Psychiatry wars: the lawsuit that put psychoanalysis on trial

Rachel Aviv

The Guardian

Originally posted 11 OCT 22

Here is an excerpt:

In the lawsuit, the 20th century’s two dominant explanations for mental distress collided. No psychiatric malpractice lawsuit has attracted more prominent expert witnesses than Ray’s, according to Alan Stone, the former president of the APA. The case became “the organising nidus” around which leading biological psychiatrists “pushed their agenda”, he told me.

At a hearing before an arbitration panel, which would determine whether the case could proceed to trial, the Lodge presented Ray’s attempt to medicalise his depression as an abdication of responsibility. In a written report, one of the Lodge’s expert witnesses, Thomas Gutheil, a professor of psychiatry at Harvard, observed that the language of the lawsuit, much of which Ray had drafted himself, exemplified Ray’s struggle with “‘externalisation’ – that is, the tendency to blame one’s problems on others”. Gutheil concluded that Ray’s “insistence on the biological nature of his problem is not only disproportionate but seems to me to be yet another attempt to move the problem away from himself: it is not I, it’s my biology.”

The Lodge’s experts attributed Ray’s recovery at Silver Hill at least in part to his romantic entanglement with a female patient, which gave him a jolt of self-esteem.

“It’s a demeaning comment,” Ray responded when he testified. “And it just speaks to the whole total disbelief in the legitimacy of the symptomatology and the disease.”

The Lodge lawyers tried to chip away at Ray’s description of depression, arguing that he had shown moments of pleasure at the Lodge, such as when he had played piano.

“The sheer mechanical banging of ragtime rhythms on that dilapidated old piano on the ward was almost an act of agitation rather than a creative pleasurable act,” Ray responded. “Just because I played ping-pong, or had a piece of pizza, or smiled, or may have made a joke, or made googly eyes at a good-looking girl, it did not mean that I was capable of truly sustaining pleasurable feelings.” He went on, “I would say to myself: ‘I am living, but I am not alive.’”

Manuel Ross, Ray’s analyst from the Lodge, testified for more than eight hours. He had read a draft of Ray’s memoir and he rejected the possibility that Ray had been cured by antidepressants. He was not a recovered man, because he was still holding on to the past. (“That’s what I call melancholia as used in the 1917 article,” he said, referring to Freud’s essay Mourning and Melancholia.)

Ross said that he had hoped Ray would develop insight at the Lodge. “That’s the true support,” he said, “if one understands what is going on in one’s life.” He wanted Ray to let go of his need to be a star doctor, the richest and most powerful in his field, and to accept a life in which he was one of the “ordinary mortals who labour in the medical vineyard”.

Ray’s lawyer, Philip Hirschkop, one of the most prominent civil rights attorneys in the country, asked Ross: “As an analyst, do you have to sometimes look inside yourself to make sure you’re not reacting to your own feelings about someone?”

“Oh yes,” Ross said. “Oh yes.”

“You who’ve locked yourself into one position for 19 years with no advancement in position other than salary, might you be a little resentful of this man who makes so much more money, and now he’s here as your patient?” Hirschkop asked.

The article is here.

Your Land Acknowledgment Is Not Enough

Joseph Pierce

hyperallergic.com

Originally posted 12 OCT 22

Here is an excerpt:

Museums that once stole Indigenous bones now celebrate Indigenous Peoples’ Day. Organizations that have never hired an Indigenous person now admit the impact of Indigenous genocide through social media. Land-grant universities scramble to draft statements about their historical ties to fraudulent treaties and pilfered graves. Indeed, these are challenging times for institutions trying to do right by Indigenous peoples.

Some institutions will seek the input of an Indigenous scholar or perhaps a community. They will feel contented and “diverse” because of this input. They want a decolonial to-do list. But what we have are questions: What changes when an institution publishes a land acknowledgment? What material, tangible changes are enacted?

Without action, without structural change, acknowledging stolen land is what Eve Tuck and K. Wayne Yang call a “settler move to innocence.” Institutions are not innocent. Settlers are not innocent.

The problem with land acknowledgments is that they are almost never followed by meaningful action. Acknowledgment without action is an empty gesture, exculpatory and self-serving. What is more, such gestures shift the onus of action back onto Indigenous people, who neither asked for an apology nor have the ability to forgive on behalf of the land that has been stolen and desecrated. It is not my place to forgive on behalf of the land.

A land acknowledgment is not enough.

This is what settler institutions do not understand: Land does not require that you confirm it exists, but that you reciprocate the care it has given you. Land is not asking for acknowledgment. It is asking to be returned to itself. It is asking to be heard and cared for and attended to. It is asking to be free.

Land is not an object, not a thing. Land does not require recognition. It requires care. It requires presence.

Land is a gift, a relative, a body that sustains other bodies. And if the land is our relative, then we cannot simply acknowledge it as land. We must understand what our responsibilities are to the land as our kin. We must engage in a reciprocal relationship with the land. Land is — in its animate multiplicities — an ongoing enactment of reciprocity.

A land acknowledgment is not enough.

The info is here.

Cross-cultural variation in cooperation: A meta-analysis

Spadaro, G., Graf, C., et al.

JPSP, 123(5), 1024–1088.

Abstract

Impersonal cooperation among strangers enables societies to create valuable public goods, such as infrastructure, public services, and democracy. Several factors have been proposed to explain variation in impersonal cooperation across societies, referring to institutions (e.g., rule of law), religion (e.g., belief in God as a third-party punisher), cultural beliefs (e.g., trust) and values (e.g., collectivism), and ecology (e.g., relational mobility). We tested 17 preregistered hypotheses in a meta-analysis of 1,506 studies of impersonal cooperation in social dilemmas (e.g., the Public Goods Game) conducted across 70 societies (k = 2,271), where people make costly decisions to cooperate among strangers. After controlling for 10 study characteristics that can affect the outcome of studies, we found very little cross-societal variation in impersonal cooperation. Categorizing societies into cultural groups explained no variance in cooperation. Similarly, cultural, ancestral, and linguistic distance between societies explained little variance in cooperation. None of the cross-societal factors hypothesized to relate to impersonal cooperation explained variance in cooperation across societies. We replicated these conclusions when meta-analyzing 514 studies across 41 states and nine regions in the United States (k = 783). Thus, we observed that impersonal cooperation occurred in all societies-and to a similar degree across societies-suggesting that prior research may have overemphasized the magnitude of differences between modern societies in impersonal cooperation. We discuss the discrepancy between theory, past empirical research and the meta-analysis, address a limitation of experimental research on cooperation to study culture, and raise possible directions for future research. 

Discussion

Humans cooperate within multiple domains in daily life, such as sharing common pool resources and producing large-scale public goods. Cooperation can be expressed in many ways, including strategies to favor kin (Hamilton, 1964), allies and coalitional members (Balliet et al., 2014; Yamagishi et al., 1999), and it can even occur in interactions among strangers with no known future interactions (Delton et al., 2011; Macy & Skvoretz, 1998).  Here, we focused on this later kind of impersonal cooperation, in which people interact for the first time, they have no knowledge of their partner’s reputation, and no known possibilities of future interaction outside the experiment. Impersonal cooperation can enable societies to  develop, expand, and compete, impacting wealth and prosperity. Although impersonal cooperation occurs in all modern, industrialized, market-based societies, prior research has documented cross-societal variation in impersonal cooperation (Henrich, Ensminger, et al., 2010; Hermann et al., 2008; Romano et al., 2021). To date, several perspectives have been advanced to explain why and how impersonal cooperation varies across societies. 

A pdf is here.

Loss aversion, the endowment effect, and gain-loss framing shape preferences for noninstrumental information

Litovsky, Y. Loewenstein, G. et al.

PNAS, Vol. 119 | No. 34

August 23, 2022

Abstract

We often talk about interacting with information as we would with a physical good (e.g., “consuming content”) and describe our attachment to personal beliefs in the same way as our attachment to personal belongings (e.g., “holding on to” or “letting go of” our beliefs). But do we in fact value information the way we do objects? The valuation of money and material goods has been extensively researched, but surprisingly few insights from this literature have been applied to the study of information valuation. This paper demonstrates that two fundamental features of how we value money and material goods embodied in Prospect Theory—loss aversion and different risk preferences for gains versus losses—also hold true for information, even when it has no material value. Study 1 establishes loss aversion for noninstrumental information by showing that people are less likely to choose a gamble when the same outcome is framed as a loss (rather than gain) of information. Study 2 shows that people exhibit the endowment effect for noninstrumental information, and so value information more, simply by virtue of “owning” it. Study 3 provides a conceptual replication of the classic “Asian Disease” gain-loss pattern of risk preferences, but with facts instead of human lives, thereby also documenting a gain-loss framing effect for noninstrumental information. These findings represent a critical step in building a theoretical analogy between information and objects, and provide a useful perspective on why we often resist changing (or losing) our beliefs.

Significance

We build on Abelson and Prentice’s conjecture that beliefs are not merely valued as guides to interacting with the world, but as cherished possessions. Extending this idea to information, we show that three key phenomena which characterize the valuation of money and material goods—loss aversion, the endowment effect, and the gain-loss framing effect—also apply to noninstrumental information. We discuss, more generally, how the analogy between noninstrumental information and material goods can help make sense of the complex ways in which people deal with the huge expansion of available information in the digital age.

From the Discussion

Economists have traditionally treated the value of information as derivative of its consequences for decision-making. While prior research on noninstrumental information has shown that this narrow view of information may be incomplete, only a few accounts have attempted to explain intrinsic preferences for information. One such account argues that people seek (or avoid) information inasmuch as doing so helps them maintain their cherished beliefs. Another proposes that people choose which information to seek or avoid by considering how it will impact their actions, affect, and cognition. Yet, outside of the curiosity literature, no existing account of information valuation considers preferences for information that has neither instrumental nor (concrete) hedonic value. By showing that key features of Prospect Theory’s value function also apply to individuals’ valuation of (even noninstrumental) information, the current paper suggests that we may also value information in some of the same fundamental ways that we value physical goods.

The research is here.

Moral disciplining: The cognitive and evolutionary foundations of puritanical morality

Fitouchi, L., André, J., & Baumard, N. (2022).

Behavioral and Brain Sciences, 1-71.

doi:10.1017/S0140525X22002047

Abstract

Why do many societies moralize apparently harmless pleasures, such as lust, gluttony, alcohol, drugs, and even music and dance? Why do they erect temperance, asceticism, sobriety, modesty, and piety as cardinal moral virtues? According to existing theories, this puritanical morality cannot be reduced to concerns for harm and fairness: it must emerge from cognitive systems that did not evolve for cooperation (e.g., disgust-based “Purity” concerns). Here, we argue that, despite appearances, puritanical morality is no exception to the cooperative function of moral cognition. It emerges in response to a key feature of cooperation, namely that cooperation is (ultimately) a long-term strategy, requiring (proximately) the self-control of appetites for immediate gratification. Puritanical moralizations condemn behaviors which, although inherently harmless, are perceived as indirectly facilitating uncooperative behaviors, by impairing the self-control required to refrain from cheating. Drinking, drugs, immodest clothing, and unruly music and dance, are condemned as stimulating short-term impulses, thus facilitating uncooperative behaviors (e.g., violence, adultery, free-riding). Overindulgence in harmless bodily pleasures (e.g., masturbation, gluttony) is perceived as making people slave to their urges, thus altering abilities to resist future antisocial temptations. Daily self-discipline, ascetic temperance, and pious ritual observance are perceived as cultivating the self-control required to honor prosocial obligations. We review psychological, historical, and ethnographic evidence supporting this account. We use this theory to explain the fall of puritanism in WEIRD societies, and discuss the cultural evolution of puritanical norms. Explaining puritanical norms does not require adding mechanisms unrelated to cooperation in our models of the moral mind.

Conclusion

Many societies develop apparently unnecessarily austere norms, depriving people from the harmless pleasures of life. In face of the apparent disconnect of puritanical values from cooperation, the latter have either been ignored by cooperation-centered theories of morality, or been explained by mechanisms orthogonal to cooperative challenges, such as concerns for the purity of the soul, rooted in disgust intuitions. We have argued for a theoretical reintegration of puritanical morality in the otherwise theoretically grounded and empirically supported perspective of morality as cooperation. For deep evolutionary reasons, cooperation as a long-term strategy requires resisting impulses for immediate pleasures. To protect cooperative interactions from the threat of temptation, many societies develop preemptive moralizations aimed at facilitating moral self-control. This may explain why, aside from values of fairness, reciprocity, solidarity or loyalty, many societies develop hedonically restrictive standards of sobriety, asceticism, temperance, modesty, piety, and self-discipline.

A pdf is here.

Institutional betrayal, institutional courage and the church

Susan Shaw

Baptist News Global

Originally published 26 JUL 22

Betrayal by trusted people, like pastors, teachers, supervisors and coaches can inflict devastating consequences on victims. According to psychologists who study trauma, betrayal trauma affects the brain differently than any other trauma, particularly when the victim depends upon the perpetrator. Betrayal trauma threatens the very sense of self of the victim, who often cannot easily escape because of physical, psychological or spiritual dependence.

Institutional betrayal

When institutions don’t address perpetrators but rather meet survivors with denial, harassment and attack, they engage in institutional betrayal. Institutional betrayal occurs “when an institution causes harm to people who depend on it.”

Betrayal blindness describes ignoring, overlooking, “not-knowing” and forgetting betrayal. People, including victims themselves as well as perpetrators and witnesses, exhibit betrayal blindness to “preserve relationships, institutions and social systems upon which they depend.”

We don’t have to think very long to name a depressing list of instances of institutional betrayal by the church: segregation, clergy sex abuse, conversion therapy, exclusion of women from church leadership and ordained ministry, purity culture, the Magdalene laundries, witch hunts, Indian schools, on and on.

In recent days, we’ve seen institutional betrayal at work in megachurches like Hillsong and Highpoint, where popular pastors engaged in abusive conduct and their churches enabled them. The clergy abuse scandals in the Catholic Church and Southern Baptist Convention are textbook examples of institutional betrayal — institutions that chose to protect themselves rather than address the harm done to members.

Rather than challenging itself to create welcome, repair harm and do justice, the church often has chosen to preserve itself, to overlook harmful behavior by leaders and to demonize and ostracize those who speak out against abuse

Findley Edge, who taught religious education at Southern Baptist Theological Seminary, wrote about the process of institutionalization. Edge explained people developed great and exciting ideas, and these ideas lead to innovations and movements. As time goes along, these innovations and movements develop structure to continue to facilitate their growth. Eventually, the first generation that formed the great and exciting idea dies out, and soon people only know the institution and not the idea that sparked it. Their goal then becomes preservation of the institution, not the idea.

Uncritical dedication to the preservation of an institution can easily lead to institutional betrayal, especially when people depend upon organizations like the church, work or family.

Jennifer Freyd, the psychologist who coined “institutional betrayal,” says people protect institutions by participating in what she calls DARVO — Deny, Attack and Reverse Victim and Offender.

The info is here.

Functional neural changes associated with psychotherapy in anxiety disorders - A meta-analysis of longitudinal fMRI studies

Schrammen E, Roesmann K, Rosenbaum D, et al.

Neuroscience and Biobehavioral Reviews. 2022 

Sep;142:104895.

Abstract 

Successful psychotherapy for anxiety disorders is thought to be linked to functional neural changes in prefrontal control areas and fear-related limbic regions. Thus, discovering such therapy-associated neural changes might point to relevant mechanisms of action. Using AES-SDM, we conducted a coordinate-based meta-analysis of 22 whole-brain datasets (n = 419 anxiety patients) from 18 studies identified by our systematic literature search following PRISMA criteria (preregistration available at OSF: https://osf.io/dgc4p). In these studies, fMRI data was collected in response to negative stimuli during cognitive-emotional tasks before and after psychotherapy. Post-psychotherapy, activation decreased in the right insula, the anterior cingulate cortex, and the dorsolateral prefrontal cortex; no region had increased activation. A subgroup analysis for CBT revealed additional decrease in the supplementary motor area. Reduced activation in limbic and frontal regions might indicate therapy-associated normalization regarding the perception of internal and external threat, subsequent allocation of cognitive resources, and changes in cognitive control. Due to the integration of diverse treatments and experimental tasks, these changes presumably reflect global effects of successful psychotherapy.

Highlights

• We conducted a coordinate-based meta-analysis of studies assessing fMRI pre- and post-therapy in anxiety disorders.

• Our results are based on whole-brain findings and include more than 50% original statistical maps.

• From pre to post, activation decreased in the insula, the anterior cingulate cortex, and the dorsolateral prefrontal cortex.

• Subgroup-analysis for CBT and exposure revealed an additional cluster of activation decrease in the supplementary motor area.

The research is here.

Fetal frontolimbic connectivity prospectively associates with aggression in toddlers

Hendrix, C. L., Ji, L.,  et al. (2022).

Biological Psychiatry Global Open Science. 

https://doi.org/10.1016/j.bpsgos.2022.09.003

‌

Abstract

Background

Aggression is a major public health concern that emerges early in development and lacks optimized treatment, highlighting need for improved mechanistic understanding of aggression etiology. The present study leverages fetal resting-state functional MRI (rsfMRI) to identify candidate neurocircuitry for the onset of aggressive behaviors, prior to symptom emergence.

Methods

Pregnant mothers were recruited during the third trimester of pregnancy to complete a fetal rsfMRI scan. Mothers subsequently completed the Child Behavior Checklist to assess child aggression at 3 years postpartum (N=79). Independent component analysis was used to define frontal and limbic regions of interest.

Results

Child aggression was not related to within network connectivity of subcortical limbic regions or within medial prefrontal network connectivity in fetuses. However, weaker functional coupling between the subcortical limbic network and medial prefrontal network in fetuses was prospectively associated with greater maternal-rated child aggression at 3 years of age even after controlling for maternal emotion dysregulation and toddler language ability. We observed similar, but weaker, associations between fetal frontolimbic FC and toddler internalizing symptoms.

Conclusion

Neural correlates of aggressive behavior may be detectable in utero, well before the onset of aggression symptomatology. These preliminary results highlight frontolimbic connections as potential candidate neurocircuitry that should be further investigated in relation to the unfolding of child behavior and psychiatric risk.

Discussion

In a prospective study of 79 mother-child dyads, we found that lower intrinsic functional coupling between medial prefrontal and limbic regions prior to birth was associated with greater maternal report of aggressive behavior when children reached 3 years of age. This association was specific to between network coactivation, as neither within-network connectivity of the mPFC nor within-network connectivity of the limbic network was associated with subsequent child aggression. Our results are consistent with extant fMRI studies showing links between aggressive behavior and altered frontolimbic circuitry in childhood, adolescence, and adulthood, and extend these findings to demonstrate prospective associations with frontolimbic connections measured prior to the onset of symptomatology and prior to birth.

The research is here.

Not quite Minority Report, but stunning nonetheless.

Neural processes in antecedent anxiety modulate risk-taking behavior

Nash, K., Leota, J., & Tran, A. (2021). 

Scientific Reports, 11.

Abstract

Though real-world decisions are often made in the shadow of economic uncertainties, work problems, relationship troubles, existential angst, etc., the neural processes involved in this common experience remain poorly understood. Here, we randomly assigned participants (N = 97) to either a poignant experience of forecasted economic anxiety or a no-anxiety control condition. Using electroencephalography (EEG), we then examined how source-localized, anxiety-specific neural activation modulated risky decision making and strategic behavior in the Balloon Analogue Risk Task (BART). Previous research demonstrates opposing effects of anxiety on risk-taking, leading to contrasting predictions. On the one hand, activity in the dorsomedial PFC/anterior cingulate cortex (ACC) and anterior insula, brain regions linked with anxiety and sensitivity to risk, should mediate the effect of economic anxiety on increased risk-averse decision-making. On the other hand, activation in the ventromedial PFC, a brain region important in emotion regulation and subjective valuation in decision-making, should mediate the effect of economic anxiety on increased risky decision-making. Results revealed evidence related to both predictions. Additionally, anxiety-specific activation in the dmPFC/ACC and the anterior insula were associated with disrupted learning across the task. These results shed light on the neurobiology of antecedent anxiety and risk-taking and provide potential insight into understanding how real-world anxieties can impact decision-making processes. 

Discussion

Rarely, in everyday life, must we make a series of decisions as anxious events fit in and out of awareness. Rather, we often face looming anxieties that spill over into the decisions we make. Here, we experimentally induced this real-world experience, in which we examined how antecedent anxiety and the accompanying neural processes modulated decision-making in a risk-taking task. Based on past research demonstrating that anxiety can have diverging effects on risk-taking, we formulated contrasting predictions. An anxious experience should modulate dmPFC/dACC and anterior insula activity, brain regions tightly linked with anxious worry, and this anxiety-specific activation should predict more risk-averse decisions in the BART. Alternatively, anxiety should modulate activation in the vmPFC, a brain region important in emotion regulation and decision-making and this anxiety-specific activation should then predict more risk-seeking decisions in the BART, through disrupted cognitive control or heightened sensitivity to reward.

We found evidence related to both predictions. On the one hand, right anterior insula activation specific to

antecedent anxiety predicted decreased risk-taking. This finding is consistent with considerable research on the neural mechanisms of risk and the limited prior research on incidental anxiety and decision-making. For example, the threat of shock during a decision-making task increased the anterior insula’s coding of negative evaluations and this activation predicted increased rejection rate of risky lottery decisions. For the first time, we extend these prior results to antecedent anxiety. The experience of economic anxiety is a poignant and difficult to regulate event. Presumably, right anterior insula activation caused by the economic anxiety manipulation sustained a more cautious approach to negative outcomes that trickled-down to risk-averse decision-making.

The research is here.