big Pharma and academic psychiatry to label a normal reaction to trauma as a “mental illness” to be treated with drugs. If my memory serves me well, PTSD was “invented” as a disease by DSM-III.

  25. evhantheinfidelon 13 Jun 2013 at 2:15 pm

    The whole recreational drug issue is one that is difficult for me to work out. By many of the criteria people often list, it seems to me that alcohol should absolutely be illegal. The problem is that we tried that out, and it failed utterly. Maybe for other drugs, there could be legal levels like blood alcohol content. The problem is that it may be difficult to test, like the commonly heard poppy seed and positive opium test story. Of course, I’m not saying that specific case is a problem.

  26. praktikon 13 Jun 2013 at 2:28 pm

    The main problem is seeing prohibition as a vector to reduce the harm of drug use. This assumption undergirds the thinking in Novella’s posts.

    Skeptics should be conditioned to question this as a matter of course….

  27. praktikon 13 Jun 2013 at 2:37 pm

    Actually I can safely say that Drug War politics, and the skeptical study of prohibitionist claims, was a major signpost on my journey to skepticism!

    It was one of those things as I grew up in my teens where things I believed turned out to be entirely untrue…

  28. steve12on 13 Jun 2013 at 2:56 pm

    “The main problem is seeing prohibition as a vector to reduce the harm of drug use. This assumption undergirds the thinking in Novella’s posts.”

    Exactly. The free will argument is almost irrelevant to the public policy prescription re: prohibition because it does nothing to stop drug use.

  29. Hannahon 13 Jun 2013 at 3:12 pm

    I haven’t read most of the comments, so this point has probably already been made, but I don’t see the neurological research as an argument against legalizing drug use as much as an arugment in favor of decriminalizing drug use. Currently our justice system treats drug addiction as a crime, rather than a medical issue in need of treatment, although that has started to change somewhat in recent years.

    It’s a tricky question because, on the one hand, we don’t want to encourage drug use, but on the other hand, we don’t want to lock people up simply for being addicted, which I don’t see as a crime. As others have said, making drugs illegal seems to have done very little to prevent their widespread use, and the war on drugs has been a total failure. Our society needs to find a better way of dealing with drugs and people who use them rather than simply arresting and incarcerating drug addicts over and over for something they can’t help.

  30. chrisjon 13 Jun 2013 at 3:14 pm

    Steve,

    I didn’t mean to suggest that addiction can be simply over come with will power and I agree that addicts generally cannot overcome addictions without help. However, counseling is not a direct pharmacological intervention on the reward/aversion system. As I understand it, the consensus is that cognitive behavioral therapy is the best form of counseling. This consists in helping patients think about their situation in a new way and in suggesting ways to build new behavioral patterns. The patient presumably has to CHOOSE to accept this advice and implement it. So there is an element of choice in overcoming addiction. My complaint is that you are oversimplifying the problem by ignoring the cognitive element.

  31. praktikon 13 Jun 2013 at 3:15 pm

    Good point Hannah, thats probably the right direction to take if we take the mechanistic approach to understanding drug approach at face value…

  32. daedalus2uon 13 Jun 2013 at 3:15 pm

    A balancing of harms due to legality and drug use and illegality and drug harms might be defensible if illegality of drugs was dealt with in ways to try and minimize harm to drug users, but it isn’t. Drug laws are made, designed and enforced to maximize harms on drug users at the whim of “authorities” so as to harm drug users.

    Those who design, enforce, prosecute, sentence and incarcerate drug offenders claim they are simply trying to deter drug use. There is zero evidence that deterrence can work against drug addicts.

    It is well known that drug addicts will share needles with people they know are HIV positive. Law makers who claim to be trying to “protect” drug addicts from themselves by making clean needles more difficult to obtain are lying. Their actual goal is to harm drug addicts to the point of death.

    My hypothesis of the euphoria of drug use is that it hacks into what I call ENDS, the euphoric near death state, where physiology induces euphoria so that organisms can run themselves to death while trying to escape from a predator. If my hypothesis is correct (and there is no data I am aware of that conflicts with it), then deterrence cannot work against anything that induces an ENDS-type state because no civil society can invoke or threaten the kinds of harms that are acceptable to those in an ENDS-like state. What possible deterrent is there for a crack-whore who is willing to share needles with HIV positive individuals?

    The whole point of an ENDS-type state is to allow organisms to run themselves to death because organisms that can do that will escape from more predators than organisms that cannot divert metabolic resources to that extent. Running oneself to death doesn’t help a particular organism, but the ability to do so can be lifesaving, which is why it persists.

  33. LittleBoyBrewon 13 Jun 2013 at 3:17 pm

    ConspicuousCarl: I think you misunderstand my comment. Steve Novella suggests that using the ‘right to personal freedom and liberty’ as a basis for legalizing drugs is not a choice based in science, since the resulting addiction takes away the freedom and liberty the addict desires. I merely pointed out that taking away the freedom and liberty of the addict by criminalizing a drug can impact the freedom and liberty of others due to the unintended side effects of drug laws.

  34. praktikon 13 Jun 2013 at 3:23 pm

    *if we take the mechanistic approach to understanding drug addiction at face value…

    (small correction)

  35. chrisjon 13 Jun 2013 at 3:27 pm

    I am very interested in this topic. Can you suggest a review article or some other source of information that supports your claim that the consensus among addiction experts is that addiction ought not be framed in terms of choice? Again I agree it is not a matter of willpower, but that is not the same thing as saying that choice plays no roll at all.

  36. cannotsay2013on 13 Jun 2013 at 3:33 pm

    Now, I will put a comment with respect to the matter of drug addiction that “takes away the freedom and liberty the addict desires”

    As a strong proponent of free will, I think that this argument is preposterous. In August last year there was a conversation about “Mental Health and the Law” at the CATO institute where these matters were discussed not in the context of drug addiction but “forced treatment, involuntary commitment” in general. The best rebuttal that I read from those arguing with my position (others were good as well, but this was in addition humorous) I think that addresses this point as well,

    http://www.cato-unbound.org/2012/08/24/jacob-sullum/legal-moral-problems-involuntary-commitment

    “Appealing to libertarians, Jaffe wants to flip that view of reality, saying coercive psychiatric treatment actually restores people’s freedom. One way we know this, he says, is that most people who are civilly committed for treatment of schizophrenia “retrospectively express gratitude.” Frances likewise writes that “the majority [of involuntarily treated mental patients] are unhappy at the moment when involuntary treatment is imposed on them, but they understand why it was necessary once they have recovered from their acute symptoms.” This retroactive validation of coercion seems suspect to me, not least because formerly confined patients may surmise (perhaps correctly) that agreeing they were correctly diagnosed and properly treated helps them remain free by showing they have recovered their senses.

    Then, too, retrospective gratitude could be used to justify all manner of paternalistic interventions, whether or not they involve a psychiatric diagnosis. If the government began kidnapping obese people and forcing them into a strict diet-and-exercise program, how many newly thin former captives would eventually be thankful for the help? Let’s not find out.”

  37. Steven Novellaon 13 Jun 2013 at 3:42 pm

    Cannotsay – I’ll take the time to thoroughly deconstruct your arguments, but won’t do this dance forever.

    You wrote: “Again, insulting and “strawmanning” will not take you very far.”

    Pointing out illogic is not an insult, but it is a very common dismissive strategy to call valid argument insults. By contrast your comments are frequently directly insulting (writing, “for those of us for whom science matters” for example).

    I also disagree that my characterization of your logic is in any way a straw man. You keep throwing out the names of logical fallacies, but not correctly.

    Regarding validity, this is yet another example of how you don’t actually address the points that are being made, you simply introduce a new variable. In this last case you may be demonstrating that you don’t know what validity means. You refer to playing “semantic” games but that is exactly what you are doing.

    Validity simply means that a measure has real-world implications – it predicts or correlates to some objective measure of outcome. The diagnosis of ADHD has validity because it correlates to real world outcomes – whether or not you think those outcomes constitute a disorder. You see how you are mixing variables at will? This gives you the ability to dodge any point – you simply bring up a different point as if it is address the one that is being made, when it isn’t.

    The diagnosis of ADHD has validity. Whether or not we consider ADHD to be a disorder is a separate question. I argue that having impairment in a function that most people have, which results in demonstrable harm (harm being defined as a negative outcome that most people would consider undesirable), is a reasonable definition of disorder. People with ADHD have higher divorce rates, higher imprisonment, shorter life-expectancy, lower income, etc.

    Obviously you dismiss the entire concept of mental disorder, but it all circles back to your refusal to accept the premise, so it’s just circular reasoning on your part.

    Meanwhile – the diagnosis of ADHD has both validity and reliability, relates to real world outcomes, and “disorder” is being reasonably and operationally defined.

    Your homosexuality example is yet another example of shifting variables and criteria at will in order to dodge valid criticisms of your position. You have incorrectly framed my position as being inconsistent, because I accept the validity of ADHD but not homosexuality as a disorder. You never asked why, and don’t seem to understand the consensus opinion for this.

    In order to be considered a mental disorder the dysfunction has to be on the part of the person, not simply a cultural bias or bigotry in society. Like everything in psychiatry, this is not black or white, and we have to confront the fuzzy nature of social constructs when talking about human thought, mood, and behavior. But again, the fuzzy lines do not mean the extremes cannot be meaningfully defined.

    Further – we need to distinguish human variation from dysfunction. Homosexuality was thought of as a sexual dysfunction, but improved knowledge has put this behavior into a more thorough context in that we now recognize a far greater spectrum of diversity in sexual behavior and much of it can reasonably be considered part of the normal human diversity. Also decades of research has shown that there is no harm from being homosexual – it does not correlate with any negative or harmful outcomes. This evidence, btw, was a strong argument in favor of removing it as a DSM diagnosis. Homosexuals are no more likely to have any form of mental illness, disorder, or dysfunction than heterosexuals.

    In other words – there are valid reasons to reject homosexuality as a mental disorder even if we accept ADHD and other diagnoses without any internal inconsistency.

    Other points – dismissing all genetic linkage analysis as merely correlational is not a valid criticism, and betrays a misunderstanding of this research. This is also pure denialism – denying entire categories of evidence because you don’t like their implications. Genetic linkage analysis is a proven valid method for determining which genetic variants are causally related to certain clinical syndromes. We need other data (biochemical, physiological) to determine how a genetic variation causes a specific outcome, but not to know that it has a causal role. You cannot reasonably dismiss all this evidence as “dead fish” science, as you try to do.

    Regarding validity you also write:”YOU ARE THE ONE who have as notion of validity adaptation with society. No real biological disorder has that notion of validity. ”

    Your first sentence is misleading – it’s not just adaptation with society, but lack of an ability or function that most people have. Societal factors certainly affect how much of a problem a disorder is in practical terms, but not if it’s a disorder.

    For example, if someone has complete dyslexia, and inability to read, this is a disorder, since most humans are able to read. Dyslexia is not a problem in a society that does not have a written language, however. It is more of a problem the more reading is critical to functioning in society.

    You also return to your arbitrary “biological” criterion for what is valid. As I and others have already pointed out, and you have failed to address, brain function depends on the pattern of robustness of circuits in the brain and biochemical factors that affect the functioning of those circuits, and how they interact with other circuits in the brain. We don’t expect to always find classic pathology for mental disorder. Rather we expect to find a pattern of brain activation that is different from healthy controls. This, of course, is very complex to tease apart, but that is exactly what researcher are doing – they are finding neuroanatomical correlates to clinical mental disorders. I already gave you a link to one for ADHD, which you ignored.

    Do you deny that brain function is demonstrably different in many mental disorders? This is a factual claim that can be resolved with evidence. I can send you links all day to studies showing that brain function does correlate with mental disorders – or you could do an honest search for this evidence yourself.

    You write: “Just as for all the reasons I have described I claim that you lack critical thinking skills and that you argue from the point of view of “skeptic dogmatism” -you are even on record now admitting that this is a matter of controversy in scientific circles, but you still insist on showing as “proof” something that shows “correlation” at best.”

    If you really want to take the position that I lack critical thinking skills, go ahead. I only have over a thousand articles online as evidence for what my critical thinking skills are, and your claim puts your own logic and critical thinking into sharp focus.

    I never stated that “this” is a matter of controversy in scientific circles. I am assuming that by “this” you meant the validity of mental illness. I said that there is a diversity of opinion among skeptics, to counter your false accusation of “skeptical dogma.” The skeptical community is not the same as the scientific community. Not all skeptics are scientists. Further – when deciding if a position is truly controversial, only relevant scientific experts really matter.

    As I said – among neuroscientists the notion that there is such a thing as mental illness which has its cause in brain function is not controversial. Many of the details, of course, are, but not the existence of brain-function determined mental illness. Again – typical denialist strategy to confuse controversy over details as if they call into question the larger question of validity, and further to confuse popular controversy with scientific controversy.

    I never claimed “proof” of anything – I have offered evidence to support the conclusion that some mental disorders are clinically valid and correlate to genetic markers as well as altered brain function, using ADHD as one example. This is just a quick sample to counter your position that such evidence is lacking.

    If you actually come back with any valid response I will be happy to address it.

  38. praktikon 13 Jun 2013 at 3:47 pm

    http://www.tdpf.org.uk/blueprint%20download.htm

    This offers perhaps the most comprehensive vision I have come across w/ respect to what a legalized world could look like.

    from page 75:

    “However, while the physiological elements of drug action as it relates to dependence can be assessed and potentially ranked, dependency issues are dramatically complicated by the individual user, and the range of psycho-social factors that interface with physiological processes.
    This interaction produces dependency-related behaviours, which may require the attention of policy makers and service providers. The psycho-social influences upon, or components of dependency relating to, a given drug are far harder to quantify and rank, and far more contentious in the literature. For example, psychological dependence—‘addiction’—is now also associated with sex, shopping, gambling, the internet and so on.34

    These psycho-social components are, however, arguably no less important in terms of determining behaviours. Some drugs that have relatively moderate or low physiological dependency effects are none the less frequently associated with powerful psychological dependency, cocaine being an obvious example. Whether physiological and psychological dependence should be pooled together in rankings remains a moot point—as does the question of whether ‘addiction’ remains a useful term, as opposed to dysfunctional, problematic or dependent use.”

    There is a useful discussion of the issues around how addiction is conceptualised in
    B.Alexander, ‘The Globalisation of Addiction: A Study in Poverty of the Spirit’,
    Oxford University Press, 2008.

  39. steve12on 13 Jun 2013 at 3:50 pm

    I think this is an important point, so I will break a little.

    I’ve interviewed a lot of schizophrenics (maybe there’s a study re: this – I don’t know) and almost all of them mention at some point how thankful they are that they were civilly committed, because they were terrified and in an awful state w/o help.

    When someone is psychotic, they’re not going to get help! The idea that the person running up and down the street ranting and raving is enjoying some sort of “freedom” is preposterous on its face.

    I think this is much the same for recovered addicts. If we decriminalize most drugs, as I think we should, some form of forced treatment is a must.

    Naive and high minded ideas about “freedom” simply ignore the horrific nature of what we’re talking about.

  40. steve12on 13 Jun 2013 at 3:52 pm

    Just to clarify, forced treatment would only be for people committing crimes due to their addiction, not grabbing pot smokers out of their house or something like that.

  41. steve12on 13 Jun 2013 at 4:00 pm

    “As I said – among neuroscientists the notion that there is such a thing as mental illness which has its cause in brain function is not controversial. ”

    I think that this cannot be stated enough as these posts go on. While trolls can be irritating, I think the far worse outcome would be a well-meaning lay person coming to your blog only to be mislead due to the sheer volume of nonsense posted.

    There is no scientific controversy here. None.

  42. cannotsay2013on 13 Jun 2013 at 4:38 pm

    Steven Novella,

    I appreciate your more conciliatory tone, but it is in my nature to be sarcastic, so I am going to use it a little bit, and that should not be interpreted in a way as being disrespectful to you :D .

    Wow, you are now getting to semantics, it cannot get more fallacious than that. I let the readers decide if when Tom Insel said,

    http://www.nimh.nih.gov/about/director/2013/transforming-diagnosis.shtml

    “While DSM has been described as a “Bible” for the field, it is, at best, a dictionary, creating a set of labels and defining each. The strength of each of the editions of DSM has been “reliability” – each edition has ensured that clinicians use the same terms in the same ways. The weakness is its lack of validity. Unlike our definitions of ischemic heart disease, lymphoma, or AIDS, the DSM diagnoses are based on a consensus about clusters of clinical symptoms, not any objective laboratory measure.”

    He meant,

    “Validity simply means that a measure has real-world implications – it predicts or correlates to some objective measure of outcome. The diagnosis of ADHD has validity because it correlates to real world outcomes – whether or not you think those outcomes constitute a disorder. You see how you are mixing variables at will? This gives you the ability to dodge any point – you simply bring up a different point as if it is address the one that is being made, when it isn’t. ”

    NOTE: It is obvious that Insel meant “validity” in a “biological sense” as in “HIV is the cause of AIDS”.

    Now, if you are saying is that I, Tom Insel, David Kupfer and in fact, the majority of psychiatrists who claim that “psychiatry has validity” have a different notion of “validity” than yours, sure, I agree with that proposition. I have a disagreement with Insel that his program will ever be able to find “valid” (in the sense he discussed in his blog) biomarkers for so called “mental illness”, but I side with his notion of validity because at least that can be falsified.

    Now, you say that I unfairly accuse you of strawmanning, but, you keep at it,

    “Your first sentence is misleading – it’s not just adaptation with society, but lack of an ability or function that most people have. Societal factors certainly affect how much of a problem a disorder is in practical terms, but not if it’s a disorder.

    For example, if someone has complete dyslexia, and inability to read, this is a disorder, since most humans are able to read. Dyslexia is not a problem in a society that does not have a written language, however. It is more of a problem the more reading is critical to functioning in society. ”

    You are just trying to define “social maladaptation” in a different way, but you are still defending “social maladaptation” as valid notion for “disease”. Even accepting your concept of “validity” this way for dyslexia, you seem to suggest that for the longest time humans have been on Earth, dyslexia was not a valid “illness” while as soon as some humans started to be able to read, an epidemic of “dyslexia” affected human kind. Note that before “ability” to read came to existence the notion of “dyslexia” didn’t make sense. And, if you are of the opinion that humans were never destined to be able to read in the first place (that it all happened “by accident”) you cannot claim that the very notion of “dyslexia” existed in prehistoric times. Compare this to “cancer”, whose notion of biological validity means that it has existed regardless of any social interactions for as long as there have been human beings on Earth and regardless of human’s ability to establish or measure the biological cause of cancer.

    “brain function depends on the pattern of robustness of circuits in the brain and biochemical factors that affect the functioning of those circuits, and how they interact with other circuits in the brain”

    This point have been addressed many times over with the sw/hw problem. Now, your dogma makes it for you impossible to accept “the mind” even as a useful “abstraction” for the programming of the brain that results from millions of years of evolution and interaction with the environment. So once you accept that the sw/hw model a is a valid abstraction that explains problems of living , the notion of “mental disorders” has a completely different meaning -as a metaphor for behavioral problems-, and one that explains better how is that these people http://openparadigmproject.com/ or John Nash can fully recover from whatever extreme mental states they were going through without any hw (ie drugging, ECT, insulin therapy, etc) intervention whatsoever.

    If you lack the background to understand what the sw/hw difference means -because like BO have not kept up with the latest developments in technology like content addressable memory-, I give you that, but nobody has refuted the above in any meaningful way. They have just limited themselves to repeat dogmas.

    “I only have over a thousand articles online as evidence for what my critical thinking skills are, and your claim puts your own logic and critical thinking into sharp focus. ”

    WOW, now “I am holier than you” type of argument. Great. Look, if I had not been abused by psychiatry, I would challenge you to public, Intelligence Squared US type of debate with a jury and I am very confident that I would win it because your arguments are nonsensical. But because I was harmed by psychiatry, and I don’t want psychiatry to harm me for a second time, I am perfectly comfortable with people making their own judgements on whether my arguments have value. I think that I have convinced a few of your readers that they have. The sad thing though, is that I came armed with the same arguments a few months ago, before Tom Insel started the current crisis in psychiatry, and nobody took them seriously. Now, all it took was the director of the NIMH to validate my most important argument, to be taken seriously, including by you. So sir, I think that this whole episode speaks very well of the dogmas in this community.

    “As I said – among neuroscientists the notion that there is such a thing as mental illness which has its cause in brain function is not controversial. Many of the details, of course, are, but not the existence of brain-function determined mental illness. ”

    Again, straw man, because I never claimed that there is controversy on this matter among neuroscientists or psychiatrists. What I said is that the mainstream thinking in psychiatry now is that NONE OF THE DSM DISORDERS HAS BEEN SHOWN TO HAVE BIOLOGICAL VALIDITY. That is a simple statement that has now been agreed by the top dogs of psychiatry. And that, again, is perfectly compatible with these same people “believing” that biological validity will eventually be found. But while one is a statement of fact about the current lack of biological markers for so called “mental illness”, the other is a statement of belief, like “most computer scientists believe P is different from NP”.

    “I never claimed “proof” of anything – I have offered evidence to support the conclusion that some mental disorders are clinically valid and correlate to genetic markers as well as altered brain function, using ADHD as one example. This is just a quick sample to counter your position that such evidence is lacking. ”

    Well, we are faced with another “semantics” issue, because to me claiming that,

    “ADHD is demonstrably a brain disorder”

    Means that an actual proof that passes the scientific criteria of falsifiability has been found, such as when one says “HIV is demonstrably the cause of AIDS”,

    - Diagnosis of HIV infection is made through presence or absence or HIV antibody test (ELISA/Western Bolt) or the HIV virus itself (so called NAT testing).

    - The overwhelming majority of people HIV positive, eventually develop AIDS, except for a minority called “Long-term nonprogressors”. But even then, we know that “Long-term nonprogressors” have within their bodies the ability to keep HIV replication under control, so it’s not like HIV infection goes out of control and these people do not develop AIDS, it’s that their bodies keep HIV under control naturally and AIDS does develop, providing extra validation to HIV as the cause of AIDS.

    And yet, there are very few cases where AIDS type of symptoms that have been found in people who test negative for HIV infection (fact that is used by AIDS denialists to put forward their nonsense).

    If you believe that “ADHD is demonstrably a brain disorder” has been established in the same qualitative way HIV infection has been established as the cause of AIDS, then we’ll just have to agree again to disagree about what “demonstrably” means in addition to disagreeing to what “validity” means.

    Now, one thing you’ll have to agree. When psychiatry makes outrageous claims about “validity” of this or that disorder, the reaction they are seeking into the public and policy makers is not the notions of “validity” and “proof” you have defended here but the notions of “validity” and “proof” that I have defended, ie, that which transformed AIDS from a sure death sentence to a chronic condition for most people (unfortunately, some people on HIV drugs still die of AIDS, although at much lower rates than previously),

  43. cannotsay2013on 13 Jun 2013 at 5:04 pm

    steve12,

    “I’ve interviewed a lot of schizophrenics (maybe there’s a study re: this – I don’t know) and almost all of them mention at some point how thankful they are that they were civilly committed, because they were terrified and in an awful state w/o help. ”

    As I said, and I can attest to that, the main driver behind people claiming to have been helped by “psychiatry” when interviewed by so called “professionals” of mental health, is to get out of their unfair incarceration.

    I always ask those who make yours or Allen Frances’ type of outrageous claims about the “help” people feel in retrospect to produce a single study that shows it -a study that eliminates the captive nature of the “shrink” in a hospital setting or the threat of going back for non compliance- and I haven’t seen a single one. This fits into psychiatry’s tendency to make outrageous and unscientific statements about their “ability to predict violent behavior” or “depression is caused by a serotonin deficit”. Psychiatry is so used to make unscientific statements that go unchallenged by their own peer review and by those who would otherwise object (but are fearful to do so because of psychiatry’s legal sanctioned status as a coercive force) that they have come to believe their own lies.

    This is why what happened in May 2013 was as an incredible crisis: we had psychiatry’s top dogs in public admitting that they regularly speak nonsense but that “a scam known as DSM is better than nothing”.

  44. cannotsay2013on 13 Jun 2013 at 5:12 pm

    steve12,

    “Just to clarify, forced treatment would only be for people committing crimes due to their addiction, not grabbing pot smokers out of their house or something like that.”

    You’ve always had a totalitarian streak (also a trait that I have noticed among so called “skeptics”). Sorry to disappoint you but under SCOTUS standard, what you suggest is in most cases illegal,

    http://en.wikipedia.org/wiki/Sell_v._United_States

    “The Court in its decision wrote that the standards it outlined will allow involuntary medication for the sole purpose of rendering the defendant competent to stand trial only in rare instances. The standard implies that a court must find that important governmental interests are at stake and that its interest in bringing the accused to trial for serious crimes is important enough to override constitutional issues, and that the forced medication will not significantly interfere with the defense or have untoward side effects. Therefore, in each case the facts and circumstances must be considered individually, balancing the government’s responsibility to ensure timely prosecution with an equal interest in making sure a defendant obtains a fair trial. The court must weight these factors and decide if forced medication will significantly further or hinder these conflicting interests of the state.”

    ” others disagreed, arguing that the strict limits imposed by the Supreme Court on involuntary medication meant that the involuntary medication of a non dangerous defendant would be rare, especially since government’s “important” interest in bringing the defendant to trial must be unattainable by alternative, less invasive means.[10]

    At the very least however, the criteria set forth by the court will ensure that the lower courts considering the issue of forced medication must determine why it is medically appropriate to force drug an individual who is not dangerous and furthermore is competent to make up his own mind about treatment”

    Which is why I feel so confident about our SCOTUS ability to inflict damage to psychiatry. I hope that the current crisis brings another case that results in psychiatry losing even more power to force itself onto its victims :D .

  45. steve12on 13 Jun 2013 at 5:19 pm

    Not that I believe you were ever committed, but I have come to believe you have real issues. I mean, haven’t you just replaced your OCD fear of AIDs with OCD fear of psychiatry?

    You’ve said psychiatry has performed every bad deed save for steeling the Lindbergh baby.

    The only caveat that you would offer in saying that psychiatry’s victims were worse than those of the holocaust was that psychiatry caused the holocaust. You make casual joke about how wonderful it woulld be to round up all the psychiatrists and shoot them.

    And this is not even mentioning that you seem reasonably intelligent, but can’t add 2+2 when the evidence relates to psychiatry.

    Why don’t you stop posting here and get some help, regardless of what that means to you. Cause dude, you are obssessed with psychiatry. And it ain’t healthy.

  46. cannotsay2013on 13 Jun 2013 at 5:30 pm

    steve12,

    “Not that I believe you were ever committed, but I have come to believe you have real issues. I mean, haven’t you just replaced your OCD fear of AIDs with OCD fear of psychiatry?”

    Again, what an anonymous poster thinks about whether I am telling the truth is irrelevant to me. What counts is that you have made a fool of yourself with your nonsensical arguments that only showed to the world that you are clueless about Bayesian statistics.

    “Why don’t you stop posting here and get some help, regardless of what that means to you. Cause dude, you are obssessed with psychiatry. And it ain’t healthy.”

    This is like asking a rape survivor to forget to forget about rapists. Some do, some don’t. Some others channel their experience in a way to help prevent future abuse. That’s what I am up to. The people in this community, like Novella, or you if it is true that you work with victims of psychiatry, are intellectually complicity with psychiatry’s atrocities (those 10000 British citizens who had their civil liberties abused, your program to forcibly drug criminal defendants that are “addicts”, etc). Intervening here is my way to fight this scam that has impacted negatively so many people.

    While you, and Steven Novella, side with the tormentors, I side with the victims of the abuse. I also happen to have the science backing me (actually, in psychiatry’s case the lack of science) but the reason I am here and other blogs debunking your nonsense is the moral sense that with knowledge comes the responsibility to fight this scourge up until it loses all of its coercive powers. Tom Insel made that goal achievable in my life time.

  47. etatroon 13 Jun 2013 at 5:40 pm

    Several years ago I attended a lecture from a psychiatrist a Johns Hopkins and the topic was on addiction, addiction treatment paradigms and mental health. The lecturer was a well-respected researcher/clinician in the field and always gave insightful talks. The crescendo of the talk was in a story that he told about a series of experiments with rats and (I think) heroin. The paradigm that they used to study the rats and addiction was that they were rigged to a device that would give them a dose of heroin if they pushed a lever, but each time they got a dose, it increased the number of pushes necessary for the next dose. So first dose on 1 push, second dose after 2 pushes, 3rd dose after 3 pushes; etc. They could get them up to 10,000 pushes to get the dose (and then it’ll start pushing to get to 10,001 …. which must have taken a long time!). But the rats are stuck in cages, and it’s pretty boring, and life isn’t satisfying to them, so why not take a drug. They wanted to see what would happen if they took the rats out at night to the middle of a football field in the suburbs, opened the cage doors. They expected to come back the next morning and find the rats pushing on the levers. But it didn’t happen. The rats opted for freedom. He then made the analogy to humans and our sociological, psychological, mental “cages” that would drive or maintain addiction. If you take the person out of the cage, they will choose freedom. I suppose for a rat to be suddenly freed at night in a wide open field vs. having been stuck in a cage its whole life would be like for a human taken from the worst of the worst parts of Baltimore, addicted to some substance (e.g. cocaine or heroin) and then bringing them to a tropical paradise where every pursuit and action they choose to take is the most rewarding and valuable things ever, vs. being stuck in their crappy neighborhood in Baltimore getting high — they’ll choose the tropical paradise. The task for clinicians, policy makers, voters, neighbors, family, and friends — is to recognize peoples’ cages and make life rewarding. Yes …. it’s all wired in the brain. I’m by no means supporting a viewpoint that this metaphor is separate from brain circuitry & chemistry driving behavior; just that context in which a particular brain is acting is what sets up its circuitry & chemistry. The rewards and reward systems that are available are what a brain will respond to. In other words, we need our environment, actions, and opportunities to be more motivating, stimulating, and rewarding than the reward from getting high; and there’s individual variation. Regarding marijuana — I do think that even though it’s not physically addicting, the fact that it activates reward centers so strongly makes it psychologically addicting. I have had several friends waste several years of their lives spending >$300 per month on pot. They weren’t physically dependent on the pot, but getting high was the only satisfying thing they had going for them. Most people grow out of this though.

  48. cannotsay2013on 13 Jun 2013 at 5:47 pm

    etatro,

    “I’m by no means supporting a viewpoint that this metaphor is separate from brain circuitry & chemistry driving behavior; just that context in which a particular brain is acting is what sets up its circuitry & chemistry. ”

    You “de facto” are. I don’t understand why there is this reluctance in this movement to accept “the mind” as a useful abstraction/metaphor or whatever.

    When a computer executes software (and as I said, FPGAs can reconfigure their own damaged circuits as part of execution, fact used by NASA to design computers that are able to fix their own circuits when damaged by radiation), there is a lot of electrical signalling going on. If you had access to the micro and nano level you’d only see electrical signals going around, but software is a very different abstraction. Nobody thinks that software can be “fixed” by adjusting the conductivity levels in transistors, even though these transistors carry the electrical signals that make software execution possible.

  49. etatroon 13 Jun 2013 at 5:48 pm

    steve12 – I had actually reached your conclusion a while back about CS2013. He is clearly unhinged. He’s got all the markings of someone who is manipulative and vindictive in their personal lives. I’m sure that his ramblings here are markers of a larger problem and he acts just this way in other aspects of his life. He’s got the attributes of someone with (perhaps) paranoia and delusions of grandeur. He thinks there’s a large conspiracy of psychiatry keeping everyone down and that inflicted great harm on his life. His delusions of grandeur are that only HE can see the truth and that he is a savior and will “bring psychiatry down.” I can make predictions on how he treats his friends / girlfriends / family, too. This isn’t because of my background in neuroscience … I learned more about human behavior from several years as a waiter and bartending in college.

  50. etatroon 13 Jun 2013 at 5:53 pm

    CS2013 – No. I, de facto, am not. Our reward systems are in flux and constantly getting stimulus and reinforced or inhibited by input from around us and by our own actions. At a casino – put in money, pull a lever – lights! noise! moving colors! – activates the reward circuitry. Doing drugs – going to a place, rolling a joint, sniffing, getting high – activates the same circuitry. Exercising – tying up shoes, running 5 miles, endorphins, running high, bragging rights – activates reward circuitry. How strongly, how often, and how susceptible we are to these behaviors and rewards varies, but is encoded in the physical substrates of our brains.

  51. cannotsay2013on 13 Jun 2013 at 6:03 pm

    etatro,

    “He’s got all the markings of someone who is manipulative and vindictive in their personal lives. I’m sure that his ramblings here are markers of a larger problem and he acts just this way in other aspects of his life. He’s got the attributes of someone with (perhaps) paranoia and delusions of grandeur.”

    WOW! Now I have been diagnosed on the spot by somebody who is not even a shrink (this is what happens when you spend too much time with them).

    ” He thinks there’s a large conspiracy of psychiatry keeping everyone down and that inflicted great harm on his life. His delusions of grandeur are that only HE can see the truth and that he is a savior and will “bring psychiatry down.” ”

    Actually, and it is funny that every shrink I have encountered in my life always tries to project “conspiracy theories” into their victims, I have been on record several times that I do not believe in conspiracy theories (you can double check my previous entries).

    There is no conspiracy because every single information on which I have based my arguments is public. It comes from trials, depositions, settlements (such as this one http://www.justice.gov/opa/pr/2012/July/12-civ-842.html ), the NIMH director’s own words that, despite accusations to the contrary, are not taken out of context and the chair of the DSM-5 task force response to them http://www.madinamerica.com/wp-content/uploads/2013/05/Statement-from-dsm-chair-david-kupfer-md.pdf .

    So no conspiracy pal. It’s a demonstrable fact (as in established by the court of law) that Big Pharma companies have spent tens of millions of dollars bribing psychiatrists that are considered the top of their profession (Joseph Biederman, Martin Keller, Charles Nemeroff) to promote their drugs off label. Maybe one day you’ll reach KOL status and you too will be bribed with millions.

    Neither I claim I am the only one that sees these things. It is interesting that Bob Whitaker was also put in the company of AIDS denialists when he published his ground breaking work Anatomy of an Epidemic http://www.amazon.com/books/dp/1455884197 . Now he has been invited to speak at this year’s NAMI convention. See how things go!

    “I can make predictions on how he treats his friends / girlfriends / family, too. This isn’t because of my background in neuroscience … I learned more about human behavior from several years as a waiter and bartending in college.”

    That explains probably your own “delusions of grandeur”. From waiter to the “pride” of being an assistant professor who still has to be slave of associate and full professors (ie suck their penises) if he wants to obtain tenure. Advise to you: there is life beyond the Ivory Tower.

  52. cannotsay2013on 13 Jun 2013 at 6:06 pm

    etatro,

    It’s a different name for what in computer science is called “software”. Software is not the lines of code nor is the encoding in zeros and ones, it’s the intelligence that drives the computer that the programmer expresses in “lines of code” and that the compiler translates into “zeros and ones” so that the computer can execute it.

    I understand that to get tenure you have to agree with your masters at your university that “the mind” doesn’t exist because that is academia’s fad du jour in neuroscience, but you have “de facto” admitted that “the mind” is a useful abstraction to think about these matters :D .

  53. Hosson 13 Jun 2013 at 6:07 pm

    Cannotsay,

    There isn’t a single argument of Steve’s that you logically refuted. If “skeptical dogma” is rationality and critical thinking, you need to get some of it. You keep making the same logical fallacies and demonstrably false claims. Stop repeating yourself, especially since you’re not changing your arguments after they have been thoroughly refuted, it’s annoying.

    I believe there is enough evidence to conclude that you are a walking, talking, non sequitur, although there is room for debate if you can actually walk or talk.

    End assertion.

  54. cannotsay2013on 13 Jun 2013 at 6:12 pm

    Hoss,

    Steven Novella has gone to the game of semantics, which is an implicit admission that there was not much logic in his arguments.

    The way I see it comes down to this: I and Steven Novella (and his followers) have different notions of what “validity” means in the context of medicine and what “demonstrably” means in the context of science.

    Only I can claim that my concepts are behind AIDS having been transformed in most cases in a “chronic” disease, and human’s ability to build the LHC, while your and Novella’s concepts have resulted in 10000 British citizens -and counting- having had their civil liberties violated gratuitously.

    Again, let the people be the judge!

  55. Hosson 13 Jun 2013 at 6:15 pm

    Cannotsay,

    Your argument would be more convincing if you said, “OH YEA”.

  56. etatroon 13 Jun 2013 at 6:17 pm

    I think that CS2013 is possibly addicted to posting on this forum. To him, the reward is to see his writing and for us to respond to it. We’re feeding his paranoia by confirming his suspicions of a grand conspiracy and also his delusions of grandeur in being the lone voice and savior from psychiatry. He must be on to something if we are responding and arguing. If only he could write 3 – 4 more paragraphs, maybe then we’d see the light and come around. I didn’t post my anecdote to get into a comment war with CS2013, I wanted to share a memorable story on this topic to a group I thought might find it interesting.

  57. cannotsay2013on 13 Jun 2013 at 6:19 pm

    Hoss,

    Look, Steven Novella himself started the “semantics” discussion. When you have to go to a discussion about what in mathematical terms is called axioms http://en.wikipedia.org/wiki/Axiom , is that the disagreement is not in the “rules of logic” or in the “deductive logic” used to make the arguments but in the axioms themselves.

    We’ve known for a long time that logic is a shaky endeavor in that regard http://en.wikipedia.org/wiki/G%C3%B6del%27s_incompleteness_theorems . So I take Novella’s attempt to talk about semantics as further proof that his arguments do not stand any ground by themselves :D .

  58. cannotsay2013on 13 Jun 2013 at 6:24 pm

    etatro,

    Fearful that your tenure committee might be reading part of your nonsense? Look, I have made my arguments at length here,

    http://theness.com/neurologicablog/index.php/the-genetics-of-mental-illness/

    It was established that,

    - Posters Mlema and sonic agree with the proposition that Insel’s statement (and the subsequent crisis) validates my main point: to this day there are no biomarkers for so called “mental illness”.

    - Steve12 attempted to pull off a nonsensical argument based on statistical inference that only showed that he doesn’t understand Bayesian statistics well. But even he agreed that much of the DSM is nonsense.

    - Some poster (I think it was BO) agreed that DSM disorders are real diseases if one considers the “social context”, ie, that it is legitimate (although he never endorsed it) to call “homosexuality” a “mental illness” in the context of a homophobic society.

    All that was argued to oblivion. If there is anything that is not clear to you from that discussion, please let me know and I will address it in a that even a PhD in chemistry who works with shrinks can understand it. Don’t worry, I will not tell anybody at UCSD that you are on record saying things that might challenge the dogma of non existence of the mind :D .

  59. cannotsay2013on 13 Jun 2013 at 6:31 pm

    etatro,

    You might find useful to read this to get out of Ivory Tower dogmatic thinking,

    https://www.madinamerica.com/2013/02/five-decades-of-gene-finding-failures-in-psychiatry/

    “Two generations of molecular genetic researchers have attempted, yet failed, to discover the genes that they believe underlie the major psychiatric disorders. The most recent failure is a molecular genetic study that was unable to find genes for symptoms of depression. Like most genetic researchers in psychiatry, the authors failed to consider the possibility that no such genes exist, and instead concluded that much larger samples of at least 50,000 subjects are needed to detect genes”

    This is why I am so confident that Tom Insel will fail miserably!

  60. praktikon 13 Jun 2013 at 8:07 pm

    @ # etatro
    “I have had several friends waste several years of their lives spending >$300 per month on pot.”

    Still not all that far off from some healthy alcohol budgets in the 25-40 age range! The thing that galls me though is how high prices are due to prohibition – I could keep an ounce a month habit up for 30-60$, even with really high taxes.

    One wonders if the business case for prohibition couldn’t be made solely on the delta between what legal and illegal prices are – all that money people could be rediverting back to legitimate business subject to taxation. I know in some of my crazier days I mighta been able to buy more clothes and electronics if I wasn’t paying such high prices for illegal drugs.

    Issues such as repurposing of law enforcement assets, rising addiction and resocializing gang members into more productive work could likely be largely paid for on the back of that effect and the peace dividend.

  61. praktikon 13 Jun 2013 at 8:08 pm

    (and I would even say that rising addiction from the end of prohibition is very much a debated downstream effect – I threw that in there for the legalization skeptics who worry about that [without much backup])

  62. bgoudieon 13 Jun 2013 at 9:34 pm

    As my wife (a Doctor of Psychology) often reminds me, one shouldn’t form dialogistical opinions of someone just by what they post. That said, can we stop feeding the paranoid delusions of cannotsay2013 by giving leave to post here? I’m sure he can find other spots on the internet where his muddle of poor logic, quote mining and pretensions to education will find an audience that cares.

  63. ccbowerson 13 Jun 2013 at 9:50 pm

    “While DSM has been described as a “Bible” for the field, it is, at best, a dictionary, creating a set of labels and defining each. The strength of each of the editions of DSM has been “reliability” – each edition has ensured that clinicians use the same terms in the same ways. The weakness is its lack of validity.”

    Cannotsay- Tom Insel has explained that the quotes you are using were directed towards researchers, and the problems with the use of the DSM in research. The concept of validity comes into play when a given diagnosis in the DSM may, in theory, refer to more than one distinct disorder physiologically, but manifest clinically in very similar ways.

    That does not mean that there is anything wrong with attempts to create this “dictionary,” in fact it is necessary and has been very helfpul. His point was that there is much progress that needs to be made (and commented that recent progress has been less than people had hoped) with regards to understanding mental disorders themselves, and he implies that this lack of progress has been in part due to prioritizing research that focus on treatment. You use his words as if they support your denial when they don’t.

  64. ccbowerson 13 Jun 2013 at 10:03 pm

    “I am not very familiar with PTSD…”

    …but that doesn’t stop you from denying its existence. As if we needed another example of your white knuckle grip on your denialist ideology.

    “Many veterans came back, had some issues adjusting back to civil society but they eventually did, to the point that many WWII, Korea and Vietnam veterans are among our most successful members of society…. If my memory serves me well, PTSD was “invented” as a disease by DSM-III.”

    This is absurd. So because some veterans had successful professional lives after war, that is evidence for the nonexistence of PTSD? No one is claiming that PTSD eliminates the possibility of professional success, but a disproportionate number have great difficulty with personal and professional relationships, suffer from anxiety/mood disorders, and all you have to say is ‘look at him, he looks like he’s holding it together. Why can’t you?’

    Don’t forget PTSD is not just a wartime phenomenon, but can occur with other types of physical abuse. These difficulties can be improved with various treatments. Your denial of its existence also denies treatments because it denies the need for treatments.

    I still find it unbelievable that you start by saying you don’t know much about PTSD and then end the paragraph by denying its existence. Denialism that anyone can see

  65. Hosson 14 Jun 2013 at 12:17 am

    I wish cannotsay hadn’t hijacked this thread. I find the possibilities for involving addiction fascinating.

    Is it possible to constantly stimulate the pleasure sensors in the brain while maintaining “functionality”? Is it possible to disassociate free will from our pleasure sensors? Both possibilities seem likely due to Murphy’s Law of the brain, although this is a gross characterization.

    If either possibility has a high potential of occurring due to selection or some other potential process, then perhaps the future of addiction won’t looks as grim as it does today. I don’t think this kind of adaptation will happen on a mass scale any time soon though, if ever.

  66. crtopheron 14 Jun 2013 at 12:38 am

    Steve Novella wrote “neuroscientific research into addiction seems like a powerful argument against legalizing recreational drugs…”

    He should have added “…but isn’t”.

    It SEEMS like a powerful argument, BUT ISN’T.

  67. cannotsay2013on 14 Jun 2013 at 12:49 am

    bgoudie,

    Sure, a PhD in psychology is as relevant in a discussion about the scientific foundations of psychiatry as a PhD in English literature, ie, useless.

    ccbowers,

    “The concept of validity comes into play when a given diagnosis in the DSM may, in theory, refer to more than one distinct disorder physiologically, but manifest clinically in very similar ways. ”

    I am happy that at least we can agree that what you, Novella and the like call “validity” is different from the concept “validity” that is used in the rest of medicine. However, what you call “validity” of so called “mental illness” is what I have called several times more appropriately “social control”, which again, it is preposterous to be left in the hands of unaccountable, self appointed “mind guardians” that impose their own concept of “normal behavior” on the rest of society.

    “…but that doesn’t stop you from denying its existence. As if we needed another example of your white knuckle grip on your denialist ideology.”

    Not being familiar with PTSD, just as not being familiar with “binge eating”, doesn’t prevent me from making the argument that it was introduced in DSM-III or to make the case that today’s veterans are not any more stressed than the veterans of previous wars. According to you, Allen Frances is also a “denialist” of “binge eating”.

    “but a disproportionate number have great difficulty with personal and professional relationships, suffer from anxiety/mood disorders, and all you have to say is ‘look at him, he looks like he’s holding it together. Why can’t you?’ ”

    The veterans of WWII fought an enemy like no other. Those who flew bombers for instance had a very important likelihood of not coming back alive http://en.wikipedia.org/wiki/Strategic_bombing_during_World_War_II . 400000 American soldiers died in WWII. So to claim that today’s veterans have a harder time than previous veterans is simply to be an ignorant of the history of the wars the US has been involved in (not uncommon in today’s academia since ROTC has been all but banned from many universities).

    What today’s veterans have going against them is the unholy alliance Big Pharma with Charles Nemeroff and the like http://www.youtube.com/watch?v=93sdAPOmHcE . That soldiers die of the cocktails veterans are administered? Big Pharma has no problem at all, and the army sincerely doesn’t care.

  68. cannotsay2013on 14 Jun 2013 at 1:23 am

    To our young apprentice etatro, here is Ben Goldacre exposing the type of trickery Big Pharma regularly uses to “make it look like” its treatments are effective,

    http://www.youtube.com/watch?v=ihooFXrGBM0

    While that type of trickery is not exclusive to psychiatry, the nature of psychiatry as an unscientific endeavor that has no objective measures of efficacy makes that corruption more pervasive in psychiatry than in other areas of medicine. Just, as I pointed out in the other thread, psychiatrists regularly top the list of the most bribed doctors by Big Pharma,

    http://www.medscape.com/viewarticle/780835

    “Once again, psychiatrists top the updated Dollars for Docs list of large payments from pharmaceutical companies to individual US clinicians.”

    Now, true denialism, and psychosis, is in my opinion to deny that these things happen or that these doctors are not biased by the money they receive from Big Pharma.

  69. cannotsay2013on 14 Jun 2013 at 1:48 am

    etatro,

    In the same vein (sorry for so many postings, but the lack of “edit” button makes things difficult)

    http://www.ncbi.nlm.nih.gov/pubmed/23521369

    “Review of the literature and analysis of the multiple pathways through which the industry has directly or indirectly infiltrated the broader healthcare systems.”

    WOW, are these people also conspiratorial? Are they also deluded?

    “RESULTS:
    We located abundance of consistent evidence demonstrating that the industry has created means to intervene in all steps of the processes that determine healthcare research, strategy, expenditure, practice and education. As a result of these interferences, the benefits of drugs and other products are often exaggerated and their potential harms are downplayed, and clinical guidelines, medical practice, and healthcare expenditure decisions are biased.”

    While I do not agree with the proposition that more regulation is the answer (in fact, it’s precisely regulation what has made of Big Pharma an oligopoly with such influence) the language they use to denounce the corruption that pervades the healthcare industry, which is disproportionally present in psychiatry, would no doubt deserve insults from etatro. Alas etatro, these people have no psychiatric masters to please to achieve tenure, which is probably they can be so blunt about what is going on.

  70. etatroon 14 Jun 2013 at 2:32 am

    CS2013. While it’s been a pleasure serving as your punching bag, I would just like to point out a few things. You responded to my prediction that you are manipulative and vindictive by attempting to target insecurities of mine to lure me into a rabbit hole with you. You attacked my masculinity, my status, and my career trajectory — probably assuming that those are things that I value or am insecure about. You’ve probably successfully gotten a rise out of 30-something males before and lured them into arguments with you then bombasted them with gish-gallops of links, non-sequitors, unverified assertions. When I didn’t respond, you moved to using creepy overly-familiar language and patronizing. How many times over the past several weeks have you checked this forum for responses to your posts? How much time passes between thinking about it? Do you get anxious if you don’t know whether someone has responded to you? Do you stay up later than you normally would, skip a meal, ignore other responsibilities?

  71. cannotsay2013on 14 Jun 2013 at 2:47 am

    etatro,

    See, this is the difference between not having “masters to please” (as you do), and being a free thinker (me). I don’t have to backtrack from my statements.

    You can try to project your frustrations on me, it doesn’t cut it. Unlike your pathetic “publish or perish” life, I have more than enough time to spend here and elsewhere. Are you perhaps envious that you don’t have such latitude? Do you feel betrayed that being an assistant professor is not the bargain it looked to you as a grad student?

    Remember that while all you get after you sucked all those penises at UCSD is the illusion of a “job for life” while life outside academia has a lot more to offer, both economically and intellectually. As somebody said, what is pathetic in academia is that the viciousness of its politics are amplified because there is usually so little at stake.

    The funny thing is that you are not even a shrink. Apparently you spend too much time with them so they have corrupted your think.

    Oh, and BTW, it’s you who started your interactions with me insulting. If you cannot stand the heat, get out of the kitchen!

  72. Hosson 14 Jun 2013 at 3:09 am

    Cannotsay,

    You sound like a pseudo-professional, psychiatry denier, apologist running the Gish Gallop at 100mph. I believe Steve would actually have a discussion with you, but you keep spouting abject nonsense.

    Do you really expect to change the minds of scientific skeptics on a matter of science without using, you know, science?

    I know, I know, but the homosexuals, the AIDS, the “sw/hw problem”, the Tom Insel, the (insert irrelevant babble here).

    Your arguments have been weighed, your arguments have been measured, and your arguments have been found wanting.

  73. bthomas001on 14 Jun 2013 at 3:14 am

    I understand that in order to investigate even enormously complex problems as occur in neuroscience, one must deconstruct those problems to their roots, their bare-bones, to be able to design and execute experiments that reveal useful knowledge. That is inescapable.

    What I suppose I take some issue with is that those deconstructed problems, which give rise to a line of research, are sometimes applied from an equally narrow vantage point.

    I absolutely respect what you have assembled here, Dr. Novella. And I am continually quite satisfied with your analyses, conclusions and further comments on the issues you raise. At the risk of applying the evidence presented a bit too broadly, I would simply encourage that basic neuroscience research be interpreted in the context of its data source: an entire brain. It is my feeling that the arguments presented do not consider much beyond the binary control system demonstrated by the research, when in fact there is an entire person to consider. While it may be true that our baser instincts are controlled by reward and aversion, it is how we approach situations (and usage of certain molecules) that can generate one or both that determines how adaptive our behavior actually becomes.

    As one commenter pointed out, it is only a small proportion of humans that sample (possibly even use with some regularity) drugs of abuse, whose use actually progresses to abuse and addiction. For those that do become addicted, often it is only to one drug or a family of drugs among the many they have tried. Why is it that we are so often able to recognize and curtail potentially problematic behaviors before they escalate? Perhaps the drive to seek out pleasure and avoid pain is counterbalanced by the drive to avoid change and maintain control and predictability. More poignantly, what have addicts “done wrong” that so many “do right” almost instinctively?

    Until we can answer these questions, perhaps it is irresponsible to unleash powerfully addictive substances on the masses. But it must be considered that many can and do use these potentially dangerous drugs responsibly. Maybe it is time that our criminal justice system, medical/research establishment, and perhaps society at large, start to recognize and apply this distinction more readily. Does a “responsible heroin user” sound more like a “responsible drinker” or a “responsible smoker”? Only time and experience will tell, but I would be far more comfortable with evidence-based laws and interventions than our current, ineffective prohibition.

  74. cannotsay2013on 14 Jun 2013 at 3:22 am

    Hoss,

    If your criticism is about my exchanges with this etatro guy, I remind you that he is the one who started with the insults. I am not the kind of guy to back away from rough language. If he didn’t want to be insulted back, all he need to do is to have been polite to begin with.

    Regarding my arguments, I agree that they are pretty clear. They might not be convincing to people like you, but that’s OK. You guys have an agenda which, for some reason, has “validity” of psychiatry as one of its dogmas, even if to accomplish that you need to be elastic with the concept of “validity” to the point that it means something completely different from what “validity” means in the rest of medicine, let alone in the rest of science. Same thing with the concept of “proof”. Actual “proofs” are only possible in mathematics (the trick there is that axioms are the starting point). In the rest of science “proof” is ability to make falsifiable predictions that happen to predict the actual result consistently. In your world, “validity” and “proof” are wishy washy concepts that can be massaged to mean whatever you guys want to mean so that psychiatry is considered legitimate.

    And that is the part of the “skeptic dogma” that I still don’t get, ie, why is that you guys put on the same category AIDS denialism and fair criticism of psychiatry of the kind that was recently validated by Insel and the like. Not sure where your agenda comes from given that the foremost critic of psychiatry, Thomas Szasz, was an atheist, winner of the Humanist of the Year award. In other words, maybe in your “worldview” the connection “atheism-psychiatry” is obvious, but it is certainly not for many atheists.

  75. Bruce Woodwardon 14 Jun 2013 at 4:00 am

    Cannotsay13, this is the third thread this whole dance has been played out, might I suggest one of two most likely scenarios:

    1) You are right, we are the dogmatics and we are all sheeple to Steven Novella’s shepherd. In this case we will not change our minds after going over this issue over and over again. This means you posting here actually does nothing to change anything.

    2) You are wrong and your logic is flawed and no matter how much we point it out you will not change your point of view. This means that you posting here does nothing to change anything.

    Either way might I ask you to please leave this topic alone so that we can move on to discuss other issues?

  76. Mad Vertexon 14 Jun 2013 at 4:41 am

    Such an interesting topic to read and a discussion to follow (well, it was, up to a point the troll joined – please stop feeding him).

    I was curious about whether behavioral addictions (like gambling or video game addiction) are documented to cause physical withdrawal effects similar to drug addiction in some people?

  77. Bill Openthalton 14 Jun 2013 at 7:53 am

    @ starik

    Once we’re able to do this without harm, plus immortality, it would be hard to convince anyone to opt out. Maybe this is why haven’t seen any evidence of advanced alien civilizations.

    Welcome to the Matrix…

  78. nybgruson 14 Jun 2013 at 8:04 am

    I’ve actually read most of the comments on this thread and I would like to take a moment to point out something very important: the honest skeptics here have been disagreeing with Dr. Novella and arguing to refine and improve the post. That bears significant note, particularly by those who would think that Dr. Novella merely has a bunch of mindless acolytes running around agreeing with whatever he writes. Couldn’t be further from the truth – it just so happens that he usually writes things that are correct because he – like us – takes the time to research the topic and writes it with intellectual honesty. It is also worth pointing out that he doesn’t take the criticism as anything but constructive – exactly what a proper scientist and skeptic should be doing. Being proven wrong is a wonderful experience – it demonstrates clearly that you have learned something new.

    I don’t have the time or desire to enter into the meat of the conversation, but felt it was worth noting the dynamic seen here clearly and unequivocally demonstrates that there is no such thing as a “skeptic dogma.”

  79. nybgruson 14 Jun 2013 at 8:10 am

    @cannotsay:

    If you believe that “ADHD is demonstrably a brain disorder” has been established in the same qualitative way HIV infection has been established as the cause of AIDS, then we’ll just have to agree again to disagree about what “demonstrably” means in addition to disagreeing to what “validity” means

    Nothing in medicine has been demonstrated to 7-sigma so if you believe that HIV infection is the cause of AIDS has been established in the same qualitative way that the Higgs Boson has been established as part of the Standard Model of physics, then we’ll just have to agree again to disagree about what “demonstrably” means in addition to disagreeing to what “validity” means.

    So clearly, nothing in medicine has ever been demonstrated nor is any of it valid.

  80. Bill Openthalton 14 Jun 2013 at 8:37 am

    a Hoss

    Is it possible to constantly stimulate the pleasure sensors in the brain while maintaining “functionality”? Is it possible to disassociate free will from our pleasure sensors? Both possibilities seem likely due to Murphy’s Law of the brain, although this is a gross characterization.

    Constant stimulation reduces sensitivity to the stimulus. There is no reason this would not apply to pleasure, so that after a while, “functionality” would return to normal levels. Addictions tend to wear off with age.

    Free will is in all likelihood becoming aware of conflicts between various parts of the brain. What religion describes as “temptations” are attempts of certain parts to determine behaviour. We experience “free will”, when other parts (often the social/moral part) generate opposing feelings and manage to alter the behaviour.

  81. The Other John Mcon 14 Jun 2013 at 9:07 am

    From an evolutionary perspective, we are designed to always be chasing things that we *think* will make us happy (mates, resources, job success, the total destruction of psychiatry, etc.). And sometimes we are happy for a time, but it wears off, so then we are on to chasing the next thing. Such a design keeps us going like the Energizer Bunny, but suggests something like eternal happiness will always remain elusive.

  82. Kawarthajonon 14 Jun 2013 at 9:18 am

    Wow, I’m sorry I didn’t get in on the debate earlier. These comments have really gone off into some interesting tangents!

    I want to go back to the original subject of Steve’s post: Addiction. While I agree with your statement regarding how the brain reward/dysphoria system works (although I am not qualified to counter your experience/training as a neuroscientist), I think that you are generalizing a bit. Not all people become addicted when they use highly addictive drugs, nor do all people who gamble become addicted. Not all people who have sex become addicted to him.

    There is tremendous variability in how an individual responds to a particular stimulus. I, for one, will never become addicted to gambling. To me, it is boring, nonsensical and a total waste of time/money. I could easily, however, become addicted to smoking cigarettes (I actually used to smoke, but managed to quit after many agonizing years). I have tried a variety of drugs and have never been addicted to any of them (other than tobacco and caffeine, of course). I could easily become addicted to alcohol, because I love it sooo much, but my body doesn’t like it, so I have to limit the amount I drink.

    I think that your post dismissed the individual variations in people’s addictive behaviours and did not address the fact that many people never develop addictions at all, even after trying addictive substances. Anecdotally, I work with people who have addictions and there is tremendous variety. Some people are so addicted that their addiction will likely kill them sooner rather than later (I have had a number of clients die because of their addiction). It seems to me that these folks have no free will and no matter what the cost to their lives and no matter how much suffering they have to endure, they will always return to their addiction. Treatment does not seem to work for these folks, nor does lengthy jail sentences. They fit your description of addiction above.

    Other clients I have worked with (the vast majority), however, get addicted for a period of time, and then they stop. Either because of free will, or treatment or personal circumstances, they overcome their addiction. They seem to have a very different quality than the severe addicts. Maybe it is a fundamental personality difference, or maybe it is something to do with their social circumstances or brain chemistry, I don’t exactly know.

    How does your model of addiction account for people like this, or people who try various substances and never get addicted? Or people who never seek out addictive substances in the first place? My impression is that the model you are discussing comes from studying people (and rats) who are severe addicts. I think more research needs to be done to find how these folks differ from the other segments of the population who do not get addicted.

  83. Bill Openthalton 14 Jun 2013 at 9:18 am

    @ The Other John Mc

    Such a design keeps us going like the Energizer Bunny

    It’s quite impressive how even the simplest of animals have this drive to “achieve their goal (of procreation)”. The difference with humans is that we are able to retarget ourselves and keep going long after we have managed to procreate (or lost our fertility).

  84. ccbowerson 14 Jun 2013 at 9:45 am

    “So to claim that today’s veterans have a harder time than previous veterans…”

    Cannotsay – No one claimed this. You made this claim up yourself. Part of my point is that the recognition of PTSD has helped many people today, and those in the past did not get that help. Many veterans of previous wars simply did not get helped, and that certainly damaged a lot of lives, causing pain and suffering. Just because that pain is obvious to you doesn’t mean it doesn’t exist, it just existed in the everyday lives of millions.

    “I am happy that at least we can agree that what you, Novella and the like call “validity” is different from the concept “validity” that is used in the rest of medicine.”

    Actually validity is a statistical term used in research, not specific to medicin. It addressed whether a conclusion or measure reflects an underlying reality. You may be thinking about the use of the term in logic which is slightly different. Either way you seem to be confused.

    You are intellectually dishonest and have hijacked enough of this conversation. There are great diminishing returns from conversing with you, and I do not find it productive to do so. I hope you are able to one day switch gears from motivated reasoning to motivated understanding.

  85. Hosson 14 Jun 2013 at 9:46 am

    “Free will is in all likelihood becoming aware of conflicts between various parts of the brain. What religion describes as “temptations” are attempts of certain parts to determine behaviour. We experience “free will”, when other parts (often the social/moral part) generate opposing feelings and manage to alter the behaviour.”

    Thanks Bill for the insight. I haven’t heard free will described in such a way. I’ll have to some reading on to cure my ignorance the subject. I hear Dennet is a good place to start.

    “Constant stimulation reduces sensitivity to the stimulus. There is no reason this would not apply to pleasure, so that after a while, “functionality” would return to normal levels. Addictions tend to wear off with age.”

    I’m wondering if this is true for all people.

  86. ccbowerson 14 Jun 2013 at 9:48 am

    “It addressed whether a conclusion or measure reflects an underlying reality.”

    I did not mean for this to read like reality in the metaphysical sense, just that the measure or conclusion corresponded to the ‘real world’ outside of the research.

  87. ccbowerson 14 Jun 2013 at 9:54 am

    nybgrus-

    Nice to see you back, if only temporarily. Regarding the skeptical dogma: I have pointed out the very same thing regarding the pushback from this post above. I’m glad to see it repeated, because it is noteworthy. At least the use of word ‘dogma,’ and its derivatives, have decreased. It was in nearly every sentence before. The pushback would be even more clear if the conversation were not hijacked. Must switch gears now to ignore

  88. Nate Greeneon 14 Jun 2013 at 11:06 am

    Great post, Steve. I started drinking in Middle School and loved it. Looking back, alcohol became my prime motivator pretty quickly. I put it above family and school and friends. By my 20s I really was in a state of “dysphoria”, where I was not happy when sober and quitting just made me eventually so miserable that drinking looked good again, damn the consequences.

    I’ve been sober for many years now and I do a fair amount of volunteer work to try to help other problem drinkers. One of the things I do is go into the county Jail every third Monday and spend an hour talking to guys who want help. Many of these guys seem to genuinely want to stop drinking and drugging, but when they get out of jail, they usually go right back at it.

    As I read your post, Steve, I kept saying “YES! Exactly!”. Then I read many of the comments, for example by Praktic, noting that most people who use drugs and alcohol do not end up like me or my buddies at the jail. What is the difference? My sister grew up right down the hall from me and presumably had nearly the same upbringing, yet she does not have a problem with alcohol. My wife has been drunk a few times and didn’t like it much and just enjoys a single glass of beer or wine (I don’t understand this type of behavior, why bother??)

    I love your analogy to “hacking” the reward system. And as drugs (or other methods) get better and better at cleanly targeting our reward system, I worry that more and more people will fall into the euphoria/dysphoria trap. What will become of our world? But perhaps I’m wrong. I’m personally exposed to a lot of people who are terribly addicted, so that’s how I see things. Perhaps there are just segments of the population that are vulnerable to certain addictions and some that are not. You said that it seems we are not “evolutionarily prepared for drug addiction”, and I agree, but I’m wondering if some (most?) of us have better hacking defenses than others. Fascinating topic. Thanks for posting.

  89. Bill Openthalton 14 Jun 2013 at 11:14 am

    @ Hoss

    I’m wondering if this is true for all people.

    Not necessarily. There is quite a lot of variability between humans, and we know that certain individuals are far more addictable than others and have more problems kicking their habit. This might be related to their continued sensitivity to repeated stimuli.

    I find it useful to consider the brain module that implements consciousness as a mere observer, which probably started as a means to provide and acquire extended status information to/from other humans. All real “decision-making” occurs in other modules.

  90. Glennon 14 Jun 2013 at 12:13 pm

    I’m 80 and I submit to you that cell phone usage is our newest addiction/affliction. Raise you head and look around you; verbal communication is a dying art form…

  91. Bookeron 14 Jun 2013 at 12:21 pm

    Excellent article, Steve, and I must say that I learn a lot from your rebuttals of denialists like cannotsay2013.

    I’d love to see skeptical commentators venture into the area of addiction treatment a bit more than they do. As you know, it’s a field rife with ideology and it is often difficult for a lay person to figure out what is accurate and science-based. There are, of course, many devotees of religion-based recovery programs, the 12-Steps, and it seems that even secular organizations make use of that model. I know that it can be helpful in terms of the re-socialization of addicts, but I’m skeptical of its success in the actual treatment of the disorder.

    Have you heard anything about the use of the drug Baclofen for addiction treatment (described in the book, The End of My Addiction, by Olivier Ameisen)?

  92. Mlemaon 14 Jun 2013 at 12:27 pm

    CS, you’re rude. You’re undermining the value of your argument through your reactionary and insulting comments.

    There’s something you have to understand:

    There are forms of thought, mood and behavior that everyone agrees are painful for the individual experiencing them. A young woman who’s cutting herself is not OK. People who’ve experienced severe trauma can have lasting psychological problems that they need help to deal with. Because we are all alike in the most basic ways, we tend to react to similar physical/psychological environments in similar ways. Because of this, we can label things like PTSD. The problem with psychiatry is it’s attempt to make these problems into brain problems. We need people who can differentiate between problems caused by a person’s biology vs. their experience.

    You’ve got to find a way to make your case against the evils of psychiatry without denying psychology. It’s hard to hear it with the ears of others, but: it sounds like you’re oblivious and uncaring toward people who are in pain.

  93. Mlemaon 14 Jun 2013 at 12:33 pm

    Nate Greene,
    how did you overcome your addiction?
    Do you think it’s true that a person has to realize that willpower is only useful to make the decision that willpower won’t help?

  94. Ori Vandewalleon 14 Jun 2013 at 12:42 pm

    Glenn:

    I agree.

    Posted from my iPhone.

  95. ninjalawyeron 14 Jun 2013 at 2:11 pm

    I really like Steve’s blog generally, but I have to say I’m a little disappointed in this post. It’s simplistic with no real analysis applied. Where are the stats that say that most people who try addictive drugs will become addictive? Where is the evidence that the cost of addiction is higher than the cost of criminalization?

    There’s just no substance to this argument.

  96. ninjalawyeron 14 Jun 2013 at 2:15 pm

    I should add, I mean to say that there may be meat in the argument but Steve hasn’t presented any of that meat. Frankly, I find Steve’s post a little embarrassing and far more glib than I expect.

  97. cannotsay2013on 14 Jun 2013 at 3:19 pm

    nybgrus,

    The problem is that psychiatry has not validated ANY of its invented disorders to the degree other areas of medicine have validated theirs. In that NPR discussion that has been mentioned a few times here, all there, including Jeffrey Lieberman (president of the APA), and Tom Insel (director of the NIMH) agreed that psychiatry is a step child of medicine precise because it lacks this validity that, to more or less degree, has been established in the rest of medicine. Psychiatry has been promising to be “around the corner of finding validity” for like 200 years. That alone should make anybody suspicious about any of their proposition. In other words, psychiatry has dug itself in the hole it currently is with a pattern of over promising and not even under delivering, but NOT DELIVERING AT ALL. If psychiatry was not responsible for perpetrating human rights abuses, I couldn’t care what academics think about the status of this quackery as a science. The problem is that because some take psychiatry seriously, many people have had their lives ruined as a result.

    ccbowers,

    “You are intellectually dishonest and have hijacked enough of this conversation.”

    The only intellectual dishonesty is from those who have hijacked the well established concept of “validity” in medicine to defend psychiatry. What “validity” means in the context of medicine is finding a biological agent (be it external such as in the case of AIDS, or internal such a in the case of cancer) that can be shown to be the cause of a particular disease. Ie, it is not enough to find correlates (which BTW have not been found with any high degree of certainty for psychiatry’s invented diseases), you need to provide a plausible explanation that empirical experiments validate or falsify.

    When psychiatry speaks of “mental illness” they are saying that the brain is diseased in the way a cancerous pancreas might be diseased. Yet, and that is what the discussion of validity means in this context, none of the DSM invented disorders have been validated by a biological cause.

    Mlema,

    Please read the insults that etatro threw at me in his first intervention. I have been very respectful with everybody who has not insulted me.

    What this etatro guy said was very offensive and in fact reflective of how the typical shrink treats those under their control. If people want to be respected and not be insulted, they have to start by being respectful and not insulting. Starting a conversation saying,

    “He’s got all the markings of someone who is manipulative and vindictive in their personal lives. I’m sure that his ramblings here are markers of a larger problem and he acts just this way in other aspects of his life. He’s got the attributes of someone with (perhaps) paranoia and delusions of grandeur. He thinks there’s a large conspiracy of psychiatry keeping everyone down and that inflicted great harm on his life. His delusions of grandeur are that only HE can see the truth and that he is a savior and will “bring psychiatry down.” I can make predictions on how he treats his friends / girlfriends / family, too. This isn’t because of my background in neuroscience … I learned more about human behavior from several years as a waiter and bartending in college.”

    Is not going to gain him any friends. With that simplistic reasoning, I can also make predictions about the pathetic life of an assistant professor seeking tenure at a department dominated by shrinks.

    With respect to psychology, I do not deny its value, just I do not deny the value of religion, meditation or other endeavors that deal with the hard questions of life. All I am saying that it is not a hard science. That was the whole point of my comment. What a PhD in psychology thinks about what “validity” means in hard science is about as relevant about what a PhD in English literature thinks about the same.

    In fact, not only I do not deny the value of psychology, I give it the value many of these people deny. By seeing things in terms of sw vs hw, I categorically reject the notion that psychological problems (that are sw in nature) can be addressed through psychiatric hw interventions (ECT, forced drugging, lobotomy, etc).

  98. cannotsay2013on 14 Jun 2013 at 4:07 pm

    BTW, to those who claim that human rights abuses are part of the past, or, if present, do not happen in the US, think twice,

    http://www.examiner.com/article/letter-to-three-connecticut-politicians-about-involuntary-electroshock

    http://www.examiner.com/article/a-summary-of-references-against-electroshock-treatment

    These are articles by a writer from the examiner that considers himself a survivor of psychiatric abuse as well as part of the loosely defined “anti psychiatry movement”.

    Now, here is Steven Novella is intellectually complicity with these abuses,

    http://theness.com/neurologicablog/index.php/how-electroconvulsive-therapy-works/

  99. Mlemaon 14 Jun 2013 at 4:15 pm

    Mom! He started it! :)

    “For the wrath of man worketh not the righteousness of God.”

  100. Mlemaon 14 Jun 2013 at 4:17 pm

    PS – I’m not saying you shouldn’t be angry. But you can’t let it detract from your argument.

  101. Nate Greeneon 14 Jun 2013 at 5:10 pm

    Mlema,
    I sobered up well before becoming a skeptic, in a 12-step program. I was highly resistant to trusting or being honest with anyone at all, but these other lay-people seemed to share my struggles and spoke my language and, in a sense, kept me entertained enough to get some distance from my drinking. I am incredibly impressed by this blog and the intelligent discussion that (by in large) follows, and Steve just layed down some awesome simplicity describing something that can be terribly complex: What first brings good feelings gradually becomes necessary to suppress negative feelings.

    To answer your question, I don’t think that fighting a drink directly with will power works very well, but using it to drag one’s ass outside and to work and to interact with other (hopefully sober) people can be effective. The 12-step program is a place to go and be around other people who are moving in the same direction. We’re social animals. I also think that altruism is a great mood elevator. I always feel great when I leave the jail, or if I talk to a friend who is struggling and we end up laughing.

    There is so much woo discussed in 12-step meetings, though, it’s terribly embarrassing and I want to say to new people, “we’re not all like that,” but some people find it helpful, I guess. Also some meetings are much worse than others. I never talk about God or tell anyone to surrender. I just try to be friendly and encourage people. Of course 12-step programs do not have a high success rate but it seems to be helping me and some of my friends. I could tell lots of success stories (anecdotes) but I know that doesn’t carry weight here. I am sober and feeling quite good so I will probably keep it up. Thanks for asking.

  102. Mlemaon 14 Jun 2013 at 6:52 pm

    Nate, thanks. Someone whom i love very dearly is an addict. It’s a really tough one and i just think he’s not willing to accept that he has a problem he can’t solve on his own. Too proud and too smart for his own good.

    I asked the question I did because I know the 12-step’s first step is:
    “We admitted we were powerless over our addiction – that our lives had become unmanageable”
    and that the very next one has to do with a “higher power” greater than ourselves, which is repugnant to many, as “woo”. But since 12steps are effective as support groups that have basic tenets and practical actions to take to avoid relapse, it seems like they could be used to design a useful approach. Perhaps it’s critical when you’re trying to re-build healthier attitudes and habits, but maybe once you have those it’s not as important.

    I just am starting to wonder how bad things have to get before a person says “I have a problem. I need help.” Especially when the most critical people in the person’s life aren’t willing to take an either/or stand and instead they do all the tricks: denial, excuses, enabling, etc. Anyway, that’s certainly a different and too involved topic.
    I too see a simple truth in what Dr. Novella’s saying regarding addiction. I’m unable to form an opinion on forced treatment vs. jail. Forced treatment doesn’t work for lots of addicts, whereas jail has a tendency to focus the problem if you know what I mean, but isn’t a great supportive experience.
    This guy’s done a few turns in jail. I’ve been praying someone like you will cross his path. He doesn’t respect me and he’d never respect a room full of people who were all humbling themselves before a “higher power”. He’s a freakin’ genius – but not too smart – do you know what i mean?

    anyway, thank you

  103. cannotsay2013on 14 Jun 2013 at 9:12 pm

    Mlema,

    Well, what this guy said was deeply offensive. From my point of view, way more offensive than anything that I told him back in return. This gratuitous, “on the spot”, “diagnosing” might sound funny for somebody like him who spends his day among shrinks, but for those who have been told horrible things by shrinks along those lines, it hurts. Not that I was ever told those things, but I was told that I was destined to become homeless, that I was going to lose my job, friends, etc. All kinds of threatening stuff. As the above guy who was forcibly ECT-ed tells,

    http://www.examiner.com/article/letter-to-three-connecticut-politicians-about-involuntary-electroshock

    “In the end, I realized that I only had two options: Continue my honest opposition and fighting the staff, while my memory and body seemed to get worse…or start lying about how the treatment was slowly making me feel better. I chose option two, exaggerating whatever positive effect the treatment might have had on my mood, doing it slowly to make it more believable. I lied not only to the staff, but also to friends and family who visited. It felt horrible, but that was how fearful I was. But it worked and on February 17, I was released”

    That is how it usually goes. So when a shrink comes with testimony that former so called “patients” have expressed “gratitude” I always know that it’s BS. That these shrinks keep repeating this mantra only tells of a) shrinks inability to determine people’s true feelings or b) shrinks enormous capacity for self deception. Or probably both.

    So come to this guy and he thinks he can go around labeling people as if this was a psychiatric club of comedy. WRONG. He should be forcibly ECT-ed then come back with his jokes. That would be true karma!

  104. Mlemaon 14 Jun 2013 at 9:32 pm

    CS, I really do understand. And it’s wrong of people who don’t understand to be a-holes about it. We should be able to discuss our viewpoints, experiences, and our logically-reasoned arguments without crass insults. Never mind the bullocks.

  105. Mlemaon 14 Jun 2013 at 10:23 pm

    Dr. Novella, sorry this is off-topic, but is in response to your comments on ADHD and mental illness

    “People with ADHD have higher divorce rates, higher imprisonment, shorter life-expectancy, lower income, etc.”

    But this doesn’t establish adhd as a brain disorder that causes the other problems. Such problems tend to be correlated in life. Also, do you know how these outcomes relate to the drug treatment? (I’m asking because I don’t know, but I think it would be important in drawing conclusions)

    “…when deciding if a position is truly controversial, only relevant scientific experts really matter.”

    I believe that the reason homosexuality was dropped from the DSM had more to do with changes in societal norms than medical outcomes. Medicine and science are both endeavors that are subject to the vagaries of society’s beliefs and values. It’s very possible that “we the people” could decide there’s nothing medically wrong with ADHD kids and that they’re just the victims of expectations that they don’t have the family or community support to meet. Or possibly aren’t meant to try to meet these expectations at all. We’re diagnosing more and more ADHD every year. The trend is inverse to that of public school funding.

    Did you know that the youngest in a Kindergarten class is 50% more likely to be treated with stimulants for ADHD? How can we say a 4-5 year old has a brain disorder when a brain at that time has such a broad range of normal? Did you know that a kid from a single mom family is almost 2x as likely to be diagnosed with ADHD?

    What is your medical explanation for a brain disorder that would be higher in white boys than white girls? higher in whites than blacks? suddenly increase hugely in black boys and Latinos, and then increase in black girls? and rise overall since 2000 – to 10.4 million children?

    I don’t see the research providing anything other than correlation between brain and behavior, which is to be expected. I hope you will read these:
    http://www.boston.com/lifestyle/health/childinmind/2013/01/adhd_is_not_a_real_disorder.html
    http://www.boston.com/lifestyle/health/childinmind/2013/06/too_many_psychiatric_diagnoses.html

    Did you know that we used to treat homosexuals by showing them pictures of naked men and then shocking them? Can we at least entertain the possibility that we’re drugging kids who have nothing wrong with them other than family problems, or problems with fitting into the “mold” that western society has cast for them? Or, even worse, because their parents and teachers like the result?:
    http://www.nytimes.com/2012/10/09/health/attention-disorder-or-not-children-prescribed-pills-to-help-in-school.html?pagewanted=3&_r=0&smid=tw-nytimes&partner=rss&emc=rss

    If children like those talked about in the NY times article above are finding themselves diagnosed with ADHD, what is the validity of the research on ADHD? hopefully such kids would not be included in a research program, but, since they’ve been officially diagnosed with ADHD, it would be possible.

    I believe it behooves skeptics to study sociology. We each have our own perspective within time and society. We have to be careful to avoid narrowing our analysis of any given topic. We don’t want to overlook out own biases.

  106. cannotsay2013on 14 Jun 2013 at 10:32 pm

    Mlema,

    And the question to which I have not still had a satisfactory answer: why is that skeptics like Novella feel so threatened by criticism of psychiatry to the point of preferring the “elasticity” of concepts like “validity” (that Novella just transformed in what most people would consider “social control”) and “proof” rather than admitting that psychiatry has more in common with astrology than with oncology.

    That is still the enigma that boggles my mind, especially since many skeptics are adamant in their criticism of astrology :D .

  107. Jared Olsenon 14 Jun 2013 at 11:09 pm

    Is it true that we have receptors in the brain that specifically respond to THC? Or are they just hijacked by THC ?

  108. steve12on 14 Jun 2013 at 11:23 pm

    Mlema:

    “But this doesn’t establish adhd as a brain disorder that causes the other problems. Such problems tend to be correlated in life. Also, do you know how these outcomes relate to the drug treatment? (I’m asking because I don’t know, but I think it would be important in drawing conclusions)”

    Right before the quote you’re referring to, Steve said this:

    “The diagnosis of ADHD has validity. Whether or not we consider ADHD to be a disorder is a separate question. ”

    The post where he was giving evidence about it being a brain disorder was here:
    # Steven Novellaon 13 Jun 2013 at 1:17 pm

    So you should counter this evidence if you’re uncomfortable with his conclusions.

    I think that there is evidence that ADHD is overdiagnosed for a variety of reasons, but this is very different than doesn’t exist. I saw a talk where a psychiatrist said that ADHD diagnosis is difficult, and that some treaters make it too quickly, calling kids with emotional problems ADHD, e.g.

    While I think that ADHD is real – in that people properly diagnosed have real brain differences – I also think that these differences would not be considered pathological in all cultures. If we were hunter-gatherers, these brain differences wouldn’t matter as much. But we’re not hunter-gatherers, and people with these brains show poor outcomes. we should worry about that.

  109. cannotsay2013on 14 Jun 2013 at 11:38 pm

    steve12,

    You are just sounding as nonsensical as Novella with your notion of validity as “social control”.

    Today’s Macs and PCs use exactly the same HW: Intel CPUs and memory chips fabricated by some Asian manufacturer. Yet, when you look at the “action” -ie the fast electrical switching- that goes on in the hw is very different depending on whether the computer runs MacOS or Windows. I wouldn’t be surprised even if you could tell only from the electrical signaling whether a given computer is running MacOS or Windows, given that many more difficult problems have been solved that way http://en.wikipedia.org/wiki/Side_channel_attack . Yet, nobody would claim that a computer that runs MacOS has a “hardware problem” just because it’s the only computer doing that in a company where the standard is Windows.

    This is how idiotic your reasoning about “validity” sounds :D .

  110. cannotsay2013on 14 Jun 2013 at 11:45 pm

    Cure for “skeptic nonsense”: take a computer 101 class. Novella, your university, despite not being MIT, has actually a pretty good Computer Science department. You could start by talking to this guy http://www.cs.yale.edu/people/angluin.html or this other guy http://www.cs.yale.edu/people/aspnes.html about their respective research areas. Your misunderstanding about what computers are currently capable of doing and your simplistic understanding of the complexity of designing good and robust software would be dissipated and perhaps you’d open your mind to the sw/hw analogy as a good one to explain behavioral issues, certainly better than canards about chemical imbalances in neurotransmitters.

  111. cannotsay2013on 15 Jun 2013 at 12:40 am

    steve12,

    More criticism along my lines,

    http://www.ft.com/intl/cms/s/0/44a3504c-d283-11e2-88ed-00144feab7de.html#axzz2WFuaDLk6


    The authors of the DSM V have been searching for clear diagnostic labels to the point of absurdity. I suggest that we psychiatrists abandon this obsession with categorising every aspect of human suffering. It is time to discard the unfounded and closed-minded assumption that mental and emotional illnesses are primarily caused by abnormal functioning of brain nerve cells, when, for example, we know that the brain has more immune cells than nerve cells. The current outdated concepts perpetuate the excessive reliance on side-effect-laden medications as the solution to mental problems. The basic sciences have proved that all brain functions – cognitive, emotional and vegetative such as sleep and appetite – are inseparable from a diverse set of bio-psycho-social systems ranging from the immune and gastrointestinal systems to the economy, community and culture.

    Psychiatrists need to be open to knowledge from fields such as epigenetics, which demonstrates that genes are not destiny; rather, we have the power to turn our genes on and off, for better or worse, through lifestyle choices. We must recognise that all the systems that affect mental health are also at the root of many common chronic physical illnesses. Diabetics, for example, are more likely also to have a psychiatric disorder such as depression, and vice versa.”

    Basically, another guy who defends the notion of a “mind” even if he doesn’t call it that way :D .

    What I find fascinating is that appeal that “Psychiatrists need to be open to knowledge from fields”. Boy, if the average psychiatrist was capable of such exercise of openmindedness, psychiatry would have closed its doors long time ago. What is the average psychiatrist going to do without “chemical imbalances”, and “medication prescription”? Not much, it turns out!

  112. saburaion 15 Jun 2013 at 6:10 pm

    I must say, I lost a lot of respect for Dr. Novella over the course of this post. This may simply be the weakest argument I’ve ever heard him make.

    Here is the structure:

    A exists (evidence presented).
    A is bad.
    B should be illegal.
    [long argument with resident "I will respond to everybody" odd person, mostly on topics X, Y and Z]

    That’s the whole thread.

    Let’s break it down.

    Steve says, in essence, addiction (“A”) exists and has a strong neurological basis. He provides good evidence of this. So far so good.

    He then postulates that addiction reduces human freedom, and is therefore bad. This is an argument of preference, and really fails to make any logical case. Steve would prefer not to be shackled by addiction. So would I. Others, maybe not so much. A slippery slope is presented (what if a new drug or VR is created that is so good that EVERYONE gets addicted? What then?) but it is only loosely connected to the status quo and does little to support the case that addiction is a unique threat.

    It all falls short of proving that “A” is objectively bad, bad enough to interfere in the lives of others in order to preempt. I happen to think that hockey and pro-wrestling are bad and make the human race worse. This doesn’t give me the authority to declare they must be stopped at all costs. But, for the moment let’s go ahead and grant that addiction is always bad for everyone, and in a perfect world, there would be a solution to cure addition in all cases, even for people who actively choose to be addicted.

    Steve then jumps to saying that drugs (“B”) should be illegal. This is a huge leap. Consider:

    1. Drugs do not always cause addiction (as many pointed out, the vast majority of people who try drugs never become addicted). Thus [if drugs, addiction] is not always true, and [if no addiction, no drugs] is also generally not true.

    2. Drugs are not the only way to cause addiction. Thus [if addiction, drugs] is not always true, and [if no drugs, no addiction] is also not necessarily true.

    Without a direct causal relationship between the two, you have to make a strong factual case for correlations to bring this argument forward. What exactly IS the relationship between drugs and addiction? Steve simply elects not to, which is a serious structural failure.

    If he looked at countries that have ended prohibition, such as Portugal, he would see that decriminalization does not lead to increases in drug use or addiction, and leads to better outcomes for addicts. (http://www.cato.org/publications/white-paper/drug-decriminalization-portugal-lessons-creating-fair-successful-drug-policies)

    If he wishes to dispute this evidence, he is free to. But he can’t make the leap without doing so. Banning drugs and reducing addiction are not very well correlated. There are many other factors that are just as or more important.

    Besides this gaping structural flaw, he is choosing to make a very selective argument.

    As many people pointed out, nicotine and alcohol create the same neurological addictions, and yet I don’t presume that Steve is calling for making them illegal. People can be addicted to behaviors like gambling or danger. The reason for selectively banning some illegal things and not others almost always is due to one’s personal preferences for pleasurable behaviors. Not hanging out with pot smokers, Steve feels very little sympathy for their loss of liberty. Hanging out with wine drinkers, however, Steve would very acutely feel sympathy if their liberty were impinged, even though wine can in theory lead to addiction (far more so than pot, if my limited reading on the subject is to be believed).

    This sort of cultural bias is inexcusable in a logical argument (ban F but not G, because my friends like G). It’s a sort of argument from popularity, where the population being sampled is selected to create the impression that the presented opinion is uniform. So it’s not even a really honest argument from popularity.

    Ironically, his argument in favor of continuing the drug war, which has caused America to be the number 1 jailer on Earth, imprisoning more of its population than any other nation, is fundamentally that “drugs destroy freedom.” Jail also destroys freedom, Steve.

    Steve says “the deeper conflict here is between living in harsh reality, and making the best of it, vs bypassing the adaptive nature of the reward/aversion circuits in our brain in order to escape to a pharmacologically/electrically/virtually induced fantasy euphoria.”

    That sounds very pretty, but’s an obvious false dilemma. Is someone who smokes pot (or drinks a glass of wine) after a hard day’s work “living in harsh reality” or is she “bypassing” her brain’s circuits to “escape into a fantasy euphoria”? Neither, obviously.

    If we agree that addiction, when properly defined, is bad in all circumstances because it limits freedom, let’s treat addiction by all means.

    Meanwhile, let’s end our ineffective, expensive, life-destroying war against drugs, which has neither eliminated drugs nor their sort-of-sometimes-correlated condition of addiction, and has in the process destroyed freedom for countless people. I know Steve inserted some weasel words about “well, there may be practical arguments against prohibition” but my practical argument is the same as yours: prohibition limits freedom just like addiction does. What is the rationale for counting one and discounting the other?

    I am all in favor of freedom-maximizing arguments. “Let’s keep drugs illegal, toss addicts and non-addicted recreational users in jail, create a massive black market that kills 20,000 people in Mexico and makes our streets far more dangerous, because that will make everyone free of addiction, even though it won’t” is about the worst one I’ve ever heard.

    I seriously hope Steve reconsiders this weak argument. It is structurally unsound, inconsistent, and also isn’t backed up by facts, history, or human nature. Moreover, as it contributes to an expensive, racist, disastrous policy that significantly hurts countless people every year, Steve’s argument is DANGEROUS. Just as dangerous as arguments defending the teaching of creationism or the practice of homeopathy… in fact, arguably MORE dangerous.

    I expected better.

  113. cannotsay2013on 15 Jun 2013 at 6:43 pm

    To Steven Novella,

    It has just been brought to my attention that you are a “fake Yale affiliate”,

    http://www.bolenreport.com/feature_articles/Doctor%27s-Data-v-Barrett/novellahumiliation.htm

    “Novella, evidence shows, works for a medical center that “rents” the name “Yale” from the University, who then, assuming the monthly payments are up to date, gets to claim that all their staff doctors are, in fact, professors at Yale”

    Is this true? Meaning, I was very suspicious that someone of your age was a “tenure track assistant professor at Yale”. Not that I haven’t met people who have taken that step late in their careers, but the suspicion was how come somebody can stay as “assistant professor” at a university like Yale without being promoted to Associate Professor or dismissed. The above would explain the whole thing. It would also explain the poorness of your reasoning. Now I have had my heart broken :( .

  114. cannotsay2013on 15 Jun 2013 at 7:40 pm

    Steven Novella,

    I sincerely hope that you address my question because that would put your steadfast refusal to accept criticism to psychiatry in a complete new light, or even this post about addiction that has also caused a lot of criticism among your followers.

    Yale Medical Group was forced to tighten its conflict of interest policies in response to the Chuck Grassley investigations,

    http://www.pharmalive.com/yale-medical-group-tightens-conflicts-policy

    And, as it is painstakingly explained in the docs made public at the time the US Department of Justice announced its 3 billion dollar settlement with GSK, the tactics Big Pharma used(maybe still uses?) to promote psychiatric nonsense included the bribing of doctors that work for organizations like the Yale Medical Group,

    http://www.justice.gov/opa/gsk-docs.html

    This would explain the poorness of your reasoning as well as your “elasticity” when it comes to redefining concepts such as “validity” and “proof” in order to continue to claim that psychiatry has validity and that ADHD is demonstrably a “brain disorder”.

    The only regret that I have is to have wasted my time with another Big Pharma supporter!

  115. nybgruson 15 Jun 2013 at 8:25 pm

    @ccbowers:

    Just in case you are reading, nice to be back as well. I’m dine with this thread since I have less patience and even less time time for trolls these days, but I just wanted to say hi and thanks!

  116. cannotsay2013on 15 Jun 2013 at 9:11 pm

    OK, from the information available, if I had to bet, it seems to me that Novella is an Assistant Professor in the Clinician-Educator track (not even Associate Professor),

    http://medicine.yale.edu/facultyaffairs/appts/ranks_tracks/tracks.aspx#page4

    Steven, could you confirm that? I cannot see how is that you have spent such a long time as an assistant professor at Yale Medical Group except if you are this type of professor.

    That is VERY different from being a tenure track professor at Yale, which is where the prestige and “arguments from authority” would be expected to have some credence.

    Obviously, when you started to be elastic about the definition of validity I told myself that there was something fishy here. As fishy as in http://www.nbcconnecticut.com/investigations/LWRD-Local-Doctors-Get-Big-Bucks-from-Big-Pharma-208255321.html

    “One of the top earners in the state by our count is Fairfield neurologist Dr. Peter McAllister. Drug companies Allergan, Eli Lilly, GlaxoSmithKline, Pfizer, Forest and Novartis have all paid him a total of just under a half million dollars since 2009. About $95,000 of that has been for research, but the rest was for meals, speaking engagements, travel and consulting.”

    That guy is not associated with Yale Medical Group, but that Yale Medical Group had to adapt its policies in the aftermath of Grassley’s investigations tells a lot of what it was probably going on there.

    Note that the bias in favor of what Big Pharma preaches doesn’t need to be explicit. As the IRS scandal with the political targeting of conservative groups shows. All that is required is a subconscious culture in which the bias affects actions of the allegedly unbiased members of an organization.

    So here is where we are: arguments form a non tenured, non tenure track doctor at an organization associated with Yale Medical school that look suspicious in that they seem to be aligned with the story Big Pharma wants to tell -”biological validity” is not all the “validity” there is- vs my arguments about what biological validity out to be in medicine that have been validated by Tom Insel and the like. You guys be judge!

  117. hadronon 15 Jun 2013 at 9:51 pm

    Lol! Tim Bolen!?

    Showing your true colours CS! :)

    here’s some balance in response to your Cato/Koch nonsense:

    http://fullfact.org/factchecks/Portugal_decriminalisation_drugs_effects-3276

  118. Jared Olsenon 15 Jun 2013 at 9:57 pm

    Cannotsay. I looked at the link you provided. Calling Dr Novella “carpet head” and “pissant” among other things and insinuating he and Randi are lovers is f$&king pathetic. I also saw the ‘Dr Oz’ show in question and claiming he (Oz) wiped the floor with Steve is just a lie. I can’t be sure of Steve’s credentials, but so what? We’re all familiar with the argument from authority logical fallacy. Dr Novella has EARNED his place in the Skeptical community because he is damn good at it. You are a fool. Now please go away.

  119. cannotsay2013on 15 Jun 2013 at 10:11 pm

    hadron,

    I don’t know who Tim Bolen is, but what I do know is this: in the US there is a HUGE difference between being a tenured, or tenure track, professor at a university like Yale, and being the type of position that apparently Novella has at Yale Medical Group. HUGE, in terms of prestige and in terms of how their value judgements are considered. Since Novella is on record defending arguments from authority from “experts” he owes everybody an explanation.

    He has distorted the notions of “validity” and “proof” that accepted in other areas of medicine in order to make psychiatry acceptable in a way that matches the Big Pharma story. From where I stand, he seems more of a Big Pharma crank than somebody with authority among experts.

    Jared Olsen,

    Let’s put it this way. If everyone in your so called “skeptic movement” has the notions of what “science” is or what “validity” and “proof” are that Novella has, I am not surprised that you are the laughing stock in scientific circles.

    Novella complained some time ago that big names in science stayed away form the conferences he organizes. Who wouldn’t really? Because the type of nonsense that has been repeated here to defend psychiatry by people like Novella himself, BJ7 or steve12 would not stand any chance at any serious academic institution that takes science seriously. I was scratching my head how is that Novella was getting away with that nonsense at a place like Yale. Well, now we know the answer: he wasn’t. He is just a clinician at an institute that has the name “Yale” on it and that Yale agrees to call “non tenure track professor” in exchange of whatever money Yale Medical Group pays to Yale, knowing that he will never be given any chance at being proposed for a tenure track position, let alone tenure itself!

  120. hadronon 15 Jun 2013 at 10:11 pm

    Sorry saburai,

    I conflated your post with CS’s.

    You make a good argument which you spoil by referencing Cato, IMO.

  121. cannotsay2013on 15 Jun 2013 at 10:22 pm

    Sorry guys, I got my PhD from an institution that has several Nobel Prize winners in physics and chemistry (together with many other honors such as memberships in the National Academy of Sciences or the American Academy of Arts and Sciences) among its faculty. I learned from these people!!!!

    Now, I have been arguing with a Big Pharma crank about what “validity” and “proof” means. My fault, really! I am really upset that I have been duped this way. But now everything makes sense, of course!

  122. hadronon 15 Jun 2013 at 10:26 pm

    Your credentialism strikes me as rather hypocritical.

    Could it be some form of projection?

  123. cannotsay2013on 15 Jun 2013 at 10:29 pm

    hadron,

    My credentials are real. And again, the real joke is that people here believe so blindly in the arguments put forward by this guy. Steven Novella is on record saying that big names in science don’t want to be seen in his company. Now everything makes sense, really! Again, who would!

  124. Jared Olsenon 15 Jun 2013 at 10:53 pm

    Okay Cannotsay, you’ve blown the conspiracy wide open. It’s all over now. If, in your opinion, this blog is at worst a shill for Big Pharma, at best deluded nonsense, why do you stay?

  125. cannotsay2013on 15 Jun 2013 at 11:04 pm

    Jared Olsen,

    What conspiracy? OK, a few facts that obviously you guys are unaware of. These were reported in Nature, that, in case you know, is one of the two most prestigious scholar publications in science, the other being Science,

    http://www.nature.com/news/2009/090916/full/461330a.html

    Please read. It was an earthquake that exposed many of Big Pharma’s dirties tricks which affected, not surprisingly, psychiatry disproportionately.

    That even forced many institutions, including Yale Medical Group, to adapt their conflict of interest policies,

    http://www.pharmalive.com/yale-medical-group-tightens-conflicts-policy

    Nothing of what Novella says is pertinent to his continuous employment at Yale Medical Group except if what he says advances Yale Medical Group’s economic interests. In other words, Novella’s employment at Yale Medical Group does not depend on the quality of his scholarship (in this case, lack thereof). So obviously, he can claim all kinds of nonsensical reasoning, including his own versions of what “validity” actually is without fearing any repercussions because he is not a tenure line professor at Yale!

    What a pathetic master and followers, really!

  126. Jared Olsenon 15 Jun 2013 at 11:10 pm

    You didn’t answer my question. What is your motive here at Neurologica?

  127. cannotsay2013on 15 Jun 2013 at 11:17 pm

    Jared Olsen,

    I came here referred by an online contact as a place to argue about psychiatry. It was presented to me as run by a Yale professor. Since I first came, it was a bit suspicious how is that somebody with Novella’s age could still be an assistant professor. Again, I have known people who have gone to become tenured professors later in their lives, so I wasn’t really shocked either.

    When he started to argue with his strawmen, mantras and “alternative notions of validity”, I suspected something fishy might be going on here. Then I learned about the nature of his appointment at Yale Medical Group and now everything makes perfect sense.

    If you read that article at Nature, which is a paper in which Novella will never dream of publishing anything because nothing of what he has done in his scholar life reaches the quality required to have a Nature article, you’ll understand the way Big Pharma has corrupted medical research in the US, and research in psychiatry in particular. Yet, Novella keeps dogmatically defending psychiatry with ever increasing equally nonsensical arguments like what “validity” actually is.

    Steven Novella is an intellectual fraud and he should be upfront with his followers about what his Yale position is and, more importantly, what it IS NOT!

  128. Jared Olsenon 15 Jun 2013 at 11:23 pm

    Okay. Non sequiturs, avoidance and obscurantism. Life’s too short. C ya! :-)

  129. cannotsay2013on 15 Jun 2013 at 11:26 pm

    Jared Olsen,

    You are pathetic, going back to the mantras. As I said I make a living out or real science, not the type of pseudo skepticism that Novella presents here as “actual science”. Novella doesn’t have any relevant published research anywhere, certainly not in Nature or Science. He has status only among ignorant pseudo skeptics who think that repeating mantras is the same as making cogent arguments. What a waste of time really! :D .

  130. cannotsay2013on 15 Jun 2013 at 11:30 pm

    Here is a critique of psychiatry by somebody who is also a so called “skeptic” but who, from a pure academic credentials and stature point of view has way more credibility than Novella,

    http://whyevolutionistrue.wordpress.com/2011/06/25/is-medical-psychatry-a-scam/

    A full professor of biology (ie, tenured) at University of Chicago vs a non tenured, pseudo skeptic from Yale. Clearly, those who know, give more credence to Jerry Coyne than to whatever Novella says on this topic. BTW, it is Novella who is on record defending the authority of “experts”. By credentials alone, Coyne is more credible than Novella, period.

  131. cannotsay2013on 15 Jun 2013 at 11:36 pm

    From a pure ranking point of view, University of Chicago is even rated higher than Yale when it comes to parameters that focus solely on excellence or research output,

    http://www.shanghairanking.com/ARWU2012.html

    So here we have a tenured full professor from University of Chicago debunking the nonsensical arguments form a non tenure pseudo skeptic who works as clinician at Yale Medical Group!

  132. Dianeon 16 Jun 2013 at 12:47 am

    @etatro

    How did they know the rats weren’t sitting there, happily pushing the lever, when they got snatched up by an owl?

    This is a serious question. Lab rats are about as equipped to survive in the wild as you and I are. I bet they didn’t make it through the night.

  133. steve12on 16 Jun 2013 at 1:50 am

    http://medicine.yale.edu/steven_novella-1.profile?source=news

    http://www.yalemedicalgroup.org/

  134. cannotsay2013on 16 Jun 2013 at 1:54 am

    steve12,

    Novella IS NOT a tenure line professor. Period. And that makes a great deal of difference with respect to his ability to speak as an “expert”. He is a clinician.

  135. cannotsay2013on 16 Jun 2013 at 1:56 am

    steve12,

    You claim to have a PhD in cognitive neuroscience. Do you understand the difference between a tenure track appointment at a medical school such as Yale’s and an appointment as a non tenure track clinician?

  136. steve12on 16 Jun 2013 at 2:02 am

    I think we have to keep site of a bigger goal: greater empowerment of mental health professionals to civilly commit those with mental disorders and addiction

  137. saburaion 16 Jun 2013 at 2:03 am

    Hadron:

    1) I’m glad you read carefully enough to know that I am not cannotsay2013.

    2) Yes, the paper I cited was published by Cato. It was also written by super-progressive (nowadays famously so) Glenn Greenwald. Associating the paper with the Koch brothers is something of an ad hominem, and also isn’t accurate. I assure you, Glenn Greenwald is no stooge of the Koch brothers. Period, full stop. But even if he was, association does not refute.

    3) I read your source. It cites generally the same information Greenwald did, and comes to broadly the same conclusions. The source you sent me was clarifying a debate between Sir Richard Branson and some UK politician, a debate which I am not familiar with and have no say on. But it said this: “A much-cited paper by Glenn Greenwald from the Cato Institute in 2009 (although also the source of controversy from, among others, the US Office of National Drug Control Policy), also examines these figures for more specific age groups. These demonstrate a counter-trend amongst 15 to 19 year olds – hence the source of some claims that usage has decreased in some quarters.” That accurately portrays Greenwald’s claim, though he makes other useful observations about the Portuguese project.

    Here is my advice to you: Stop judging papers because they have the letters “cato” in them, and actually read them; at least the executive summary. You will see that, in this case, Greenwald looks very carefully at the data and makes limited but important conclusions that are very relevant to Steve’s argument, i.e. that legalization corresponded to, at MOST, very modest increases in drug use in some groups, DECREASES in others, and better outcomes for addicts.

    You might even discover you agree with him.

  138. cannotsay2013on 16 Jun 2013 at 2:13 am

    For those who do not know the difference.

    In a US context, an academic appointment as a tenure track professor means that the professor is given a certain amount of time (at Yale that’s apparently 6 years with a middle review after 3 years) in which the professor is given the chance to establish himself, by way of publishing research a scholarly journals, of groundbreaking results that put him/her at the top of his profession US/worldwide. In science, the top journals are Nature and Science. In neuroscience there are specialized journals like Neuron who are also appropriate.

    So the professor needs to build a group of researchers (typically PhD students), apply for grants, get money, do research, publish at peer reviewed venues, etc. Once he/she is showed to be at the top of his/her game, the appointment is made permanent as a “job for life” in a rank that is called “associate professor” at most US universities. The idea is to give scholars who are able to prove themselves through this brutal tenure process the reward of a life in which they will be able to pursue their intellectual interests without the concern that they might lose their jobs if they pursue controversial matters (that’s why Thomas Szasz could not be fired from Syracuse University). Only the best of the best are able to achieve this at a university like Yale.

    Now come the so called, “clinician, non tenure track”. These are just jobs, which are typical in medical schools, whose main responsibility is to see patients or teach basic medical school classes. Ie, no top notch research required. In addition, these are not jobs for life, but renewed for a limited amount of time. Apparently, this is the type of appointment Novella has at Yale.

    In non medical schools, the equivalent job is called “lecturer”, which are again non tenured jobs in which lecturers teach the most basic, and boring, classes such as calculus 101 or English 101.

    The top notch research, and the top notch classes, are taught by the tenure track professors.

  139. steve12on 16 Jun 2013 at 2:25 am

    saburai:

    I think you’re not taking this statement into account:

    “I know there are potentially practical arguments to be made for legalization, but that is a debate I am not addressing here.

    and simply going on this one:
    “I simply don’t buy arguments for drug legalization premised on liberty and freedom, when those drugs by their very nature take away liberty and freedom.”

    So you don’t really know what Steve is ultimately saying re: policy, you just know that on libertarian grounds alone he doesn’t buy legalization

    As I argued above, I think the practical considerations (i.e., the hopeless and ridiculous drug war) trump libertarian arguments, especialy considering that drug prohibition doesn’t keep drugs away from addicts.

    But I think Steve’s right about the 2nd argument: many are not freely choosing to do drugs.

    You said:
    “Steve would prefer not to be shackled by addiction. So would I. Others, maybe not so much. A slippery slope is presented (what if a new drug or VR is created that is so good that EVERYONE gets addicted? What then?) but it is only loosely connected to the status quo and does little to support the case that addiction is a unique threat.”

    I agree that the gov’t shouldn’t have the right to tell people they cannot change their mental state,and I think many drugs are used recreationally w/o addiction.

    But the notion that addiction isn’t bad…that’s naive. Addiction means less choice for the individual. That is by its nature bad. Wouldn’t any addict like to be able to do whatever it is they are addicted to do by choice rather than compulsion? No one would prefer addiction to choice.

    Addiction is a bad state, but drugs should be legal anyway.

  140. steve12on 16 Jun 2013 at 2:26 am

    http://medicine.yale.edu/steven_novella-1.profile?source=news
    http://www.yalemedicalgroup.org/

  141. Hosson 16 Jun 2013 at 2:28 am

    Cannotsay

    “Novella IS NOT a tenure line professor. Period. And that makes a great deal of difference with respect to his ability to speak as an “expert”. He is a clinician.”

    Speaking only to the logic of your statement, clinician and expert are not mutually exclusive. You can minimize your fallacious statements by recognizing your cognitive biases and cognitive errors and trying to correct them (this applies to everyone).

    Please don’t respond to me unless you’re addressing my points on mutually exclusive terms or recognize cognitive errors. I really don’t feel like addressing an argument that’s tangent and irelivent to my points.

  142. saburaion 16 Jun 2013 at 10:33 am

    Steve12,

    Thanks for that nuanced response. I know my post was long (I’m verbose; on the Internet, electrons are cheap), but I think you need to reread parts of it.

    You wrote that I wasn’t taking this statement into account:

    “I know there are potentially practical arguments to be made for legalization, but that is a debate I am not addressing here.”

    On the contrary, I referenced and directly refuted this statement. I will reiterate my reasons and expand on them a little.

    First, here’s what I said: “I know Steve inserted some weasel words about “well, there may be practical arguments against prohibition” but my practical argument is the same as [Steve's]: prohibition limits freedom just like addiction does. What is the rationale for counting one and discounting the other?”

    So my refutation to that statement is pretty clear: According to Steve, when I say “banning drugs has limited people’s freedom by throwing them in jail” I am raising pesky “practical” arguments for legalization, while Steve is pursuing (I must presume in contrast) “pure” and “intellectual” arguments in favor of continuing prohibition. And what is his “pure, intellectual” basis for this position? That drugs “limit freedom”. It’s EXACTLY the same motive as my “practical argument.” Thus I don’t see a distinction between my case and his, and don’t understand why my case is outside of the “debate I am… addressing here”. It’s the same debate, because the same concept is being debated: Human freedom.

    In other words, he is a priori excluding my arguments as “practical” and “outside the debate” just so he doesn’t have to respond to them, and he is doing so unfairly. My arguments and motives are of the same type as his, and should not be excluded as merely “practical”. Me wanting to avoid hurting freedom is just as practical or non-practical as Steve’s wanting to avoid hurting freedom. He’s worried about the prison of the needle, and I’m worried about the prison of… well, prison. You don’t need a metaphor when you’re going a father of two who’s going to spend 25 years in jail for a first offense of selling pills to a narc. (http://www.theatlantic.com/politics/archive/2013/04/a-heartbreaking-drug-sentence-of-staggering-idiocy/274607/) Read that article and tell me who is making arguments that protect people’s freedom? I WILL admit, my arguments are a LOT more practical than Steve’s.

    Let’s move on.

    You said: “But the notion that addiction isn’t bad…that’s naive. Addiction means less choice for the individual. That is by its nature bad. Wouldn’t any addict like to be able to do whatever it is they are addicted to do by choice rather than compulsion? No one would prefer addiction to choice.
    Addiction is a bad state, but drugs should be legal anyway.”

    I never said “addiction isn’t bad”. My case was a lot more nuanced than that. Here are my words (again, I apologize for the text wall):

    “[Steve] then postulates that addiction reduces human freedom, and is therefore bad. This is an argument of preference, and really fails to make any logical case. Steve would prefer not to be shackled by addiction. So would I. Others, maybe not so much. A slippery slope is presented (what if a new drug or VR is created that is so good that EVERYONE gets addicted? What then?) but it is only loosely connected to the status quo and does little to support the case that addiction is a unique threat. It all falls short of proving that “A” is objectively bad, bad enough to interfere in the lives of others in order to preempt. I happen to think that hockey and pro-wrestling are bad and make the human race worse. This doesn’t give me the authority to declare they must be stopped at all costs. But, for the moment LET’S GO AHEAD AND GRANT that addiction is always bad for everyone, and in a perfect world, there would be a solution to cure addition in all cases, even for people who actively choose to be addicted.”

    All I did was recognize that some people (not me or Steve) would prefer to be addicted. That is just true. For many people, the oblivion of drug use is preferable to their abusive, unpleasant lives. Otherwise, all addicts would be in treatment, trying to get cured, and almost no one would try addictive chemicals, for fear of addiction. There are many addicts who DO NOT WANT to be treated. I know some of them. There are happy alcoholics. I live above one.

    I think your statement, that “less choice is bad” is a little naive and simplistic itself: the jury is still out on that (http://www.freakonomics.com/2009/12/02/is-the-paradox-of-choice-not-so-paradoxical-after-all/). At least in some situations, having too many choices can itself cause unhappiness, according to reproduced experiments. It is not unreasonable to imagine a person who is happier with the smaller world of the addict. Would I want to elect that person President? No. But she exists.

    But in any event, although I think you and Steve are being too simplistic in your “hey, everyone should want more choices, right?” argument, I DID grant him that point (emphasis added above), at least for scope of this discussion. None of my arguments depended on arguing that addiction was ever good for anyone.

    As I said: “If we agree that addiction, when properly defined, is bad in all circumstances because it limits freedom, let’s treat addiction by all means.”

    I don’t know how to be clearer than that.

    Again, thanks for the response, but please read me very carefully before responding because I feel like I’m just repeating points I already made pretty clearly.

  143. saburaion 16 Jun 2013 at 10:37 am

    PS: You can call me Damian, which is my name. It feels a little weird being referred to by an internet handle.

  144. sliktson 16 Jun 2013 at 10:45 am

    “I must say, I lost a lot of respect for Dr. Novella over the course of this post.”

    I second this; I’m a long time fan, but the argument that addiction removes free choice, therefore prohibition doesn’t reduce liberty and freedom, is — in a word — perverse. You’re essentially saying that addicts don’t have liberty and freedom anyway, so you might as well repress them by the criminal justice system.

  145. passionlessDroneon 16 Jun 2013 at 1:09 pm

    Mind Bending Meta Question –

    If cannotsay2013 is lighting up his/her pleasure circuits by incessant trolling, and, in fact, has become dependent on this set of rewards, is it his/her fault that they can’t stop?

    - pD

  146. Skeptical Steelon 16 Jun 2013 at 4:34 pm

    @pD: Does this make other commenters enablers or pushers?

  147. cannotsay2013on 16 Jun 2013 at 6:46 pm

    Hoss (and the rest),

    I just got an email from Steven Novella in which he claims that his appointment at Yale is an academic, tenure line appointment. If that is the case, I stand corrected. Now, I have asked him to explain how is that he has been able to be a tenure track assistant professor for such a long time given that according to Yale’s own guidelines, the maximum time a faculty member can be in such position is 6 years, after which they have to be either promoted to associate professor (ie, be given tenure) or be shown the door. I expect him to elaborate further.

    Now, as to why this matters? Because when you make arguments from “authority”, you need to be recognized as an expert by those who can claim expertise. While this might have been a “chicken egg” situation long time ago, it is not anymore the case since like a few centuries.

    A clinician, like a GP, can be a very good clinician in the sense of treating well his/her patients well and administering current applied practice. To be an “expert” on some research area though, being a good clinician is not enough. That’s what a tenure line appointment track at Yale gives. An “expert” can still be wrong, but at least to be an “expert” you need to first be, well, one.

  148. Steven Novellaon 16 Jun 2013 at 9:09 pm

    Cannotsay is completely wrong (I know, you’re shocked). They are repeating lies told about me my charlatans. I am full time faculty at Yale. The rules he refers to are outdated – you can have recurring appointments as assistant professor without limit in the clinical educator track.

    Cannotsay should be ashamed of himself on multiple levels:
    - He is repeating a vicious lie meant to discredit me
    - He continues to ask questions even after I corrected him
    - He is repeating the lie specifically to attack my credibility
    - He is accusing me of making an argument from authority. I challenge him to find anywhere that I have done so.

    Keep it up – you’re one step from being banned. Also- derail another thread with your one issue, and I will also ban you for that. You have been given enough space to make your case. Just because you have utterly failed does not justify personal attacks and lies.

  149. Steven Novellaon 16 Jun 2013 at 9:19 pm

    I think I have already pointed out that I never actually took a stand here on legalization, and in fact said I was not discussing the issue. There are many considerations, and many types of potential regulations, and net outcomes need to be considered.

    My only point was that we happen to have brains that contain the wiring for addiction. It is a potential pitfall of the human condition, and epiphenomenon of our evolution. I think we need to understand this reality and its implications. It certainly has implications for products that are potentially addictive.

    Prescription drugs that are addictive, for example, are more carefully regulated and controlled than those that aren’t.

    We have to face the irony of arguing that people should have the freedom to use a drug that may take away their freedom – and yes, in my opinion addiction absolutely reduces individual freedom.

  150. saburaion 16 Jun 2013 at 9:49 pm

    Steve, I appreciate your taking the time to revisit this topic.

    Two points:

    1) It’s disingenuous to say “I never actually took a stand here on legalization”. You wrote “…more to the point – neuroscientific research into addiction seems like a powerful argument against legalizing recreational drugs.” You brought the issue up, made an argument, and then said that argument supported the side of prohibition. If you’d just talked about the neurology of addiction, none of your critics in this thread would have had an issue. Neurology is one topic, law is another; You bridged them.

    If your only point, really, was that “we have brains wired for addiction”, then I guess I have no argument against you, since that is obviously true. But again, I think that’s a dishonest or at best VERY selective reading of your original post. The backlash on the comments was a response to something, surely? Are we all consuming the same (illegal) hallucinogen?

    2) When you say “We have to face the irony of arguing that people should have the freedom to use a drug that may take away their freedom – and yes, in my opinion addiction absolutely reduces individual freedom” you are speaking the truth… but you’re not addressing any of my arguments.

    I AGREE that drug addiction limits freedom, but I am skeptical that this is universally bad, as you assert. I also AGREE that it is ironic that one might have the freedom to make choices that limit one’s freedom, but I strongly and completely reject the prohibitionist argument that the solution to this irony is to toss the addict in jail. Surely that limits freedom most of all.

    But I am glad you agree that “many types of potential regulations, and net outcomes need to be considered” on the topic of legalization. I heartily concur, and from what I can tell, the balance of costs and benefits currently weigh IMMENSELY against the current prohibition scheme.

  151. saburaion 16 Jun 2013 at 9:50 pm

    PS: Is there a way I can block seeing comments by Cannotsay and others who hijack threads with off-topic material? I find it very rude and distracting.

  152. Steven Novellaon 16 Jun 2013 at 10:57 pm

    Cannotsay is now banned, for various reasons, but mainly because I can’t be bothered keeping track of his evolving false accusations against me.

  153. Bruce Woodwardon 17 Jun 2013 at 3:28 am

    This is the best news I have got all morning. I hope we can have some intelligent conversation on here again. As someone who’s work blocks a lot of other blogs and most forums this is my escape every so often during the day, and his ramblings were really derailing all the threads he was commenting in.

  154. Jared Olsenon 17 Jun 2013 at 4:51 am

    @ Bruce Woodward – I second that. To Steve; thank you.
    Let’s see if we can see thru his/her next handle, eh?

  155. BillyJoe7on 17 Jun 2013 at 6:38 am

    It’s not my blog of course but I am generally against banning anyone. But I have to admit I’ve been thinking along these lines for a while about whether it would be a good move to ban him. You could say to just ignore him and he will go away, but even those advocating that strategy can’t help themselves. When you see inconsistencies, logical fallacies, and blatant nonsense you feel compelled to respond to set the record straight.

    And I think when someone hijacks every thread to further their own agenda, the blog’s usefulness is eroded and I can’t blame the blogs owner for trying to protect it.

    And now we also have personal attacks and so called “revelations” which are neither here nor there, even if true, so I think there’s a limit to the tolerance you show to trolls such as our recent incarnation.

  156. Bill Openthalton 17 Jun 2013 at 7:15 am

    @ Jared

    Let’s see if we can see thru his/her next handle, eh?

    Methinks that should not be overly difficult. :)

  157. arnieon 17 Jun 2013 at 7:31 am

    Having advocated, and attempted (only partially successfully), to ignore CS and even the responses to CS, I also laud Steve’s decision to ban him. Otherwise reading the comments to Steve’s blogs would have become increasingly aversive rather than rewarding even without his resorting to lies about Steve’s credentials and credibility.

    I suspect CS won’t be able to camouflage his re-entry under new a handle but we can expect him to try to continue to infect the blog.

  158. SteveAon 17 Jun 2013 at 7:44 am

    saburai

    If Steve had taken a stand, as you put it, he would have had said:

    neuroscientific research into addiction ‘is’ a powerful argument against legalizing recreational drugs

    He didn’t, he wrote:

    “neuroscientific research into addiction seems like a powerful argument against legalizing recreational drugs.”

    The wording makes it clear that this is a moot point, open to discussion.

  159. Jared Olsenon 17 Jun 2013 at 8:06 am

    I agree with you BJ. I didn’t contribute much, but the whole time, I was thinking “don’t feed the trolls” whilst doing just that. It’s difficult to resist, just like say, addiction…

  160. Bruce Woodwardon 17 Jun 2013 at 8:20 am

    I do wonder then, if neuroscience research does imply that addiction in itself is not a good thing and takes away freedoms, then I would ask what position smoking would have in that light?

    Is it’s very addictive nature in itself something that would warrant illegality? Anectodally tobacco is much more addictive than weed or even something like E or LSD… shouldn’t that imply it is more dangerous and therefore should be more illegal?

  161. The Other John Mcon 17 Jun 2013 at 9:35 am

    BW,

    I would think legality would be best as a function of both their addictiveness AND ability to cause harm. So while internet addiction or gambling might be undeniably addictive, it’s generally not causing great physical/mental harm to the ‘user’. Whether they cause social harm is a different discussion, too.

    Whereas crystal meth or crack cocaine are probably both highly addictive and mentally/physically harmful on many levels.

  162. Steven Novellaon 17 Jun 2013 at 9:46 am

    It is a bit problematic to use the term “addiction” for things like gambling, even though I know I did in the article. There is likely a common underlying neurological phenomenon with any compulsive behavior in terms of reward circuitry. But pharmacological addiction needs to be considered a separate phenomenon from behavioral addictions, because there are additional neurological correlates with various substances.

    Tobacco is an interesting case. It is clearly pharmacologically addictive and harmful to health. If it were a new product I can’t imagine it would ever get by the FDA. Also, imagine a company using freedom and liberty arguments to justify introducing a new product on the market that is both highly addictive and causes cancer, lung, and heart disease with typical use. (Really imagine this for a new product with no cultural history.)

    But it is already deeply culturally embedded. This has profound implications for how to deal with tobacco strategically. I do not think that an outright ban would be effective. But I do agree with pretty much all of the measures taken to limit tobacco use – restrictions on advertising, warning labels on packages, age restrictions, etc. Tobacco has the other feature (unlike many other drugs) in that it can have effects on bystanders, which complicates any arguments based upon rights and freedoms.

  163. Nate Greeneon 17 Jun 2013 at 9:49 am

    Tobacco use causes terrible damage, of course.
    http://www.cdc.gov/tobacco/data_statistics/fact_sheets/fast_facts
    Knowing what we know about it now, there are lots of reasons that it “should” be illegal, and perhaps there are even lots of reasons that it should NOT be illegal. But regardless of all that, even if we wanted to, it would be pretty tough to outlaw something that 43.8 million Americans are already addicted to.

    I know Steve came under fire for not giving evidence to support his original post, but it seems to me that he was just speculating on a possible future, and certainly not making a claim that we are inexorably headed there.

    Steve asked:
    “What will happen when we can live our lives in a fully immersive virtual reality – when we can create our own reality to maximally cater to our reward centers? Will this be the ultimate trap of our neurobiology?”

    My grandmother grew up in a Quaker house where they believed it was sinful to play cards. Is our concern about immersive virtual reality just a modern day version of Quakers afraid of playing cards, or will we look back in many years and, like smoking, wish we’d never started?

    I don’t know the answer but I hope to find time to give the subject more thought and research. Steve (and commenters), thanks for sparking my curiosity. Now it’s time for me to step out of this immersive discussion and get back to earning money so I can nourish my physical body (while I still have one).

  164. Bill Openthalton 17 Jun 2013 at 10:00 am

    The case for legalisation of drugs, even the ‘hard’ ones, is simply one of control. By making (certain) drugs illegal, and absent the prospect of getting rid of them (which would mean, for example, eradicating poppies from the face of the earth), society loses control, and users are sucked into illegality and become victims of both criminals and law-enforcement.

    Make drugs legal, and they become goods that can be traded (and taxed). Apart from smuggling (a result of tax discrepancies between countries), they cease to be attractive to criminals.

    The war of drugs is based on the false premisse that once legal, the whole population will start to use the drug, and become junkies. Reality is that most people who use drugs do not abuse (cf alcohol, and even tobacco).

    Legalising drugs (and other morally divisive matters like prostitution or weapons) is a purely practical, pragmatic decision.

  165. etatroon 17 Jun 2013 at 10:31 am

    Jared Olsen > Is it true that we have receptors in the brain that specifically respond to THC? Or are they just hijacked by THC ?

    We have receptors called Cannabinoid Receptors (1 & 2). THC binds to them. Cells produce endocannabinoids (related molecules, naturally produced by human cells, not from a plant), which are similar in chemical structure to THC. The wikipedia article on cannabinoid receptors is pretty good (and was edited by researchers on the topic).

    I think the interesting function that they serve in the brain is on interneurons. Interneurons are small neurons that are ‘in between’ the main layers/pattern/network of larger neurons. The emerging picture is that they serve to synchronize the firing of the local part of the network. A good summary of this type of neuron is here (with the cannabinoid receptors discussed peripherally): http://njms2.umdnj.edu/vija/documents/Freund2003.pdf . The author of that review article, Tamas Freund, is a prolific research and happens to be an engaging speaker. If you have the time & desire, I recommend google-videoing his lectures on the topic.

  166. Mlemaon 18 Jun 2013 at 1:37 am

    Steve12,

    “I agree that the gov’t shouldn’t have the right to tell people they cannot change their mental state…”

    I agree too! Especially since we’re giving drugs to 6-year-olds in order to change their mental state.

    I can diagnose nail-biting. It’s a valid diagnosis because people are really doing it. You may decide that only someone who bites his nails every day has a problem. I may say that anyone who ever bites his nails has a problem. We are both making a valid diagnosis when we say: some people bite their nails. So what?

    If the diagnosis of ADHD is given to all different kinds of behavior from:
    children who aren’t able to focus because they’re stressed or exhausted in dysfunctional families
    children who are too young for the school work in which they’re being asked to excel
    children who are bored, uninterested, physically restless etc etc etc
    as well as:
    children of parents who simply want their kids to do better in school – how can any correlate be useful?

    The review of the genetics studies doesn’t actually reveal “several genetic correlates” for ADHD. [if you think it does, what are they?] The study on neuroanatomical correlates is able to provide no “normal” for comparison that is any less subjective than the diagnosis of ADHD itself. And even if it could, regarding those differences in tissue thickness supposedly linked to ADHD:
    “…[the] NIMH research showed that the difference was not permanent… and as children with this gene grew up, the brain developed to a normal level of thickness. Their ADHD symptoms also improved.”
    http://www.nimh.nih.gov/health/publications/attention-deficit-hyperactivity-disorder/index.shtml
    The gene may be linked to behavior, but not brain abnormality. This shows the arbitrary nature of the diagnosis, as does the fact that the youngest in a Kindergarten class is 50% more likely to be treated with stimulants for ADHD.
    It also further illustrates that: not only are we able to diagnose ADHD in all kinds of bothersome behavior on the “hyperactivity/have social problems” scale, but because we include inattention, we can also diagnose ADHD in kids on the “not hyperactive/and get along well with others” side. To me it’s more than evident that this “disorder” is a function of developmental age/appropriate expectations, and it’s no surprise more and more kids are being “diagnosed”.

    “…people with these brains show poor outcomes. we should worry about that.”

    We should worry about a society that puts kids on drugs in order to help them in a world where they would otherwise meet with that society’s disapproval. ADHD is both a cause and result of family divorce, jail, joblessness, etc. ADHD, anxiety disorders, depression, OCD, tic disorders, nail-biting, teeth grinding, conduct disorders and oppositional defiant disorders – these are all things we’re willing to drug our kids for now.

    Where there are children who have true behavioral problems, we’re not helping them with this methodology. There’s no evidence of pathology appropriately treated by these drugs other than the pathology of a society that sets a standard of behavior for all 6-year olds and drugs the ones who aren’t matching it. The drugs slow growth. Isn’t that contraindicated? This is the problem of the current psychiatric model. We determine a set of behaviors to be abnormal, and we look for a way to treat it with drugs. Have we really decided that 10% of children are abnormal?
    A Nation of Kids on Speed, By Pieter Cohen and Nicolas Rasmussen
    http://online.wsj.com/article/SB10001424127887323728204578513662248894162.html

    Anybody see a pattern? Drug the kids who can’t sit still and pay attention in class, throw the addicts who can’t control their behavior in jail. This is another situation where we’re failing to look at the big picture. Instead we’re creating a problem and looking for a correlation in the brain, and calling that correlation pathology.

    Factors that increase likelihood of addiction:

    young age at start of substance abuse
    family history of: addiction, drug/alcohol abuse, verbal/psychological/sexual abuse
    crime-ridden community where drugs and alcohol are commonly abused
    perfectionistic tendencies and low self-esteem
    drug used is: heroin, cocaine or methamphetamine

    Addictions are considered a mental illness in the DSM. ADHD is a mental disorder we’re giving kids addictive drugs for. People with serious psychological issues aren’t receiving treatment. People with borderline psychological issues are being prescribed drugs that work no better than placebos. People who could be helped with CBT are also being prescribed these drugs instead. Addicts and other mentally-ill are living in jails.

    Ugh. What percentage of the population will have to be diagnosed with mental illness and/or be living in jail/psychiatric hospitals before we decide we’re doing SOMETHING wrong? Right now, 26% of the US is diagnosed with mental illness.

  167. Mlemaon 18 Jun 2013 at 1:58 am

    Why is there: “no significant controversy among actual neuroscientists about whether or not ADHD is a brain disorder.”?
    Is it because neuroscientists don’t study psychology and sociology?

  168. Jared Olsenon 18 Jun 2013 at 5:06 am

    Thank you Etatro, I had no idea so much research had been done on cannabinoids. Interesting stuff.

  169. BillyJoe7on 18 Jun 2013 at 7:18 am

    ” You may decide that only someone who bites his nails every day has a problem. I may say that anyone who ever bites his nails has a problem”

    I would only say that someone who bites his nails till they bleed definitely has a problem.

  170. oldmanjenkinson 18 Jun 2013 at 10:02 am

    Another very good article Dr. Novella. Neuroscience is a very exciting field. The brain, the last truly “undiscovered country.” It is very exciting to live in this age of discovery. I think for some the cognitive dissonance they feel relates to their underestimation of their illusion of control and their overestimation of free will (insert your own definition of what this is). While not a scientist (well I did do research for my degree so I am familiar/understand the nomenclature etc) I am clinically trained to treat mental health issues. After 10 years what I don’t “know” far exceeds what I do “know.” Coming to accept my limitations has been a long process, one that continues to this day. It is my growth as a person. But it can be very freeing to consciously be able to say “I don’t know” and accept that for what it is. That is not to say my skill set has not increased or that I am inept. Just that I am more sensitive to becoming hubristic, recognizing it, and knowing how to counter it.

    Free Will appears to be on a spectrum and not black and white. While “lower” species seem to be more driven by biology, we appear to have more “control” to decide. Whether that is your definition of free will, it is interesting what a fine line it truly is. Our “old brain” (evolutionarily speaking) has a little more control than we thought. Our modern brain is still beholden to myths, deception, magical thinking etc. As in the movie I, Robot (2004), Sonny is driven by the three laws (old brain) while he also had a secondary system (modern brain) in which he can chose to obey or not.

    Bottom line it is important for those of us in the mental health field (and in some cases even more important for the general population) to educate ourselves regarding how easily we can be manipulated by the media (either in print, video, or online). To constantly practice our critical thinking skills by reading credible, reliable sources such as this blog, SBM, the Skeptics Dictionary, Respectful Insolence, SkepDoc etc (not an exhaustive list). An especially good book that I have read several times is Unnatural Acts by RT Carroll. Sorry to end like a commercial but I think it is important. We live in an age of open access to all sorts of information. What many lack is the ability to critically look at all that information and discern what is valid, and what is gish-gallop. Oh and don’t forget to donate to this site and others. The pseudoscientific sites have a large cabal of donors and the entertainment value on their side (anyone that has seen Finding Bigfoot on “Discovery” Channel knows what I am talking about). That is all.

  171. Mlemaon 18 Jun 2013 at 1:25 pm

    BJ, That’s what I mean! We all have our opinions. But since none of us are psychiatrists, it doesn’t matter! The trend seems to be: if you bite your nails, you’ve got a problem.

  172. Downthecrapperon 19 Jun 2013 at 3:24 am

    I’m addicted to this blog.
    Steven you need to stop writing so I can quit ;)

  173. sudo_noton 23 Sep 2013 at 1:57 pm

    We need to draw a line between actual addiction and compulsive behavior. Opiates are addictive. Cocaine, (like most recreational drugs), is not addictive. There are no withdrawals upon cessation, but a minority of people begin to use it compulsively. I think this is an important distinction to understand.
    That said, why the automatic assumption that addiction, per se, is bad? To be addicted to opiates simply means that you have take the substance a few times a day. Is that really so horrible? We have exactly the same relationship to food, yet no one feels particularly enslaved by it. Problems only arise when you don’t have access to food.
    Likewise, when addicts are given an adequate, affordable, legal supply, such as methadone or buprenorphine, their “drug” problems cease. They can then live a perfectly normal life, (though often constrained by the restrictions imposed by the rehab industry, or the law). It seems that every problem that addicts have are created by prohibition itself. Or more to the point, by people making decisions for them, based on bogus assumptions. To talk about addiction outside of this context is simply meaningless.

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