Wednesday, August 5, 2015

Robert Conquest RIP 1917 - 2015.

8/5/15. A rare human with courage, clarity of mind, and an understanding of the pervasiveness of self-deception.

Robert Conquest always knew there are many intelligent people who are akin to a high-powered rifle with a bad aim.

I'm Going to Live Forever. So Far, So Good. The Immortality Instinct.

8/5/15. Beliefs about immortality go back at least 4,000 years.

The Biology of Desire

8/5/15. Sally Satel reviews Marc Lewis' new book, "The Biology of Desire."
Kicking the Habit

If addiction is a brain disease, addicts are mad, sick and defective. If it’s a failure of will, users are bad, immoral and weak.


Sally Satel

July 21, 2015 7:42 p.m. ET

The medical and treatment establishments tell us that drug addiction is a brain disease, not an absence of willpower. Technicolor brain scans are presented as proof, and millions of dollars are invested in the search for pharmaceutical remedies.

What is unfortunate about this definition is not that it plays down the willpower dimension of addiction—the “just say no” injunction was too superficial to be of much help anyway. The danger instead lies in the black-or-whiteness of both propositions: If addiction is a brain disease, addicts are mad, sick and defective; if addiction is a failure of will, users are bad, immoral and weak.

In “The Biology of Desire,” Marc Lewis, a neuroscientist, takes a less Manichaean approach, arguing that addiction entails both biological alterations in the user’s brain and changes in his personal agency. He offers an insightful take on the interaction of mind and brain against the backdrop of the addict’s life circumstances.

Mr. Lewis is no white-coated lab shut-in. In his 20s, he consumed vast amounts of alcohol, opiates, psychedelics and stimulants, an odyssey that he chronicled in “Memoirs of an Addicted Brain” (2012). In that book and in this one, he writes about bursting neurotransmitters and sinewy neural circuitry with remarkable passion and sensuousness.

Photo: wsj

The Biology of Desire

By Marc Lewis

PublicAffairs, 238 pages, $26.99

When it comes to nomenclature, Mr. Lewis prefers “habit” to “addiction”—not to minimize the devastation of what users can incur but to point up the fact that the biology of habit formation is relevant to the compulsive use of substances. “The neural circuitry of desire governs anticipation, focused attention, and behavior . . . ,” he writes. “This process is grounded in a neurobiological feedback loop that’s present in all normal brains.”

In other words, people who discover a substance—or an activity, such as gambling—that helps them assuage pain or elevate their mood will form a strong attachment to it. Repeated behavior becomes harder to stop over time, though even a strong attachment need not create an unchangeable pattern. Addiction is “an inevitable feature of the basic human design,” Mr. Lewis writes. That design revolves around “neuroplasticity,” the ability of the brain to reorganize itself by forming new neural pathways and connections in response to modes of thinking and acting as well as inputs from the environment.


As people repeatedly look forward to and then experience certain drugs—or other strongly desired forms of pleasure or relief—the brain adjusts its mechanisms, intensifying the release of neurotransmitters in the regions involved in processing emotion and motivation. “Each network of synapses,” Mr. Lewis writes, “is strengthened and refined, so that the uptake of dopamine gets more selective as rewards are identified and habits established.” The drug habit is learned more deeply than others, Mr. Lewis explains, “due to a narrowing tunnel of attention and attraction.” Competing desires and imperatives get shunted aside or obliterated.

“The Biology of Desire” is not entirely a survey of brain science. Its middle part is devoted to portraiture, presenting real people who were once in the grip of an addictive habit, tracing the reasons for it and, finally, showing how each managed to stop. There is Natalie, for example, a college student who is drawn to OxyContin and then heroin because, she says, it “relaxed you by abolishing the sensation of threat.” Natalie gets arrested and finally realizes the state she is in. Through meditation she learns to tame her impulses and endure a craving without giving into it. She also reunites with her mother. The sounds, sights and experiences that, in her brain, she so tightly links with heroin lose their associative pull.

The same basic arc applies to other figures in Mr. Lewis’s portrait gallery: Brian the methamphetamine user, Donna the opiate addict and Johnny the alcoholic. All these young adults are in some way broken; all find solace in substances, both licit and illicit. They don’t want to be addicted, and their self-loathing only intensifies once they believe they are. But they desperately want immediate relief and so surrender.

All of Mr. Lewis’s case studies end well or at least optimistically. At the heart of the recoveries are new, more constructive habits, identities and relationships—and, in the brains of the subjects, the sculpting of new synaptic patterns. As Mr. Lewis shows, the physiology behind the addiction process can be intentionally engaged by addicts to put them on the path to recovery. By exploiting the neuroplastic capacities of the brain, individuals can develop strategies for self-control.

It may well be, as Mr. Lewis says, that addiction is a form of normal habit formation. But isn’t it more like a normal process gone awry? When outcomes are so dire, how is this not a pathological state? Mr. Lewis is deeply humane in his regard for people trapped in compulsive habits, so much so that he seems reluctant to impose any rules on their behavior and ends up treating them more like patients than he might like to admit. He is big on the so-called Vancouver model in which addicts are guided to safer drug-using methods and gently encouraged to get themselves together. But he de-emphasizes the importance of behavioral shaping through external incentives and sanctions, which are at the core of drug treatments that divert addicts from the criminal-justice system.

“The Biology of Desire” says a lot about the brain mechanisms underpinning addiction but, to its credit, does not stop there. With minor exceptions, we do not help addicts (and they do not help themselves) by ministering directly to their brains. As Mr. Lewis stresses throughout this unorthodox but enlightening book, people learn to be addicts, and, with effort, they can learn not to be addicts, too.

Dr. Satel is a psychiatrist and resident scholar at the American Enterprise Institute. She is co-author, with Scott Lilienfeld, of “Brainwashed: The Seductive Appeal of Mindless Neuroscience.”

Thursday, July 30, 2015

Sunday, July 12, 2015

What's Going On? Baby boomers and their music.

7/12/15. Published in the Michigan Psychology Newsletter, Spring 2015

I am going to live forever. So far, so good.

--- Steven Wright

Most people don’t know that the songs that defined the boomer generation have taken on new meanings for this aging population.

For instance, take Ray Charles’s 1959 song What’d I Say: The memorable lyric in this song is: See that girl with a diamond ring she knows how to shake that thing Baby boomers take this song literally due to hearing loss (“Why is everybody mumbling?”) and memory deficits.

And what about Aretha Franklin’s great 1967 tune Respect? The memorable lyrics in this song are: R-E-S-P-E-C-T Find out what it means to me R-E-S-P-E-C-T Take Care, TCB Aging boomers crave respect because they tend to think of themselves as special, very different from previous generations, rejecting traditional values, seeking higher levels of consciousness through drugs, sex, and an expectation to change the world for the better. But, try telling your grandchildren about your specialness and see how much RESPECT you get.

Then there was Motown’s Marvin Gaye who sang What’s Going On in 1971. Even today, this is a frequently heard greeting members of the boomer generation: “Hey, what’s goin’ on?” But the memorable lyric from this tune was: Brother, brother, brother… There’s far too many of you dying I hate to tell you this, fellow baby boomers, but when someone in your weekly card group doesn’t show up, it’s not because they found another group to play in.

And remember At the Hop by Danny and the Juniors in 1957? And remember when you, aging boomer, could actually hop, roll, and stroll -- and not fall down? But think of the memorable lyrics from At the Hop: You can rock it, you can roll it; Do the stomp and even stroll it. At the hop If you were to listen to this song today, you’re more likely to say to yourself: “Why is this music so loud, and why can’t I hear anything?”

Of course, everyone’s favorite rock ‘n’ roll group was the Rolling Stones. In 1965, they sang (I Can’t Get No) Satisfaction. This song captures the spirit of aging, although today, for us boomers it should be retitled: I Can’t Get the Satisfaction I Used To. But recall the memorable lyrics in the Rolling Stones hit: And that man comes on to tell me, How white my shirts can be, But he can’t be a man cause he doesn’t smoke The same cigarettes as me. You know as well as I do that your greatest satisfaction today is eating an early dinner and going to bed at about the same time your children and grandchildren are leaving their houses to go to a concert, restaurant, or bar. And if you’re still smoking cigarettes, it’s likely to be on the porch or in the garage --some satisfaction!

To comment on this article, contact Steven J. Ceresnie, Ph.D., at Dr.ceresnie@sjcpsych


7/12/15. Published in the Michigan Psychology Newsletter. Spring, 2015

I don’t think I’m either pessimistic or optimistic; I’m realistic. I don’t disparage your joy, but I think true joy only arises from acknowledging our despair. --- Rollo May, Ph.D.

As part of their training, psychologists have worked to understand the roots of their joys, miseries and despair. None of us wants to suffer, or experience pain, but we learn, and relearn to acknowledge, bear, and put into perspective our inevitable unhappiness.

This learning often brings greater emotional maturity, resilience and empathy --- post-traumatic growth some say, making us better prepared to help others.

There is an upsurge of research on positive psychology to teach people ways to aspire to virtues, character strengths, and happiness.

Since suffering is inevitable, it makes sense to teach our patients methods to systematically promote selfpunishment, guilt, and anxieties ---- on the route to post-traumatic growth. If you know how to make yourself miserable, just think what you can do with this knowledge.

Teaching misery is not easy task. Tolstoy, in the first sentence of Anna Karenina, tells us why understanding unhappiness is so challenging - -- “All happy families resemble each other; each unhappy family is unhappy in its own way” (Tolstoy, 2014).

The message here is that happy people have no history --- they get up in the morning, go to work, and come home --- drama, they don’t have. Psychologists are exposed to the dramatic stories of their patients in predicaments and interesting events - -- the more narrative a life is, the worse it is.

Unhappy families all have stories ---- and each story is different (Morson, 2015). Since each story is different, we must teach our patients some general principles of misery that apply to all unhappy people.

To help psychologists teach their patients how to make the most of their individual unhappiness, I turn to a wonderful book: “How to Make Yourself Miserable. Another vital training manual” (Greenburg, 1966).

SOME GENERAL PRINCIPLES OF MISERY Seventeen Basic Pessimistic Philosophies

1. I can’t do it.
2. I never could do anything right.
3. I have the worst luck in the world.
4. I don’t have a chance, so why try?
5. I’m all thumbs.
6. I’d only get hurt.
7. It would never work.
8. It’s not in the stars.
9. It’s never been done before.
10. It’s not who you are, it’s who you know.
11. It’s too late now.
12. It’s later than you think.
13. You can’t take it with you.
14. What good could come of it?
15. The piper must be paid.
16. The wages of sin is death.
17. The paths of glory lead but to the grave.

How to Make Yourself Miserable about the Future
1. Refuse to accept what cannot be changed.
2. Establish unrealistic goals.

What not to accept
1. Don’t ever accept your age, or your weight, or your height, or your face, or your ethnic group, or your socioeconomic level.
2. Don’t ever acknowledge the fact that you make mistakes.
3. Don’t ever accept the possibility of failure, and don’t ever prepare for it with alternative plans.
4. Don’t ever accept the fact that most people will never realize how great you are.
5. Don’t ever believe that the things other people have which you’ve always thought would make you happy aren’t making them happy either.

What goals to establish
1. Find the perfect mate.
2. Find the perfect job.
3. Write the Great American Novel.
4. Get even with the cable company.
5. Develop a foolproof system to beat the stock market.
6. Fight City Hall, and win.
7. Get revenge for every injustice you’ve ever had to put up with in your entire life.
8. Never be unrealistic again.


YOU: “Tell me frankly, what do you think of me? Be perfectly frank.”
REJECTOR: “I think you’re very nice.”
YOU: “No, tell me exactly what you think. I admire frankness more than any other quality.” REJECTOR: “Well…to be perfectly honest I do think you act a little neurotic at times.”
YOU: “Is that so! And I suppose you think you’re perfect.”

I could go on and on with sure-fire methods to be miserable -- but did you expect all the principles in one article?

Tolstoy, L. (2014). Anna Karenina. New Haven, CT: Yale University Press. Morson, G. S. (April, 2015).

The moral urgency of Anna Karenina. Commentary, 139 (4), 1-3.

Greenburg, D. & Jacobs, M. (1966). How to make yourself miserable. New York: Random House.

To comment on this article, contact Steven J. Ceresnie, Ph.D., at

Tuesday, June 9, 2015

Into the Darkness

6/9/15. Theodore Dalyrymple, prison psychiatrist.  A horrible crime where the victim isn't blameless.

Wednesday, June 3, 2015

Transgender Surgery Isn't the Solution

6/3/15. Psychiatrist Paul McHugh says a drastic physical change doesn't address underlying psycho-social problems.

The following response is from Dr. Aaron Ceresnie (full disclosure:  my nephew)

This article seems to be drawing conclusions from a lack of perspective of a person who identifies as transgender and from the perspective that being a transgender person is itself a medical/psychiatric problem. I would suggest that "transgendered" also isn't the correct language, and identifying as a different gender than given at birth is not in and of itself is not a mental disorder, unless it causes significant functional impairment and distress. The much larger incidence of suicidal thoughts/attempts in that population should also take into account (which this article does not) the proportional amount of harassment and violence transgender people are subjected to on a regular basis from as early as they begin identifying that way publicly, or even if trying to pass discreetly. There are no anti-discrimination protections for transgender people, and they are often victims of hate crimes. I didn't see any discussion regarding the influence of constant bullying, a lack of social acceptance, or recognition of their identity as legitimate. Also, people who are transgender in one form or another have always existed and have been documented in indigenous cultures. The 10 year follow-up study that found an increased risk of suicide was comparing transgender individuals to a non-transgender population. I'm wondering how that data compared to other transgender individuals who wanted but could not get the surgery. The author's statements also reflect an assumption that the transgender population is homogenous, which isn't the case. A lot of people who are identify as the opposing sex never want surgical interventions. There's just more nuance and heterogeneity than suggested in the article.

Moreover, Bradley/Chelsea Manning isn't a good example and it seems presumptuous to say he wanted to identify as female for a lesser punishment. Military documents show he started questioning his gender and asking about reassignment surgery in 2009 and he didn't provide WikiLeaks with any information until 2010. I don't see a good connection there.

I'm also not aware of any research showing success of psychiatrists or therapists "restoring natural gender feelings to a transgender minor", which sounds a lot like conversion therapy for people who are gay (which has also not been successful and denounced by the American Psychological Association due to its coercive nature).

Sexual reassignment surgery of minors is a legitimate concern, and I would argue a consenting adult who has really thought about it should be entitled to the surgery. This article seems to be more concerned with how Medicaid allocates money than the legitimacy of the surgery itself or the socio-cultural environment in which transgender individuals exist. The article is making the case that surgical intervention is never a good idea, and I'm not sure there's evidence to support that claim either. More research is always a good idea. One could make a similar argument about elective plastic surgery. 

Here's some additional information about transgender people and gender identity from the APA


Aaron Ceresnie, Psy.D.

Friday, May 29, 2015

Why Doctors Quit?


So you can keep your doctor with ObamaCare - a lie.

Because of the tangle of bureaucratic rules and regulations, good doctors are quitting or retiring early.