Editor’s note: Following on his recent post about plagiarist Jonah Lehrer, guest blogger Stanton Peele continues his critical review of mis-spent ink on addiction science in distinguished publications by recalling additional examples. Stanton may be followed on Twitter at https://twitter.com/speele5.
Jonah Lehrer’s imaginative, stylized, baseless view of neuroscience and its relationship to creativity and other cognitive functions was welcomed in seminal science blogs for Wired and The New Yorker, but also at the world’s leading scientific journal, Nature, because it corresponds with their own facile but incorrect views. Given not only the highly speculative and inaccurate nature of much of Lehrer’s writing, his lying about sources, and his alleged personality defects, we might wonder what about his pedigree justified his appearance at perhaps the premier spokesperson in our era for the new brain science.
The answer: He provided lame justification for the au courant scientific meme that neuroscience accounts (not might account) for much of human behavior. That these publications are slavishly, uncritically devoted to this meme might seem remarkable, unless one considers science – certainly popular science, but actually much more – to be merely another culturally determined social institution (the constructivist viewpoint). Today this means they are agit-prop for the most untenable, reductive claims made for modern psychiatric science, particularly around addiction and drug use/alcoholism.
I. Lehrer’s Nature Blog
Lehrer actually wrote for the leading scientific publication in the world, Nature. I described in my previous post how his editors there seemed completely unperturbed by his fantastic, unbelievable assertions about the mnemonist Shereshevsky. The neuroscientist who pointed out his errors, Daniel Bor, further noted:
[O]n page 100 he writes, “This kind of thinking takes place in the prefrontal cortex, the outermost layer of the frontal lobes.” This is anatomical rubbish–the prefrontal cortex instead, as the name implies, is simply the front-most section of the frontal lobes. Layers have nothing to do with it. I expect such mistakes from less able undergraduate students, who are too lazy to read the first line of the relevant Wikipedia article, but never ever in a respected science book. Then on page 112-3, he writes “the first parts of the brain to evolve–the motor cortex and brain stem.” Where did this come from? The brain stem very probably evolved hundreds of millions of years before the much more recent cortex, which the motor cortex is obviously a part of. So this is completely wrong as well.
What Lehrer knew was that – if you assert it definitively – you can make any behavioral claims you want about the brain. His downfall was occasioned because the same can’t be said about Bob Dylan quotes. Of particular interest to me are similar claims made about addiction in prominent science publications.
II. 2012 Scientific American Light and Torrance Blog
A Scientific American blogger recently returned to a hoary old chestnut, a study conducted by two physicians with heroin addicts deprived of legal narcotics after the Harrison Act was passed in 1914. The confusing title of the blog is “History Says Praise Drugs, Addiction Sufferers Are Just Pretending.” The point of the title is that stupid people – the most advanced thinkers even in former times – thought drugs were okay and that people could desist narcotics habits on their own. Let’s just say that this approach is at the opposite end of the universe from Virginia Berridge’s Opium and the People, which showed that massive, indiscriminate nineteenth-century opiate use (children were regularly dosed with laudanum, a tincturated opiate) was not especially noted to lead to addiction. Instead, addiction only became a widely recognized problem as medical science formulated what became our standard notion of narcotic addiction, an invariant biological template that has now been applied to every type of compulsive drug use and other addictive involvement.
This is how this blogger, Cassie Rodenberg, must deal with the earlier study in order to make sense of it from the perspective of the Scientific American meme:
In the late 1920s, two physicians attempted to note the symptoms of morphine withdrawal. After 36 hours without morphine, one patient dropped out of the study, refusing to further participate unless he was given more of the drug. The doctors then, instead, injected him with water, noting that he fell asleep and that he experienced no clear blood composition, metabolic or circulatory changes, though he did exhibit restlessness, vomiting and diarrhea. These signs were dismissed as mild and unremarkable. Their medical verdict was that withdrawal wasn’t so serious a problem, merely a (mostly) feigned illness.
Light and Torrance’s failure to identify the physiological reasons for withdrawal in 1929 was among addiction’s first medically-induced stereotypes, marketing the disease as a sign of personal weakness or hypochondria.
Of course, the point of her post – in service of the position now understood at Scientific American to be true – is, “These idiots didn’t see that withdrawal is life-threatening and that addiction is a disease!” Except they did administer a placebo which eliminated the worst withdrawal they noted among street addicts receiving doses many times as concentrated as those ordinarily available on contemporary American streets. Here’s how I dealt with Light and Torrance’s research:
In 1929, two Philadelphia physicians–Arthur Light and Edward Torrance–attempted to identify physiological correlates of the withdrawal experienced by hospitalized addicts suddenly withdrawn from morphine.1 The range and care of their measures, including detailed analysis of the blood, blood pressure, respiratory data, cardiovascular recovery rates, and urinalysis, has hardly been matched since. The research turned up no reliable biological index for withdrawal: The variability among the addicts on all the measures was too great.
Beyond these measures, the researchers reported the connection between actual administration of the drug and craving as described by the addicts was highly unreliable and subjective. The most recalcitrant subject refused to continue the experiment at 36 hours after withdrawal unless he was given more morphine, at which time the experimenters injected him with sterile water. This addict “promptly went to sleep for a period of eight hours” and “never became aware of the fact that he was given nothing but sterile water ” (p. 12). Noting their own failure to “find any marked changes” in circulation, metabolism, respiration, or blood composition, the researchers anticipated other investigators might criticize the research regimen in the experiment. They cautioned any such critics, who might have observed addict behavior during withdrawal, that “the incessant begging and annoying behavior of the addict during the withdrawal period becomes at times almost unbearable,” thereby “warping” the judgment of observers and leading them “to conclusions that would not have been reached except for the behavior of the addict” (p. 14).
Light and Torrance did observe a withdrawal syndrome composed of restlessness, vomiting, diarrhea, perspiration, and enervation. However, they considered these reactions that supposedly defined narcotic withdrawal not to be particularly singular or noteworthy; for example, they reported observing a similar syndrome among “a university football team just prior to the playing of a so-called ‘important game’…yet, when the whistle starting the game is blown, all fatigue quickly disappears” (pp. 14-15). Observations such as these led subsequent observers to accuse Light and Torrance of naiveté about the biological reality of withdrawal, and of mistaking withdrawal for a form of malingering.
Light and Torrance’s addicts were maintained on high levels of morphine, and yet their withdrawal could be overcome by admonition, forced labor, or H20 injection. Unlike the high dosage levels these 1920s addicts were accustomed to, addicts on the streets of major North American cities today often report to clinics with pronounced addictive symptoms but are not found to have any narcotics in their systems. This phenomenon has prompted the coining of phrases like “pseudo-junkie” and “pseudo-heroinism” and speculation about “psychologic vs. pharmacologic heroin dependence.” In other words, a substantial number of patients who report potent addictive symptoms have taken little or no heroin, while regularly maintained narcotics users often express feeble or inconsistent withdrawal. Our reaction to these phenomena does not conform to the supposedly empirical basis of science: We deny the former is “real” and ignore the latter in order to maintain our existing preconceptions of addiction.
Kind of captured Ms. Rodenberg’s point of view at the end, didn’t I?
In fact, as we can see, Light and Torrance performed remarkably forward-looking research that anticipated the development of theories of social cognition (a la Bandura) and its impact on drug and alcohol effects and addiction (per Marlatt), as well as of cognitive behavioral therapy (CBT), which builds on social and cognitive influences on addictive behavior and its remission.
III. 2102 Science Sibling Study
Cultural and historical concepts impact the very experience of substance’s effects — including what we call “addiction” – which was the theme of my book, The Meaning of
Addiction. By the nature of human consciousness and society, we can’t recognize the plasticity of our drug and alcohol concepts and experiences. The history of drugs and alcohol – exemplified by the work of Virginia Berridge and Harry Levine — performs the miracle of allowing us to recognize this plasticity. The worst examples are represented by David Courtwright’s Dark Paradise, which has been exceeded now by Howard Markel’s An Anatomy of Addiction (which I discuss here). Markel, a distinguished history professor, has become a full-time purveyor of the chronic brain-disease meme, rather than providing the critical historical perspective that might lead us to question our inaccurate and harmful contemporary viewpoint. As such, he performs the anti-miracle of imposing our blinders on the experience of others – in the same way as America and other temperance countries impose their views of drinking and alcohol policies on other nations, paradoxically replicating their own negative drinking outcomes in these other cultures.
When I speak to the most radical of groups concerned with substance use – drug policy reformers – I ask them whether the 1964 Surgeon General’s Report, Smoking and Health, labels smoking as addictive. They can’t guess, and history has forgotten, that the expert committee that authored the report didn’t fail to mention smoking’s addictiveness; rather, it devoted a chapter to explaining how smoking is not addictive. Stunned, audiences respond in unison that the researchers were, of course, in the back pockets of the tobacco industry. I then ask them how it made sense that the authors of a single work responsible for cutting smoking in half in the United States was written by handmaidens to the tobacco industry.
The real answer is that our conception of addiction changed after 1964 to permit a non-intoxicating, legal drug to be called – to be conceived of – as addictive, and we can never again recapture that former cultural meaning. A U.S. government report is thus more radical than the most radical of policy reformers in recognizing this plasticity when it notes: “On one issue the committee hedged: nicotine addiction. It insisted that the ‘tobacco habit should be characterized as an habituation rather than an addiction,’ in part because the addictive properties of nicotine were not yet fully understood, in part because of differences over the meaning of addiction.” At the same time, the notion of addiction is shifting radically in our own cultural epoch, as the psychiatric diagnostic manual DSM-V labels gambling and other behaviors addictive.
So when I discussed in Points for an Alcohol and Drugs History Society audience the 2012 Science study that purported to find a brain mechanism for addiction in pairs of siblings who shared the mechanism, while one was addicted and the other not, I was intrigued by the reaction of a couple of readers. I’ll summarize my post briefly here (see, in addition to my post, my follow-up comment):
1. The Science study investigated pairs of addicted and non-addicted siblings.
2. The researchers found impulsivity to hold for both of them, a common finding with substance abusers.
3. The researchers also found a brain anomaly to hold for both siblings, which they claimed might account for the observed impulsivity and thus addiction.
4. But this brain anomaly (as well as the impulsivity) could not account for addiction, since the siblings were split on that manifestation.
5. Nora Volkow was brought in to comment on the finding, in which she extended her mantra “Addiction is all about the dopamine” to speculate on brain mechanisms involved in self-restraint that would account for addiction per the study.
All of this is involved in the meme of “addiction as chronic brain disease” that Science is committed to forwarding, but which the study does nothing to accomplish. This meme was picked up and run with by a variety of popular publications, one of which was Time Healthland, which titled its treatment: “Siblings Brain Study Sheds Light on Roots of Addiction.” The author of this piece for Healthland was Maia Szalawitz, the most sophisticated of journalists who write about drugs and neuroscience. For instance:
Interestingly, the authors note, these connectivity problems are similar to those seen in the brains of teenagers, a group that is characterized by impulsive behavior. It is almost as if the brains of addicts are less mature. Perhaps that helps explain why some addiction wanes with age. Studies find that most people who struggle with alcohol and other drugs in their 20s “are out” of their problems by their 30s, typically without treatment.
But if most people outgrow their impulsivity, than how can it serve as a marker for addiction?
Ah, dear blog reader, this has become a real issue in the scientific world of the genetics of alcoholism. For the investigator most credited with finding inherited impulsivity to be the genetic root of alcoholism, Robert Cloninger, has recently changed his tune. Cloninger now finds that novelty-seeking as a personality trait enhances people’s lives as they mature!
“Novelty-seeking is one of the traits that keeps you healthy and happy and fosters personality growth as you age,” says C. Robert Cloninger, the psychiatrist who developed personality tests for measuring this trait. The problems with novelty-seeking showed up in his early research in the 1990s; the advantages have become apparent after he and his colleagues tested and tracked thousands of people in the United States, Israel and Finland.
“It can lead to antisocial behavior,” he says, “but if you combine this adventurousness and curiosity with persistence and a sense that it’s not all about you, then you get the kind of creativity that benefits society as a whole.”
My, that puts a different face on the variables that supposedly cause addiction for the Science article authors and Volkow.
Finally let me turn to the comments of two Points readers who responded to my earlier post. What I find most remarkable about these comments (though I shouldn’t have – why expect drug and alcohol historians to be any less subject to cultural memes than anyone else?) is that they reflect exactly the assumptions underlying Science’s perspective and articles that have led to the advent of people like Jonah Lehrer. Thus, “Ben” wrote:
I’d also note that the person he keeps quoting here, Volkow, doesn’t seem to actually be involved in the study itself, just the author of a commentary on it. I doubt the authors of this article would be so silly as to claim that their finding “explains” all instances of addiction in every context (although I have little doubt that the popular press could misrepresent it in this way).
No, Science’s reasoned scientific perspective wasn’t hijacked by the popular press. The journal clearly intended by having Volkow interpret the study’s findings to place it in Volkow’s constellation of “addiction as chronic brain disease,” even though it involves brain mechanisms she hasn’t investigated and knows nothing about. To wit, from the Healthland piece:
For instance, people with addiction—but not their siblings—showed decreased activity in their medial orbitofrontal cortex (OFC). “That area is crucial in terms of enabling you to have flexibility and to shift your behavior as a function of changes in [the] environment,” says Volkow. (Picture your grocer pointing to his head and saying, “It’s all in the brain.)
Finally, another commenter stated:
I agree with Ben. Even in the articles you site, they make clear that the siblings were compared with a healthy population. Also, this is irrational: “Instead of saying this study provides proof that addiction is inbred, it is equally true—truer—to say that it proves that impulsivity and brain structure have no impact on addiction. After all, only a coin flip could tell you the chances of two people who share these traits becoming addicted or not.” This argument would only be rational if 50% of the population were addicts. But when less than 10% of the population are addicts, a coin toss is pretty good statistical analysis!
No, the study didn’t study a normal (as in the meaning, unselected or general) population. It studied addicted people with non-addicted siblings who were identified for the purpose of the research. And, thus, it is the strangest of misconceptions to imagine (does the writer really imagine this?) that a pre-existing brain anomaly has been identified where one-half of those who have it become addicted?! What an amazing development that would be! Except, it hasn’t occurred, such a mechanism never will be identified, and it has already been proved that no such single, identifiable mechanism holds for even trivial numbers of people found to be addicted in different populations. Thus some people who are interested in the history of alcohol and drugs nevertheless eagerly defend what science and history have both shown time and again to be a fallacious, ungrounded, and ultimately fruitless way of thinking about addiction and its sources.