Graduation Day

What a lovely day. Our four graduates, whose self-cultivation required great bravery and persistence, have stepped past our little world into a greater one. For those who are interested, I am posting, with very little adaptation, my comments from the ceremony.

Recently a few date palm seeds were found near the Dead Sea (by the site of the Masada fortress). They were carbon dated to about 2000 years ago...one of them is now sprouting. In Buddhism teaching is said to be like planting seeds. A seed waits for the proper conditions. Sometimes it takes a long, long time.

Does anyone here use the internet? Do you ever have the sensation that you are done watching, reading, searching, whatever we do, and yet are not quite ready to let it go...

For my part I get an empty, restless feeling, a diversity of will- one part of me moving away from another part of me. Sometimes I examine this tension. I find it unpleasant. I was putting my youngest son to bed- it was hot that evening, yet he turned off the fan near his bed. He related to me with admirable clarity the reason why:

"Sometimes when it is on, my mind wants one thing and my heart wants something else and I find my fingers creeping towards the fan, so I turn it off".

This is an awareness of a divided self; the divided self being an everyday experience that is utterly universal and yet, for the most part, considered "abnormal", or undesirable, or problematic. It is as perfectly normal and adaptive as having five fingers on each hand.

Adaptive, in that it keeps many possibilities in play- choices, options. We often express these possibilities in words, as alternative plans and explanations. In some ways, this experience of a divided will is a precursor to abstract reasoning. We can imagine alternatives.

But we do not habitually use that imagination to examine ourselves. We assume- in spite of our direct experience- that our self is a more or less fixed entity. It is very difficult for me to convince myself (and here is a language problem already-convince "myself") that that very self is not a real and solid thing. This is where mindfulness comes in.

What is mindfulness? It is becoming a very popular term- and a very influential concept in psychology- because it has great utility and everyone experiences it. It is, simply put, a clear focus on the immediate present. When I am brushing my teeth, I try to keep my mind on only brushing my teeth. When I am eating, I try to keep my mind on only eating. Why?

For one thing, it immediately throws a light on how jumpy the mind is. Sometimes it seems as if we want to do everything but what we are doing in the present moment. It is a bit like looking through infrared binoculars and sitting quietly in the woods.We learn best through direct experience Knowing that this is the nature of ones minds is rather reassuring.. I am not going crazy. We are all crazy. It is perfectly normal to be crazy. But we don't have to be restless, irritated, overwhelmed, unhappy.

A rock bottom assumption of Tinicum Art and Science is that a person who is aware of the restless nature of their own mind is much more forgiving towards their own shortcomings, and that of others as well. If we can get a glimpse of how changable and restless our minds are, we can assume that if I am miserable now, I will less so in a little while. Of course, being happy now will change as well. So perhaps we should just flow along with it a little, accept it, and trust that it will change. This way we don't get stuck.

But getting stuck in a certain mode, or mood, or self conception is really easy. By sitting in silence we get a direct experience of the constantly changing nature of that "self". This is difficult for everyone. Some people are too young for it. Or too obsessive. Or too flakey. There are other types of focusing exercises to help a person move toward this awareness. But sitting in silence is very, very important.

When I was in my 20's, riding the subways in Boston, I was always, always reading. Walkmen- portable tape decks and CD players were becoming common but were not ubiquitous. I didn't like being cut off from the sounds of the city. It seemed dangerous, anyways. But my distraction was reading. And I was always perplexed at the old ladies who seemed perfectly content to sit quietly and watch the world go by. Back then, I thought they were kind of on the dull side, unintellectual. Now, with everyone fussing with ipods and cell phones every waking moment, those old ladies seem like Zen Masters to me.

I love youtube and wikipedia as much as anyone. I blog, check the baseball scores, and devour political news. But that restless, empty feeling is always there, an uneasy reminder of my divided self. Or rather, that there is no "self" really there at all.

Each of us is of multiple minds. It requires great skill to negotiate all the twists and turns and constant flow of our inner lives. Similarly, as teenagers, when our social worlds multiply and become very involved and changable, great skill is required to negotiate all of that complexity. The inner and the outer develop in parallel. And can get pretty mixed up. But neurologically speaking, the same part of the brain- a small portion of the pre-frontal cortex- is involved in the development of social awareness and inner awareness.

This is why mindfulness training makes for a happier person. We use the same neurological map to figure out both ourselves and other people. And if we practice mindfulness, an understanding of others develops. Wisdom develops. Insight develops. Fear drops away.

(to the graduates) We've planted a few seeds for you. This mindfulness and meditation training. You may not use it now, but you will realize, someday, that it works. It will help you realize that everything you need is here in the present moment. You can't breathe in the past, or the future. You can only breathe now. So go back to your breathing. And trust that if things are not so good, they will change, they will get better.

That is why we do what we do here.

The Last Day of School

That relentless rhythm of the school year has finally wound itself round to summer...tomorrow is the last day of school. The students decided to largely forgo their classes to catch up on work, to fool around, swim in the creek, and plan for the next day's party.
It has been a long year filled with marvels. A transition year, really. Over the next few weeks I will lay out some of what we accomplished and some of what we plan for next year.

One of the odder things about the education biz is the question of how you evaluate what you are doing. Can we fairly judge a school on how a bunch of 18 year olds conduct themselves? I think not. For me, the test of our school will be these kids as they approach the age of 30...are they happy, learning new things, are they pushing themselves and taking chances?

What about the handful of kids who don't graduate or moved on to other schools? Many of them keep coming back to visit. Why?

We plant seeds, and seeds take time. Maybe what a student learns at TAS just isn't relevant to the conditions of her life until much later, then suddenly, here it is.

Sometimes a seed is dormant for a long, long time. Like this one. 2000 years old, and now it is sprouting. And I thought I was a late bloomer.

Evidence Based Practice

"Evidence-Based Medicine" is a popular term these days. But it has a dark side, doesn't it? If this is a new idea, what on earth were doctors basing their decisions on before? It reminds me of a Chris Rock routine (which I have only had related to me, I have never seen it) where a father responds to criticism about his drug use and petty crimes with "Well, I take care of my children!". To which Rock says: "Aren't you supposed to take care of your children?"

Finally, it seems the evidence-based approach is wending its way through psychological circles. Not to be too snarky about it, but why now and not 10 years ago?

I hope the answer is that the high water mark of "the chemical hypothesis" has passed. The idea that behavior and emotion is determined by linear chemical processes is silly. Yet a lot of people went to the bank on that one. I think that soon it will be quite clear that a straight line from flawed gene to screwy neurochemical to maladjusted thought to an unwanted behavior does not exist. It was at best simple-minded and at worst profoundly cynical and self-serving.

But people suffer, and suffer greatly. And there is a role for medication. But psychological problems are primarily social problems and require social solutions.

Here is very interesting, modest, and clear step in that direction: a manual for evidence-based practices in children's psychology.

Page nine has the criteria. Page 11 begins with "anxious and avoidant behaviors". Take a few minutes to read through it. It is a good place to start. This has some seeds of thought for adult treatment as well.

No longer any reason to wonder...

First, some data on the medicating of children:

Foster children are medicated at rates far higher than non-foster children. Much of this drug use is not justified by standard medical practice (scroll through this brief abstract, to the conclusion).

Pre-schoolers are now frequently being diagnosed with depression and bi-polar disorder.

Newer anti-depressants do not work better than the older ones (though they are far more profitable); the older ones don't work very well either. (See the second article for a good review of illegal and quasi-illegal practices Eli Lilly engaged in order to replace the profits Prozac generated for them).

Now this: Dan Carlat admits that his take on the growing scandal at Harvard Medical School was, to use a word, ingenuous. The three doctors at HMS apparently hid millions of dollars in payments from various drug companies and failed to report them as potential conflicts of interest. Carlat calls the CME (continuing medical education credits) system a huge money laundering scheme, a way of directing cash to doctors and researchers:

Rather than paying doctors directly to give accredited CME courses (which is illegal), drug companies pay third party companies to create the courses. The checks are actually written by the education company, but the ultimate source is clearly the sponsoring pharmaceutical company. The drug industry has gravitated to this form of marketing because they realize that doctors are more likely to believe information in CME courses than information from drug reps.

The Harvard scandal represents the perfect storm of this money laundering operation. It appears that the vast majority of the money eventually reported by the Harvard Trio, a combined $4.2 million over 7 years, was drug company money that was laundered and processed to seem like it wasn't drug company money. And this, I suspect, is why it was so easy for the doctors to rationalize not disclosing it.

This is a major public health issue. Does it go to far to say that, for parents at the very least, this calls into question the legitimacy of the entire system of psychopharmacological research?

In summary we have a huge boom in medicating children, a huge boom in drug company profits, a vast and invisible payment system for biasing doctors and gaming the research, and all the major medical journals absolutely dependent on advertising from drug companies. And now, the most famous medical school in the world has been found to be caught up in the whole racket.

Vic Rawlings, noise and music, and being free

What is the difference between noise and music? When I listen to a scratchy old 78 of a one of Beethoven's Rasamovsky Quartets what is it, noise or music? What if it is a really scratchy old 78? There is no clear line, of course. Instead, it is a question productive of thought, not answers.
In Zen, action is important. Action reflects a quality of mind, but not always. Intent is very important. Zen is arguably more like philosophy than religion in the sense that moral imperatives are unimportant, even discouraged. One can judge action, and judging is the closing of one's heart. One can never truly know another's intent; we can only know our own intent. Intent, then, is the quality of mind, and can only truly be known by oneself. This is a pretty fierce subjectivity, pretty cold eyed.

As a teenager, I lived and breathed the Rolling Stone Record Guide. I highlighted any five star record I dared call familiar. I avoided those one star and two star failures; I made knowing fun of Uriah Heap, as they rated as only "bullets" , a few sorry single stars, and their masterwork, whatever it was, which was granted two. Needless to say, as my opinions began to diverge, the book lost much of its authority. But it was a place to start, like Janson's History of Art, or Ezra Pound's "from Confucious to Cummings". Its breadth was its authority. And I aspired to some kind of breadth.

But what I lost, and what I struggled with throughout my years as a musician harassed by the fates and chased down by doubts, was the sense of my own style. It emerged anyways, a function of my severe limitations, but the chorus of critics, that long-ago internalized Record Guide, rarely gave approval.

But there were moments- while writing or performing- where I felt a unity of intent, ability, and action. The critics were silent, finally, if briefly.

So where is the music, the noise? Is there a meaningful difference when one is producing sound? The intent is important. A good ear- an experienced, open ear- can often tell if the intent is to communicate. But that does not matter, really. If the maker of sounds- music or noise- is experiencing a unity of intent and action, something good is happening. A fundamental experience. Coherence. And if others are playing as well, it is delicious. It may sound like an construction site- a deconstruction site- to some. Like heavy traffic, swinging cranes, and police radios. Be brave. Play on.

When Vic Rawlings comes to Tinicum he comes to play. In the Fall, he gives two full days of lessons, in the Spring, a day of lessons and full day of electric and electronic musicnoise/noisemusic. Picture a large circle, then 10 places on the circle. One place may have an old amplifier, a short wave radio, an old electronic camera flash. Here, the flash flashes its electromagnetic pulse to our eyes when a button is pushed, but a series of slowing, dropping frequencies are registered by us as sound via the shortwave shortly thereafter.

Another station: an enclosed, circular pan with two steel balls trapped, rolling within. The wire of a contact microphone dangles from it. This connects to an antiquated speaker.

Another: a table with several things that look like inside out guitar effects pedals, the kind people stamp on to get a wail or a crunch or a phasing effect- their guts are spilling out. On the circuit board inside are wire and bits of foil. Some steel wool. These cross up the circuits, and randomly produce all manner of noise. Here one experiments. Anybody I have ever seen at that station takes on a very systematic expression- a scientist at work, or a grocer at his scales. The attempt is to reproduce that funny sound. Rarely done, and most move on, but most return.

Another: a stand holds a rectangular, black, U-shaped piece of metal about a foot long and one fifth as high. Two cello bows can be drawn across it; this sound is routed through a wah-wah pedal and off to an amplifier.

Why? Noise. Music. Put the critics to rest, give them the morning off. It is, after all, playing music, right? This is the experience of "just doing it". Zen isn't all sitting in silence.

Vic's intent is not to provide an experience of challenging Zen practice. It is, inter alia, to produce an opening, an experience of freedom and conflict. Interestingly, it was the presence of a guitar and a bass guitar that caused difficulty. Young musicians can't seem to approach these icons without the rock script, playing familiar songs and producing familiar gestures. And once you are playing from a script, you are alone, listening to the critics, doing what you are supposed to do. The conflict comes with the new, the unknown, the trying to make some sound, some communication, however untutored. There is some freedom for you. Be brave and play.

One more link on big pharma transparency

A helpful overview of the bill Sen. Chuck Grassely sponsored mandating transparency of drug company payments to physicians...

Old Links, New Links

If you are interested in the relationship between drug companies, flawed research, gigantic profits, and emotional health hit the following links:

for an up to date account of the attempts to reform the relationship between big pharma and doctors see the Carlat Psychiatry Blog. Read the article that made him famous!

Peter Breggin is likely more responsible for our awareness of how dangerous many of the these drugs are. You can link to his Center for the Study of Psychiatry and Psychology here.

You might want to read an appreciative overview of E. Foster Torrey's work. I think he is a mixed bag, but you should know about him.

If, say, Pfizer runs 20 studies on a new drug called "whoknowhowitworxiprine", one of them is bound to be positive, right? Especially if you keep tweaking the group you are using in the study by, say, not counting those people who dropped out due to "side-effects" such as chronic constipation or nervous twitches. But what happens to the other 19 studies that show the drug as being possibly dangerous or ineffective? Down the memory hole with that one! Here's another article on the same subject.

Then there is the rather disconcerting evidence that anti-depressants don't work much better than placebo. Here is one more link regarding the fact that serotonin is not the primary driver of depression.

Finally, speaking of the memory hole- which is an Orwell reference- here's a little big brother for you: that long standing attempt to find a diagnosis for every child, so they might have "access" to the mental health system. Or rather, so the big pharma companies have access to every child.

This is just a run down. Plenty more where that comes from.

Huxely, Part 3

Is it possible that a drug could wipe out guilt and shame? Is it possible that a person could take such a drug prophalactly, that is, ahead of time, so as to not remember or become preoccupied with an act of moral uncertainty? The article I linked to below brushes by that possibility.

Instead, it raised other crucial questions of the use of these drugs to patch up an terribly understaffed military mission, and of having entire units functioning less than optimally due to the drugs' many side-effects at certain dosages (I hesitate to even call them that- the deadening effect is the intent, isn't it?).

Now consider this (from Talking Points Memo):

By Andrew Tilghman - June 9, 2008, 10:09AM

The system designed to keep corporate cash from secretly slipping into the hands of doctors who do highly influential medical research isn't working very well.

Even at the nation's top institutions - such as Harvard - and affecting the most vulnerable populations - children with psychiatric problems.

A front-page story in Sunday's New York Times reports that a Congressional probe found some top child psychiatrists earning more than $1 million in often undisclosed consulting fees from drug firms.

What's most troubling about the investigation is that the these individual doctors and their public advocacy for certain drugs for mentally ill children "has helped fuel an explosion in the use of powerful antipsychotic medicines in children."

Dr. [Joseph] Biederman is one of the most influential researchers in child psychiatry and is widely admired for focusing the field's attention on its most troubled young patients. Although many of his studies are small and often financed by drug makers, his work helped to fuel a controversial 40-fold increase from 1994 to 2003 in the diagnosis of pediatric bipolar disorder, which is characterized by severe mood swings, and a rapid rise in the use of antipsychotic medicines in children. The Grassley investigation did not address research quality.

Biederman, who works at Harvard Medical School's department of psychiatry, received $1.6 million in consulting fees from drug makers from 2000 to 2007 but for years did not report much of this income to university officials, according to information given congressional investigators.

While there are rules for disclosing such payments, there's virtually no enforcement of those guidelines.

"It's really been an honor system thing," said Dr. Robert Alpern, dean of Yale School of Medicine. "If somebody tells us that a pharmaceutical company pays them $80,000 a year, I don't even know how to check on that."

While the probe, led by Sen. Charles Grassley, (R-IA) is scrutinizing the system for disclosing such payments, there is no effort to examine whether these payments may have influenced the doctors' research.

As the Times notes: "The Grassley investigation did not address research quality."

Controlling for bias is especially important in such work, given that the scale is subjective, and raters often depend on reports from parents and children, several top psychiatrists said.

More broadly, they said, revelations of undisclosed payments from drug makers to leading researchers are especially damaging for psychiatry.

"The price we pay for these kinds of revelations is credibility, and we just can't afford to lose any more of that in this field," said Dr. E. Fuller Torrey, executive director of the Stanley Medical Research Institute, which finances psychiatric studies. "In the area of child psychiatry in particular, we know much less than we should, and we desperately need research that is not influenced by industry money.

E. Fuller Torrey is a hugely influential voice in the efforts to destigmatize mental illness (a term I am very uneasy with) and to treat it as a medical disorder. He is considered the devil himself among some groups of "psychiatric surviviors". Others consider him a man who has done great good for millions of people. To read an admission from him that psychiatry is in the midst of a "credibility" problem indicates to me that things might be changing more deeply than I though they were.

In any case, this country has a big, big drug problem. It encompasses the use of drugs for recreation, managing trauma, optimized performance, exploiting and extracting human resources, addiction, dementia, learning disabilities and much more. It also means that how research is funded and who profits from both the research and the drug products has to be utterly transparent.

We have to have a comprehensive debate on these issues. I have a feeling that in five years all these issues are going to be seen converging on our cohort of Iraq and Afganistan vets. The old distinctions between illegal, legal, recreational, medical, and enhancement are going to collapse.

Huxley, Part 2

Over time, I become very disenchanted with the overall approach we took at that hospital. In the end, I think we did more slightly more good than harm. But when the insurance arrangements collapsed in the early nineties with the emergence of HMO's and funding decreased for the treatment of the most poor and vulnerable, I was pretty happy to move on to playing music full-time for a couple of years.

But it was in this program that one can see great possibility for abuse: namely, early and thorough control of a child's behavior through drugs. And with no informed consent. After all, the parents are hardly in a position to object, and no one in the system was going to either. None of these drugs were approved for these uses (of this I am pretty sure, but not completely so), and the many side effects would certainly set the child up for future ridicule: constipation, slurring of speech, awkward movements, glazed expression, etc.

Keep in mind that this was more than fifteen years ago. You would think that long term studies on the safety of anti-psychotics (haldol, risperdol, clozaril) or anti-depressants (imipramine, prozac, and so on) would have been published. You would be wrong.

Now we have another vast, underserved, and traumatized population- returning veterans- who will be desperate for treatment, who will not receive the services, training, and economic support that greatly lessens the strain of emotional distress, and who will instead be treated as damaged brains and be subject to a largely unsupervised drug regimen.

Sure, some drugs help. But unless there is a wide and comprehensive range of services, our vets, like the poor and abused children I worked with years ago, will be presented a false choice.

It will seem as if beta-blockers and anti-depressants are the only options. And that will be because we have, once again, failed to address our societal problems with societal solutions.