So What if Anti-Depressants are Placebos?

In the two months since Sharon Begley's controversial article in Newsweek, "Why Anti-Depressants are No Better than Placebos", there have been a slew of articles and books out debating the issue: doctors fighting her conclusions, patients fighting back, Irving Kirsch's exploration into the drug's reality and Gary Greenberg's equally interesting exploration of the industry surrounding these anti-depressants. In her article, Begley presents the argument that anti-depressants are little more than placebos. I think the arguments are pretty persuasive. That's because it makes a lot of sense that mental illnesses are especially susceptible to placebo effects--after all, depression is an illness of thinking, and placebos change the way one thinks about your illness.

One reason I think people are so resistant to this idea is because it challenges their assumptions about the division between body and mind*** when it comes to health. By focusing solely on the physical body as the source of all illness and thus healing, modern western medicine has rejected the power of the mind to heal OR be the source of illness. Paradoxically, I think this focus has benefitted individuals who suffer from mental illnesses like depression. But I think if Begley is right, and most anti-depressants work in a placebo manner, we should really re-think our assumptions about the mind's role in our physical illnesses.

When a patient presents with symptoms of heart disease, a doctor naturally attempts to treat the heart. This is because heart disease is an umbrella term for a whole host of problems associated with the heart. Since we are currently ignorant of the precise physical manifestations that cause depression, its more properly described as a disease of the way a person is thinking or feeling that causes them to feel predominately sad, empty, lethargic, lonely, apathetic, etc. So, naturally, when someone presents with depressed symptoms, the doctor wishes to treat the person's thoughts and feelings. Anti-depressants do exactly this. They give a person a tangible way to think and feel healthier about their depression. First, they physicalizes the symptoms of the illness, separating the individual from their depressed symptoms. Like a bad case of the measles, or even a cancer, depression becomes something that can be fought with physical manifestations like medicine. Further, they remind individuals that they are not alone in their sadness, that there is hope for them, and that they are doing something productive to help their problem. And for 75% of people, this treatment, this physicalization of their thoughts and feelings really helps them, and they are able to improve their depression.

This description does not deny that depression is caused by something physical within our brains--far from it. What I'm suggesting is it's precisely because we emphasize depression's physical dimension, and probably treat it in some way that we are unaware of currently that we give individuals a better chance at defeating its mental symptoms. But, if we admit this to be the case, then it becomes a lot more difficult for us to deny the converse of this conclusion: that if we emphasized heart disease's mental dimension we would give people a better chance at defeating its physical symptoms. I don't know for certain whether this would help people or not, simply because the research hasn't been done--(and it's debatable whether scientific research could be done, since the hypothesis seems to be questioning the scientific method). But I do think that these are assumptions that are implicit in our modern understanding of depression are the reason why Begley's article caused so much controversy. And yet, the facts remain that these drugs have helped a lot of people feel a lot better (to table the issue of over-prescription, which I think is valid). So, I think the public revelation that anti-depressants are primarily placebos should be taken as a general wake-up call for our one-dimensional view of illness in general.

***Caveat here: I'm not trying to argue here for a dualist view. When I make the distinction between mind/body, I mean to the extent that anyone distinguishes between mental/physical illnesses: that there is physical cause for the mental ailments, but the causes are so far from our current neurological understanding that the distinction still makes practical sense.

The Methuselah Foundation

I found out about the Methuselah Foundation through Hulu's non-profit advertising. It was nestled between an ad for saving the rainforest and encouraging people to send their children to camp--in other words, it was presented as just another harmless foundation, a cause that is meant to tear at our heart strings. Its mission?

"The Methuselah Foundation is a non-profit medical charity dedicated to extending healthy human life through proven programs supported by people like you. The Foundation supports a variety of strategies that will accelerate progress toward a comprehensive cure for age-related disease, disability, and suffering."

So they have created a foundation dedicated to extending healthy human life. Now, it could be suggested that in a broad sense all of medicine has this goal, as it attempts to keep people healthy, and thus living longer. But the Methuselah foundation is tweaking this project, or at least making it more explicit. After all, it isn't a far stretch to take 'comprehensive cure for age-related disease' to mean 'comprehensive cure for death'. To encourage this type of research, the foundation is sponsoring the mprize, a motivational tool to get scientists to lengthen the life of lab rats. From what I can tell, essentially, this foundation is dedicated to finding the fountain of youth.

This confuses me. When I was in 4th grade, we read Tuck Everlasting by Natalie Babbit. In the book, one family finds the fountain and lives forever, only to spend their eternal lives lonely and unfulfilled, living in an ephemeral world. The message of the book is clear: living forever would suck. I thought it was just understood--that eternal life is just one of those things that sounds good but we all realize is bad at the end of the day, like eating ice cream at every meal.

Apparently, with this kind of foundation being formed, it isn't. I can see the appeal of wanting to extend life (to an extent..hehe), but I also feel strongly that extending human life too long is actually just accelerating the experience of death. I think the mistake is in forgetting how our experience of time is linked to the amount of time we experience. To live for a thousand years would just mean that a year would seem to us like a week, and more likely than not, we would squander it in similar ways. Life's pace would slow, adolescence stretch for decades, children would rarely, if ever, be born--the milestones of our life cycle would be few and far between.

For these reasons, I think the whole foundation is wrong-headed. I'm not anti-relieving suffering at the end of life. But I'm pro-accepting death. Without it, I don't think there would be such a thing as life. It's a packaged deal, and it just seems futile and weird to try and avoid that. Why don't we take the energy surrounding the Methuselah foundation and start a different foundation: one dedicated to getting as many as people as possible to live like they were going to die tomorrow?

The Known Universe

Just in case you haven't checked this out yet. Its basically planet earth for THE UNIVERSE. Whenever you're low on awe, like truly knee shaking palm sweatin jaw droppin AWE, take a gander.

Is Feminine Domination a Goal?

In the past year or so, there's been a spate of books emphasizing the essential role the quality of 'empathy' plays in humanity. This includes: Born to Be Good, by the Ekman (the emotions guy) disciple Dacher Keltner, also behind The Greater Good Science Center, which is about as touchy-feely as science gets, Beyond Revenge by Michael McCullough which explains the importance of forgiveness, The Age of Empathy, by leading primatologist Frans de Waal, who dares to ask, what if Bonobos had been the primary focus of our evolution research instead of traditional Chimpanzees? and even a how-to book, Mirroring People, about how you can use all this new science of empathy to your social advantage...lol. And today, Arianna Huffington recommends for her bookclub (could she possibly replace Oprah?) The Empathetic Civilization, insisting that it's teachings will be the dawn of a new age, the transition from the "Age of Reason" to the "Age of Empathy".

In some ways, I think this trend is a response to the enormous influence and subsequent acceptance of selfish values as an essential part of humanity from Dawkins' The Selfish Gene. And really, I'm all for that. I think the emphasis placed on selfish instincts has led to a lot of over-simplification and unsatisfying theories about some of our most basic human experiences (to start, love).

But I think there's something more going on here. When you look up Chimpanzee on wikipedia, chimps are led by "alpha males" and bonobos are a "matriarchal" society. And it doesn't take much to translate the transition from an 'age of reason' to an 'age of empathy' to 'age of male-domination' to 'age of female domination'. Reading between the lines on these things, I start to feel like characteristics normally associated with women are now scientifically trendy, and I worry this will come to be seen as a 'victory' for the feminist movement. Individuals are being painted as 'fundamentally' having empathetic characteristics, and I have a problem with that.

Don't get me wrong. I cry every time I read the NYTimes or listen to NPR, think revenge is completely idiotic and there is definitely a part of me that wishes everyone took classes in college about how fundamentally good everyone is. And I'm not saying that these scientists and social observers were intentionally suggesting women be in charge instead of men. But rather, I think it's always wrong to suggest that people are in some sense 'fundamentally' one way or the other. And further, I don't think this should be a point of celebration or emphasis for the feminist movement. Ideally, feminism should be about equality, not domination. Isn't the ideal that we will someday balance these forces that both play a role in all of us? To unify reason and emotion, domination and submission, empathy and selfishness? Can't that be what the new 'age' is about?

Free Will and Science

I just returned from a talk by Brian Knutson, who is an assistant professor at Stanford University doing fMRI investigations into decision making. Through brain scans, Dr. Knutson has been able to pinpoint portions of the brain that are activated before we make certain decisions. These are the first steps to being able to predict individual choices.

And which decisions, you might wonder is Dr. Knutson studying? Which essential decision making process is he doing his best to flesh out? You guessed it: the decisions we make when we...spend money. The experiments he presented were based in trying to figure out when someone is going to buy something or not, or when they are going to make risky investment decisions. A majority of neuroscience research into decision making, in fact, has been focused on economic choices of the individual, as you can find here. I'm not going to speculate on why, when it comes to the vast array of decisions human beings make on a day to day basis neuroscientists have been most engaged with how people make economic decisions, but so it is.

But anyway, what it does bring to the forefront is something that has been looming in neuroscience, and science more generally, for a while now. Basically, what has always been an implicit project of science, figuring out specific causes of events so that they can predicted in the future, has now become an explicit project of neuroscience, and our conception of free will hangs in the balance.

Scientists disagree widely about when or how or even if these discoveries will be made. But to me, the point is that thousands of scientists in our country are engaged in the project of making it happen right now. Even if they are only mildly successful, our current notions of free will and moral responsibility will be fiercely challenged. If scientists are looking for ways that they can use your neurological and genetic information to predict events and behavior that you will experience, where does your free will lie? This is hardly a new question posed by science, but I think it is becoming more urgent that we think long and hard about how to address it. This way, if the data arrives, we will know how to interpret and communicate it long before we are actually presented with it.

Groups like the law & neuroscience project are already starting to deal with these issues as they come to the forefront in legal matters. But this is not enough to address the effects this information will have on average individuals' conception of themselves. How can we experience ourselves if we come to know all the reasons we will do the things we do? Sometimes, I think that there is no way to conceive of there not being free will, and that's enough to keep the concept intact. But at other moments, when I concentrate really hard, I can imagine reliable information about what decisions I'm going to make or experiences I'm going to have could be at the same time freeing and extremely limiting.

This is both exciting and scary to me. Could we be on the edge of a new paradigm, a whole new way of looking at the universe and ourselves? It would be exhilarating---but I have no answers, only questions. And the hope that we can get more smart people to really think about this question.

Atheism vs. Theism does not equal Science vs. Religion

Atheists have begun a new ad campaign to inform other atheists that there are many atheists in the country---and that their numbers are growing! Rational humanism, naturalism, the brights, United Coalition of Reason, are just a few examples of the groups these atheists have developed.

The stated or understated message of these groups is this: a naturalist, or rational world view is what makes sense, and as more and more people come to their senses, belief in God will end. In a lot of ways, I think this movement is a good thing. Religious beliefs that cause harm to other individuals, like homophobia, should be ferociously attacked and I’m glad people are taking them head on.

But the fight against religious beliefs that lead to intolerance, violence, and pain is not the same fight as a debate over God’s existence. If atheists honestly want to engage in a debate, they must argue against theism, not religion in general. Religion is an organization of people that share a belief in a specific brand of theism, just as “the brights” are an organization of people that share a belief in a specific brand of atheism. To criticize the actions of “the brights” is not a valid argument against belief in atheism generally, and the same goes in reverse.

Atheists who claim it is “rational” to be atheists have lost track of themselves. I can understand this confusion. For, as science has progressed, it has disproven many of the most sacred teachings of various religions. The sense of 'disprove' here means that the teachings have been shown to NOT be rational fact. This has served to be a red herring for those involved in the atheism vs. theism debate, as it leads to such “rational conclusions” as “the theory of evolution is a rational fact, thus there is no God.”

Atheists are engaging in a belief, not a rational conclusion. They are choosing to believe that the reality that we experience and come to understand through the scientific method, or ‘empirical reality’ as Kant called it, is the ONLY truth or reality. For atheists, there is no knowledge, truth, or reality beyond what humans can know through reason.

Theism, then, is the belief that there is knowledge beyond what humans can possibly know. We can call this knowledge, or reality, or truth, God. It is not, however, necessarily the claim that we know, in the same way we ‘know’ scientific fact, something about this knowledge. Many theists do think they ‘know’ something about God in the same way that they ‘know’ the sky is blue. But in my mind, this God is by definition something that we cannot know. Yet, once one engages in the belief of this God’s existence, there are some things that can be shown to follow logically. And this is the stuff of religion. The important point is that there is nothing inherent in theism that is counter to science.

We can imagine that eventually a vast majority of people in the world will accept that the facts derived through the scientific method are the most objective, and thus truthful way that humans can understand the world. But this will not end the debate of theism vs. atheism. The question is not whether the scientific method can create an objective viewpoint through which universal human truths can be derived. Rather, it is whether these truths are truly ‘reality’, or the ultimate truths about the world.

This debate is one that rests on faith. There is no logical path that will lead you one way or the other. This is the essential fact that I believe atheists need to do a better job of understanding and promoting. Perhaps through this, the debate can begin to transcend its current stalemate and investigate the fascinating questions about truth and reality that are constantly present in our lives.