Here is the talk that Caroline delivered at Upaya centre during her recent North America Tour. She talks about what it means when Buddhists talk about being present, and how we are always present to something, with reference to Buddhist Psychology and Other Centered Ideas (known in the US as Other Centered Therapy: Buddhist Psychology in Action).
CarolineBrazier1.27.10.wma 42 mins 20mb
CarolineBrazier1.27.10.mp3 42 mins 35mb
Talk Therapy: Off the Couch and into the Lab
Researchers gather evidence that talk therapy works -- and keeps on working
By Raymond A. Levy and J. Stuart Ablon
A remarkably important event has just occurred in the world of psychology: A leading, peer-reviewed journal has published the strongest evidence yet that psychodynamic psychotherapy -- “talk therapy” -- works. In fact, it not only works, it keeps working long after the sessions stop.
Full disclosure: We report this not as disinterested observers, but as psychotherapists and researchers on the process and efficacy of therapy. Our book, “Handbook of Evidence-Based Psychodynamic Psychotherapy,” summarized the body of research through last year and another will follow late this year. Still, we can state as fact: The movement to establish an evidence base for psychodynamic therapy has taken a giant new step forward.
This new academic paper reports positive findings about the form of therapy that began with Sigmund Freud and has historically been utilized more than any other psychotherapy treatment. What does modern psychodynamic psychotherapy look like? Its distinctive features include several basic building blocks: A focus on emotion and relationships; identification of recurring themes and patterns; discussion of past experiences; a focus on the therapy relationship; exploration of attempts to avoid distressing thoughts and feelings; and exploration of fantasy life.
Overall, the paper found, psychodynamic psychotherapy demonstrates efficacy at least equivalent to other psychotherapy treatments commonly labeled as “empirically supported” and “evidence based.” And in fact, it notes, psychodynamic therapy's "active ingredients" are shared by many other forms of therapy as well.
The paper heralds a turnaround thirty years in the making: Practitioners of psychoanalysis and psychodynamic psychotherapy were notoriously late to the research enterprise. Through the late 20th century, they eschewed the need to enter the rigorous academic world of process and outcome research, claiming that gathering observable data from psychotherapy sessions could not apprehend the essence of treatment that is based on unconscious meaning.
That stance made it ever harder for psychodynamic psychotherapists to convince insurance companies to pay for their services, especially long-term treatments. It also made psychodynamic psychotherapy look somewhat backward compared to schools of therapy that actively did gather efficacy data, such as cognitive-behavioral therapy, a treatment which focuses on patients' irrational beliefs.
In recent years, however, for reasons of self-interest and consumer interest, those attitudes have changed, and psychodynamic clinicians and researchers have engaged in research with growing force. They are measuring treatment variables such as empathy and the therapeutic alliance, the compact between patient and therapist about goals and methods of the therapy. They are also studying physiological markers such as galvanic skin response: they measure skin conductance on the patient and the therapist during sessions, and the greater the concordance between the two, the higher the level of empathy.
Additionally, research from neuroscience is beginning to offer implicit support to the mechanisms of action of psychodynamic psychotherapy. Initial findings, for example, suggest that as patients learn to regulate their emotions, that change is reflected in the prefrontal cortex, the seat of executive function.
The new paper by Jonathan Shedler, an associate professor of psychiatry at the University of Colorado School of Medicine, appeared in the journal American Psychologist. It carefully analyzes the results of randomly controlled trials -- the gold-standard for scientific studies -- of psychodynamic psychotherapy treatments for a wide range of psychological disorders.
Shedler’s paper aggregates these studies and presents the encouraging results. He analyzed multiple studies conducted around the world by clustering them into single, larger studies (meta-analyses). And perhaps his most important finding, concluded from five different meta-analyses that he created, is that positive change and patient growth continue to develop beyond therapy termination, as measured in follow-up assessments conducted as long as three years post-treatment. This finding suggests that psychodynamic psychotherapy provides patients with the tools to continue to function better in the world, feel better about themselves, reduce psychiatric symptoms and face life’s challenges with greater flexibility and freedom well beyond the end of their sessions.
Shedler explains that the scope of psychodynamic psychotherapy includes the reduction of psychiatric symptoms but is more ambitious in that it hopes to foster the positive presence of psychological capacities and resources. Improving self-esteem, changing distorted views of self and others and helping patients to find greater satisfaction in relationships while mastering life’s many challenges are often goals of the therapy, mutually determined by patient and therapist.
The second section of the paper delivers the strongest message for both the general public and the larger world of psychiatric care. Shedler’s analyses demonstrate very strong effects for psychodynamic psychotherapy. As he says, “Randomized controlled trials support the efficacy of psychodynamic psychotherapy for depression, anxiety, panic disorder...eating disorders, substance disorders and personality disorders.” Shedler’s findings withstood unusually rigorous demands of journal reviewers, over a full year, who required three revisions and re-submissions before publication.
The third section of Shedler’s paper describes studies that suggest that many forms of therapy share common “active ingredients” that traditionally characterize psychodynamic psychotherapy. And that may partly explain the positive outcomes they achieve. There may even be active ingredients -- such as empathic listening, establishing a therapeutic alliance, setting treatment goals and the patient’s hopes and expectations -- that are common to all psychotherapy approaches. For example, perhaps the distinctions between an emphasis on cognition, as in cognitive-behavioral therapy, and an emphasis on emotions, as in psychodynamic psychotherapy, are not as critical as theory dictates.
Shedler’s findings are not without detractors, however, and he too describes the limitations of his work. He calls for more research on psychodynamic psychotherapy, explaining that, despite the strength of his current findings, there are not yet an adequate number of studies. And he points out that many of the studies he analyzed are treatments for a range of conditions rather than for specific psychiatric disorders. Other treatments, cognitive-behavioral therapy in particular, have conducted studies for specific disorders -- which allows for a sharper focus on whether the specifics of a treatment are effective for a given disorder. Work to correct that deficit is under way: since 2005, an increasing number of studies have looked at psychodynamic psychotherapy treatments for specific disorders.
Other criticisms have appeared, mostly from researchers in cognitive-behavioral approaches to treatment. The criticism tends to mirror Shedler’s statements of the limitations of his conclusions but takes them to an extreme. For example, some critics dismiss the value of the research entirely because the efficacy studies are for mixed disorders rather than for a specific disorder.
This paper is born into a psychological world that has seen rancorous disputes, often seeming to be guild-based rather than scientifically based. The adherents of cognitive-behavioral therapy understandably resented the arrogance of the psychodynamic practitioners who refused to submit their treatments to research initiatives. Now that psychodynamic psychotherapists have a sense of urgency to provide an evidence base, some cognitive-behavioral researchers can’t find room to consider them scientists. Some even want only their treatments to be considered evidence-based, despite the growing evidence base on psychodynamic psychotherapy, and ask that training programs in psychology teach only their treatment approaches while accusing other psychologists of not being interested in science.
We would counter that psychodynamic psychotherapy has evolved. There is a freshness to its modern forms, which include an emphasis on the healing power of the relationship in addition to Freud's emphasis on making the unconscious conscious. It's not an outdated relic or a spiritual exercise. As accumulating research confirms, it provides lasting benefits in people's lives and is worth the energy and expense. To those who dismiss it as outmoded we would say: You might want to try it again for the first time.
ABOUT THE AUTHOR(S)
Raymond A. Levy and J. Stuart Ablon are both psychologists who study psychotherapy process research at Massachusetts General Hospital and Harvard Medical School.
Robert Sapolsky on the uniqueness of humans
Neuroendocrinologist Bruce McEwen mentioned the research of neurobiologist and primatologist Robert Sapolsky in the interview I recorded with him about the biology of stress (extended audio offering here).
Professor Sapolsky got his PhD in Bruce's lab, and is author of popular books like Why Zebras Don't Get Ulcers:A Guide to Stress, Stress-Related Diseases and Coping, and The Trouble with Testosterone: And Other Essays on the Biology of the Human Predicament, amongst others.
Here's a Stanford presentation by Sapolsky (a man of impressive curls) on 'the uniqueness of humans'.
About the Lecture
How does someone move from recreational drug use to addiction? Barry Everitt’s group at the University of Cambridge has been trying to break down the stages and neural circuitry of addiction with great precision.
Everitt’s research attempts to operationalize a progression in animals from the voluntary taking of drugs, to the acquired habit of drug-taking, to the stage of compulsive drug-seeking and consumption, “where individuals have really lost control.” This progression seems rooted in the sequential activation of different learning systems in the brain, which are particularly sensitive to the neurotransmitter dopamine.
Research suggests that drug-taking is initially dependent on the nucleus accumbens (part of the ventral striatum), but its establishment involves the dorsal striatum. Studies show that dopamine in the dorsal striatum is causally involved in establishing drug-seeking behavior in rats. As the animal gets accustomed to taking the cocaine, there’s a “shift in the balance of associative encoding from ventral to dorsal striatum.” Cocaine craving and self-administration seem to change the functioning of the dorsal striatum in monkeys and humans as well.
While this shift from ventral to dorsal striatum depends to some degree on “pharmacology” (cocaine’s impact on dopaminergic systems), Everitt has hypothesized that it may also involve “spiraling circuitry” connecting the ventral striatum, the midbrain -- the brain’s motivational and motor mechanisms -- and the dorsal striatum. Everitt speculates that the compulsive nature of drug seeking may be rooted in part in the prefrontal cortex, home to “top-down executive control mechanisms.” He describes research that attempted to model this type of compulsion. Animals with short-term access to cocaine and most animals with long-term access to cocaine suppressed their drug-seeking responses when punished. But a subgroup of 20% “persisted in seeking cocaine in the face of punishment.” This result has been replicated many times now, and turns out to have a parallel among humans. This, says Everitt, “brings up the issue of vulnerability to drug addiction.”
Additional research suggests that impulsivity is a “behavioral characteristic that predicts the transition from initial drug intake to loss of control … to compulsive seeking and taking” of drugs. Highly impulsive animals denied cocaine become more impulsive and drug seeking over time, leading to relapses. Everitt and others are tracing the neural basis of compulsivity to impairment in the prefrontal cortex, which involves “a loss of control over maladaptive habits” established after long-term drug taking.
Occult America
Mitch Horowitz
Changesurfer Radio
Posted: Mar 6, 2010
Dr. J. chats with Mitch Horowitz, author of Occult America: The Secret History of How Mysticism Shaped Our Nation. They talk about the Freemasons, theosophy, Gandhi, Edgar Cayce, the Third Reich and the New Deal, and the eventual occultification of contemporary Christianity. MP3
Depression is a Thief, Even When You Learn From It
By Ronald W. Pies, MD, Editor-in-Chief | March 5, 2010
Writer Jonah Lehrer caused quite a stir with his recent article in the New York Times Magazine, with the unfortunate title, “Depression’s Upside.” I have a detailed rejoinder to this misleading article posted on the Psychcentral website. The fault is not entirely Mr. Lehrer’s however; his sources included a psychiatrist and a psychologist, who have recently presented a strained and dubious argument claiming that major depression has certain “adaptive” advantages. Lehrer apparently spent little or no time talking to mood disorder specialists who see thousands of severely depressed patients each year.
So much of the debate turns on what is meant by the term “depression.” A major problem with Jonah Lehrer’s original piece is that he did not fully clarify what he meant by “depression” –though it is quite clear that the paper on which Lehrer bases his evolutionary claims used the term “depression” to describe DSM-IV “major depression.”
Second, we need to distinguish 3 related yet distinct concepts and claims: (1) major depression is “instructive”; (2) major depression is “adaptive”; and (3) major depression is “conducive to significant mental health (or physical health) benefits.”
I would not deny that depression, like other challenges in life, may be “instructive” for some proportion of individuals–though probably a minority. I have very serious doubts (as do most of my colleagues) that major depression is “adaptive” in any significant way, though perhaps very brief and mild bouts of depression could confer some modest advantages in an evolutionary sense; eg, by increasing one’s empathy toward others, which could be highly adaptive in obvious ways. [cf. “A broken heart prepares man for the service of God, but dejection corrodes service.”— Rabbi Bunam of Pzysha].
I'm guessing this discussion will continue.More on Depression
Posted on: March 5, 2010 4:58 PM, by Jonah Lehrer
I thought it's worth addressing this article one last time. Dr. Ronald Pies (professor of psychiatry at SUNY Upstate Medical University in Syracuse) has written three eloquent and extremely critical blog posts about the article and the analytic-rumination hypothesis. Here's his latest riposte:
Writer Jonah Lehrer caused quite a stir with his recent article in the New York Times Magazine, with the unfortunate title, "Depression's Upside." I have a detailed rejoinder to this misleading article posted on the Psychcentral website. The fault is not entirely Mr. Lehrer's however; his sources included a psychiatrist and a psychologist, who have recently presented a strained and dubious argument claiming that major depression has certain "adaptive" advantages. Lehrer apparently spent little or no time talking to mood disorder specialists who see thousands of severely depressed patients each year.I'd like to refute that last point. I talked to numerous working psychiatrists - several of which are quoted in the article - and, not surprisingly, got a wide range of reactions to the analytic-rumination hypothesis. Some thought it was interesting and might make sense for people with mild and moderate depression; others, like Peter Kramer, thought it was utter rubbish. (As Kramer says in the article, "It's a ladder with a series of weak rungs.") Dr. Pies implies that every psychiatrist shares his viewpoint, but that's clearly not the case. See, for instance, this recent Louis Menand review for more.
Let's take a seemingly straightforward fact that Dr. Pies has cited in all three of his critiques of the article:
I would not deny that depression, like other challenges in life, may be "instructive" for some proportion of individuals-though probably a minority. I have very serious doubts (as do most of my colleagues) that major depression is "adaptive" in any significant way, though perhaps very brief and mild bouts of depression could confer some modest advantages in an evolutionary sense; eg, by increasing one's empathy toward others, which could be highly adaptive in obvious ways. [cf. "A broken heart prepares man for the service of God, but dejection corrodes service."-- Rabbi Bunam of Pzysha].This could be true, in theory, for more severe depression, but there, the maladaptive aspects of the illness would likely outweigh any modest advantages by a huge margin; eg, the 15% mortality rate in major depression (naturalistic studies), mostly by suicide.
Dr. Pies doesn't cite the specific study, so it's unclear what he's referring to. But it's also worth pointing out that numerous studies have found no relationship between depression and increased mortality. See here, here and here. I'm not trying to dispute the correlation between major depressive disorder and mortality, which I think is pretty clear, especially when it comes to cardiovascular illness. I'm merely trying to show that even a fact as "obvious" as the link between depression and mortality gets complicated and contested very quickly. (Things get even more complicated, of course, when the conversation turns to things like the cognitive deficits of depression.) Here's the summary of a large review on the subject:
There were 57 studies found; 29 (51%) were positive, 13 (23%) negative, and 15 (26%) mixed. Twenty-one studies (37%) ranked among the better studies on the strength of evidence scale used in this study, but there are too few comparable, well-controlled studies to provide a sound estimate of the mortality risk associated with depression. Only six studies controlled for more than one of the four major mediating factors. Suicide accounted for less than 20% of the deaths in psychiatric samples, and less than 1% in medical and community samples. Depression seems to increase the risk of death by cardiovascular disease, especially in men, but depression does not seem to increase the risk of death by cancer. Variability in methods prevents a more rigorous meta-analysis of risk.Dr. Pies has also argued that it was irresponsible to write about this speculative theory, since it might lead people to neglect treatment. Just to be clear: Neither I, nor Dr. Thomson, ever suggest that people shouldn't seek help for depression. That's just not in the article. Dr. Thomson is critical of what he regards as the "overprescription" of anti-depressants, but that's hardly a novel criticism of modern psychiatry. In fact, one can believe that the analytic-rumination hypothesis is a deeply flawed idea - and there are many good reasons for believing so - and still believe that we're too reliant on medications that aren't better than placebos for treating mild to moderate cases of depression. (Dr. Thomson, for instance, believes that we need more therapy, just better focused on solving real life problems.) But this was not an article about how to treat depression. This was an article about a new theory that attempts to explain why a disorder that feels so goddamn awful is also so common.
As I note repeatedly in the article, this hypothesis remains entirely speculative, with no direct evidence to support it. Given the dismal history of psychiatric speculations - we have no idea, for instance, why SSRI's work, when they do work - the odds are stocked strongly against it. But let's not pretend that modern psychiatry is such a settled science that it can't tolerate a controversial new idea.
On February 23, 2010, Dr. Lynn Nadel, University of Arizona Regents' Professor, Psychology, presented "Building Brains, Making Minds" in the first lecture of the College of Science's Mind and Brain Lecture Series.
What does the brain do? The ancients thought it was a radiator, cooling the blood. Modern views see it as an activator, using inputs from the environment in combination with prior knowledge to generate behaviors (walking, talking, eating and drinking) and mental states (feelings, desires and beliefs). Recently the idea has emerged that the brain acts as a predictor, using inputs and stored knowledge to generate models of the world, and of the consequences of possible actions we and others might pursue. These models can predict what will happen in the next minute, hour or decade, and allow us to behave in the most adaptive way.
THE DALAI LAMA'S LITTLE BOOK
OF INNER PEACE:
The Essential Life and Teachings
by His Holiness the Dalai Lama
more...Dalai Lama Quote of the Week
...I try to stay joyful. If we want to work effectively for freedom and justice, it is better to do so without anger or deviousness. If we ourselves feel calm, and if we act with a sincere motivation, we can accomplish many things in the 30 or 50 active years of our life. And if some positive results have already been seen from this approach, I think I can say that this is in part because of my commitment to the pacifist cause, a commitment which is motivated by a genuine belief in the brotherhood of mankind.
We are not a very large or powerful nation, but our way of life, our culture, and our spiritual tradition have helped us follow the way of peace even at times of tremendous difficulty and hardship, and have given us courage in our wish to develop love and compassion. When the time comes, the Tibetan people longs with all its heart to take responsibility for the high plateau, which is our homeland, and to transform it into a sanctuary of peace where mankind will live side by side with nature, in harmony.
--from The Dalai Lama's Little Book of Inner Peace: The Essential Life and Teachings by His Holiness the Dalai Lama
This week's Special Announcement includes news on Tibet Uprising Day (March 10), and a link to the Dalai Lama's message. To learn more, read the latest
News from Snow Lion.
You can read the whole article online in Google Docs.Psychol Rev. 2009 Jul;116(3):620-54.
The bright side of being blue: depression as an adaptation for analyzing complex problems
Virginia Institute for Psychiatric and Behavioral Genetics, Virginia Commonwealth University, Richmond, VA 23298-0126, USA. pandrews@vcu.edu
PMID: 19618990 [PubMed - indexed for MEDLINE]Depression is the primary emotional condition for which help is sought. Depressed people often report persistent rumination, which involves analysis, and complex social problems in their lives. Analysis is often a useful approach for solving complex problems, but it requires slow, sustained processing, so disruption would interfere with problem solving. The analytical rumination hypothesis proposes that depression is an evolved response to complex problems, whose function is to minimize disruption and sustain analysis of those problems by (a) giving the triggering problem prioritized access to processing resources, (b) reducing the desire to engage in distracting activities (anhedonia), and (c) producing psychomotor changes that reduce exposure to distracting stimuli. As processing resources are limited, sustained analysis of the triggering problem reduces the ability to concentrate on other things. The hypothesis is supported by evidence from many levels-genes, neurotransmitters and their receptors, neurophysiology, neuroanatomy, neuroenergetics, pharmacology, cognition, behavior, and efficacy of treatments. In addition, the hypothesis provides explanations for puzzling findings in the depression literature, challenges the belief that serotonin transmission is low in depression, and has implications for treatment. Copyright (c) 2009 APA, all rights reserved.
Read the whole post.Emergent Dharma: By Any Upaya Necessary
Posted 02. Mar, 2010 by Hokai Sobol“When in doubt, bow.”
– anonymous master
Now we are conscious evolutionary beings, an evolving intelligence becoming aware of its own potential to go beyond present limitations. This very well applies to the way we go about Dharma. Living Dharma is about discovering the radical, indestructible, dynamic continuity, and then serving it fully, by best means available, for the benefit of everyone.
A Project for the New Buddhist Century
The days of initial immigrant Dharma are gone, but mainstream Buddhists still tend to frame a lot of their thinking in East/West terms, so the most frequently made threefold division isn’t View, Meditation, and Action, or even Buddha, Dharma, and Sangha, but instead it’s Zen, Tibetan Buddhism, and Vipassana. Perhaps it’s due to marketplace pressure and the ubiquitous brand™ management, that influence our classifications. Or perhaps it’s an attempt to create an impossible diversity, for these three modes of the tradition have never co-existed alongside, their historical forms never touching in any manner whatsoever. What will come of them in a shared timespace remains to be seen. Meanwhile, we also have a number of Buddhisms known by their national designation, including Korean, Chinese, but also American Buddhism.
A different distinction, however, needs to be made. What we ought to discern at this point is the three horizons, invisible to classical teachings, within which all previous threefold divisions, including the Zen-Tibetan-Vipassana, can be approached, practiced and interpreted: the strongly felt but often unnamed traditional, modern, and postmodern frameworks.
Because these frameworks include worldviews, identities, values, needs, and self-evident truths, they exert huge influence on the way Dharma in any form is understood, practiced, organized, and promoted. Typically they produce fundamentalist, rationalist, and relativist approaches to every aspect of Sangha, of Dharma, and of Buddha.
In terms of historical development, traditional precedes modern which precedes postmodern. There’s an undeniable organic continuity between them. Nonetheless, because of a dialectic tension, the three are notorious for deep mutual distrust, known at large as culture war. Such behavior is somewhat tragicomical, being reminiscent of actions by three generations in a dysfunctional family. As Frederick Jackson Turner wrote, “The evolutionarily later always subsumes and includes the evolutionarily earlier.”
Whether our practice is in the Vipassana, Zen, Tibetan, or any other stream of Dharma with headquarters in either East or West, we may go about it in any of the three ways. And any of these three ways has moderate and extreme manifestations. Traditional brings many values to the table, but can also produce rigidity and dogmatism. Modern approaches will emphasize pragmatism and critical inquiry, while often sliding into rationalism and reductionism. Postmodern approaches will assert the need for sensitivity and inclusion, and yet discard the many virtues of tradition and rationality as oppressive and limiting, while unwittingly paving the way for extreme relativism.
Now, the way to go forward is to develop and sustain objectivity in relation to all these, because we need their healthy aspects to establish a robust Dharma for the 21st century. To midwife a relevant, emergent Buddhadharma, we need what’s best in traditional, modern, and postmodern stages of psychological, cultural, and institutional unfolding, in addition to the unhindered ultimate realization, however defined, measured, or tested. In the words of the Integral philosopher Ken Wilber, we must “transcend and include.” That, in short, is the basis for a new Buddhist century.
Hokai Sobol is a pathfinder, commited to the formulation of an authentic, no-nonsense spirituality for the 21st century. Teaching with groups and individuals, contributing actively online and offline, he is fostering the emergence and propagation of a non-sectarian, real world, 'post-eastwest' Dharma. Living in Rijeka, Croatia, with friends and partners in Europe, United States and Japan.
Website: www.Hokai.info
Twitter: twitter.com/HokaiSobol
A COMPLETE GUIDE TO
THE BUDDHIST PATH
by Khenchen Konchog Gyaltshen
edited by Khenmo Trinlay Chodron
more...Dharma Quote of the Week
The activities of this degenerate age are like a madman's performance of dance.
No matter what we do, there is no way to please others.
Think about what is essential.
This is my heart's advice.
--Bhande DharmaradzaIn any group of people, there is always some misunderstanding. You cannot satisfy everyone, no matter what you do. The Bodhicaryavatara says that every individual has a different way of thinking. Thus, it is very difficult to please everyone. Even the Buddha could not do it, so how can we? Instead of trying to please others, please yourself by applying yourself fully to bodhicitta.
Investigate your situation carefully, according to the Dharma. For us, it is more important to know what is best than to know how to please everyone. Know what is right, and on the basis of your own wisdom and skill, just do it. Don't expect that other people will be pleased with you or that they will be happy about what you do. Rather, do what's best, what's helpful for yourself and for others. If they are happy about it, that's fine. If they are not happy, what can you do?
--from A Complete Guide to the Buddhist Path by Khenchen Konchog Gyaltshen, edited by Khenmo Trinlay Chodron, published by Snow Lion Publications
This week's Special Announcement includes news on Tibet Uprising Day (March 10), and a link to the Dalai Lama's message. To learn more, read the latest
News from Snow Lion.
The Diagnostic and Statistical Manual of Mental Disorders IV (DSM IV), a book that defines and describes the symptoms of emotional problems, has been in the revision process for years. Health professionals (and insurance companies) routinely use the manual to guide diagnosis and treatment. Recently, considerable attention has been given to the proposed changes in preparation for the fifth edition of the book (to be released in 2013). The possible changes to the section on personality disorders will certainly generate much discussion and controversy.Personality (oversimplified) refers to the patterns of behavior, emotional responses, and characteristics that tend to be stable for a long period of time. Personality disorders, as previously defined in the DSM IV, were patterns of behavior and experience that were inflexible, pervasive, stable, and led to distress and impairment. Ten personality disorders were identified. Since the DSM IV was first published in 1994, the diagnosis of personality disorders has been fraught with problems. For example, personality by definition was supposed to be stable, yet people diagnosed with one personality disorder tended to lose that diagnosis or switch to another diagnosis over time. That didn’t make sense.
Another problem with the diagnosis was that if someone had one personality disorder it was quite likely that he or she would also have another personality disorder. And finally, the DSM IV suggested that personality disorders were all or none—for example, someone with Borderline Personality Disorder had five out of nine symptoms. So, if a person only had 4, she wouldn’t “qualify” for the diagnosis. Perhaps it’s not surprising that the most common diagnosis given by mental health practitioners is Personality Disorder Not Otherwise Specified (301.9 Personality Disorder NOS).
The revision of the DSM hopes to address these problems by eliminating a number of diagnoses that were not strongly supported as reliable and valid. The current plan is to eliminate simple symptom checklists and provide a narrative description of traits for each personality disorder. The diagnosis will be made by assigning ratings indicating degree of severity.
We look forward to these developments and especially appreciate the emphasis on severity ratings as opposed to the previous all or none approach to assigning such diagnoses. (In other words, you either had one or you didn’t rather than having a small to a large amount of it.) See our earlier blog post What’s the Difference between Swine Flu, Depression, and Pregnancy?
The categories that were retained include:
- Borderline Personality Disorder (emotionally volatile, fearful of abandonment, and impulsive)
- Schizotypal (eccentric, odd, and detached)
- Antisocial/psychopathic (disregard for others, lack empathy, and break rules)
- Avoidant (hypersensitive to evaluation, fearful, and feelings of inadequacy)
- Obsessive Compulsive Personality Disorder (cold, rule bound, perfectionistic, orderly)
In the meantime, we can all say goodbye to the following personality disorders as they will no longer appear in DSM V:
- Paranoid Personality Disorder (highly distrusting and suspicious)
- Schizoid Personality Disorder (detached and emotionless)
- Histrionic Personality Disorder (dramatic and attention seeking)
- Narcissistic Personality Disorder (self aggrandizing and lack of empathy)
- Dependent Personality Disorder (clingy and submissively helpless)
Does anyone know where they went?
Laura L. Smith, Ph.D. is a clinical psychologist who specializes in the assessment and treatment of adults and children with obsessive compulsive disorder, as well as personality disorders, depression, anxiety, ADHD, and learning disorders. Dr. Smith is a widely published author of articles and books to the profession and the public, including: Obsessive Compulsive Disorder For Dummies, Seasonal Affective Disorder For Dummies, Anxiety and Depression Workbook For Dummies, Depression For Dummies, Overcoming Anxiety For Dummies, Hollow Kids: Recapturing the Soul of a Generation Lost to the Self-Esteem Myth, and Why Can’t I Be the Parent I Want to Be?
Moral Intuitions, Reliability, and Disagreement
by David Killoren
There is an ancient, yet still lively, debate in moral epistemology about the epistemic significance of disagreement. One of the important questions in that debate is whether, and to what extent, the prevalence and persistence of disagreement between our moral intuitions causes problems for those who seek to rely on intuitions in order to make moral decisions, issue moral judgments, and craft moral theories. Meanwhile, in general epistemology, there is a relatively young, and very lively, debate about the epistemic significance of disagreement. A central question in that debate concerns peer disagreement: When I am confronted with an epistemic peer with whom I disagree, how should my confidence in my beliefs change (if at all)? The disagreement debate in moral epistemology has not been brought into much contact with the disagreement debate in general epistemology (though McGrath [2007] is an important exception). A purpose of this paper is to increase the area of contact between these two debates. In Section 1, I try to clarify the question I want to ask in this paper – this is the question whether we have any reasons to believe what I shall call “anti-intuitivism.” In Section 2, I argue that anti-intuitivism cannot be supported solely by investigating the mechanisms that produce our intuitions. In Section 3, I discuss an anti-intuitivist argument from disagreement which relies on the so-called “Equal Weight View.” In Section 4, I pause to clarify the notion of epistemic parity and to explain how it ought to be understood in the epistemology of moral intuition. In Section 5, I return to the anti-intuitivist argument from disagreement and explain how an apparently-vulnerable premise of that argument may be quite resilient. In Section 6, I introduce a novel objection against the Equal Weight View in order to show how I think we can successfully resist the anti-intuitivist argument from disagreement.
Download Article PDF
Bad things happen to good people. They are unable to control the events and are rendered helpless. They are sad more for themselves than for their loss. They struggle to accommodate violations to their core beliefs and self-concepts and suffer trauma. If we see the suffering, how do we respond? If we have no response, we turn away. We are at least apathetic, indifferent to our empathy, or perhaps somewhat psychopathic, without empathy.Cole brings together mind science, spiritual practice, and daily wisdom to his explication of how we handle emotional pain (or fail to) and how we can grow from the hardest experiences in our lives.
If we respond with rage, we turn against. We demand that others stop suffering and atone for the pain they cause us. We hold them in contempt. We are mad at their madness. We are cruel, egotistic and perhaps narcissistic. Rage at helplessness is the negation of empathy.
What if we turn towards the victim and also towards our own empathy?
Pity and compassion are behaviors and emotions evoked by the suffering of others. The difference between the two is the way we practice our response. If we respond with sadness, we risk offering only pity. If instead, we respond with generosity and love (joy in a sense), then we offer compassion. Do we respond to their helplessness with helplessness or with caring action? Do we respond with rigid prescription or empathic coaching? With egotistic defense or with unguarded attunement?
We can offer pity to individuals, families, groups, cities, societies, etc. We can only offer compassion to one person at a time. For compassion to be compassion, the person suffering must feel felt and we must suffer with them. If we defend against our internal experience of their pain, we compromise our practice of compassion.
And what if we defend against our own emotional pain?Bad things do happen. When we cannot control events. We fail, disappoint, err. Some of our crises become trauma.Trauma generally involves a violation of basic assumptions [knowledge] connected with survival as a member [achievement] of a social group [social relationships]. These include assumptions (not necessarily conscious ones) about personal invulnerability from death or disease [achievement], status in a social hierarchy [social relationships], the ability to meet internal moral standards and achieve major life goals [achievement], the continued availability and reliability of attachment figures [social relationships], and the existence of an orderly relation between actions and outcomes [knowledge].
Chris Brewin et al.:4
A traumatic event is a violation of primal assumptions - a knowledge wound. It overwhelms our life-concepts: self-concept, concepts of others, and our understanding of the world. It's a kind of existential terror, like awe in a way.
Awe is a knowledge emotion (as are curiosity, wonder, foolishness or cluelessness) and tremendously potent. Awe is a positive emotion, and terror is its negative counterpart. These emotions weaken our attachments to our life-concepts and our sense of self. (p. 8-10)
Podcast: Owen Flanagan
Philosophers call theories that promote happiness "eudaimonistic." Aristotle and J.S. Mill are eudaimonistic philosophers. Kant, who famously said "it is one thing to be happy another to be good," is non-eudaimonistic. Is Buddhism eudaimonistic?
The Bodhisattva’s Brain: Eudaimonia - Buddhist Style
In the following lecture, the philosopher Owen Flanagan explores whether Buddhism is eudaimonistic. In so doing, he presents some interpretive points about the general structure of Buddhist ethics, and the plausibility of empirical claims about Buddhism and happiness.
This podcast was produced by the Columbia Society for Comparative Philosophy. To find out more about the CSCP, and our lecture series, please visit our website.
I'm currently reading Flanagan's The Problem of the Soul: Two Visions of Mind and How to Reconcile Them and will have some things to say about it in a future post.
I finally got around to listening to the second hour of this podcast.
In the second half I found myself less enthusiastic about Owen’s presentation. I find it hard to hear someone present fiction as fact…I can understand how someone not a belonging to a tradition can speak for that tradition. He even suggested that the Dalai Lama doesn’t believe in rebirth! I love thought provoking discussions, I mean to did link to this podcast in the first place but, I was disappointed by the second Question and answer section.
If you are into philosophy this podcast is worth a listen. Owen is thought provoking. There are some assertions he puts forward as Buddhist theories that are simply incorrect and this is a shame.
Minute 10.35 At one point his says that Buddhist ethics is rich although.
He goes on to say the practice of compassion and loving-kindness for all beings might be way too demanding but it is nonetheless ethically rich.
This shows me that he really doesn’t get the process of transformation presented in Buddhist meditation. Yet he says at the very start of the lecture that he is a skeptic in regards to whether Buddhist meditation can produce eudaimonistic.Is this tantamount to not believing in modern physics just because the experiments were not done by you the individual? I NOTsaying that he should just accept Buddhist theories on the production on eudaimonistic or what Buddhist yogis would call the bliss of meditation. What I am saying is it is not good science to dismiss them outright without first doing the tests.
He also over simplifies the Buddhist theory of emptiness. Minute 9.40 His description of the self as a psychologically continuous and connected being is classic Sautrantika’s view of selflessness and this is not emptiness. It is not the final view of the Buddha nor that of Nagarjuna, Chandrakirti or Tsong Khapa.
Also he says that Jay Garfield says that the Dalai Lama is pandering to Westerners by presenting Buddhadharma as a path to happiness. Because the Buddha first teaching was about removing suffering.
I think that there is something in that statement that is worth looking at.
Happiness for the sake of happiness, or put another way, happiness as the goal is not a Buddhist practice. However it is a byproduct of the path and to suggest otherwise is simply silly.
Having said all that, I really enjoyed it and I’m looking forward to the next one.
Postmodern Man
The second generation is here, and boy does it feel right.
By Morgan Meis
It's been more than 30 years since Jean-François Lyotard closed the historical door on Modernism. It was 1979, to be exact, when Lyotard published The Postmodern Condition: A Report on Knowledge. Rumors of the death of Modernism had been swirling for years. But death comes in stages, especially when the mortally wounded is a "movement" or an "age." Lyotard's book managed to tie all those rumors together and then package the result as "Postmodernism," the new next thing.
- Reality Hunger: A Manifesto by David Shields. 240 pages. Knopf. $24.95.
Lyotard focused on the idea of narratives. Past periods, Modernism in particular, had been fond of what he called "meta-narratives," all-inclusive narrative frameworks that explained everything, more or less. Think, for instance, of Marxism and the way that class struggle drives every other part of the story. Look at the objects around you, the way you're dressed, current politics, movements in the arts. Strip away the details, any good Marxist will tell you, and lurking beneath you will find the class struggle. That bottle of water you're drinking is, in its essence, a natural resource owned by someone who then employs laborers hiring themselves out to work at a price determined by the market. This central relationship between wage-earners and owners of the means of production determines political structures, ideas on morality, even the dynamics of the family. For the Marxist, class struggle is the meta-narrative overarching all the other stories that fit inside.
Lyotard called the new age Postmodern because he thought that such meta-narratives no longer captured the complexity of late-20th-century existence. The fragmentation of identity brought about by modernization and globalization was too profound. At best, any narrative was going to tell only a small part of the story. Meta-narratives had blown apart into an endless chaos of micro-narratives.
All of this probably sounds roughly plausible, if not downright obvious. The only real difficulty comes in listening to Lyotard himself talking about Postmodernism:The postmodern would be that which, in the modern, puts forward the unpresentable in presentation itself; that which denies itself the solace of good forms, the consensus of a taste which would make it possible to share collectively the nostalgia for the unattainable; that which searches for new presentations, not in order to enjoy them but in order to impart a stronger sense of the unpresentable.
Need I even take the time to point out how old-fashioned-sounding are these sentences from Mr. Lyotard? They're like a parody of hip academic prose. As turgid as anything written by a Modernist thinker, they manage also to be pointlessly obscure. This fascination with "putting forward the unpresentable in presentation itself" was a bugbear amongst French theorists of all stripes in the ’70s. America had Five Easy Pieces; the French had Maurice Blanchot and the insight that, "To write is to make oneself the echo of what cannot cease speaking — and since it cannot, in order to become its echo I have, in a way, to silence it."
That kind of jargon-madness was shared by many in the first generation of Postmodernity, French and non-French alike. They were like Modernists unhinged. They wanted to gallop off into the absolute freedom of their micro-narratives but they'd all been raised on the heavy gruel of Modernist cant. Those fattened bellies could never get off the ground. Lyotard followed up The Postmodern Condition with The Differend: Phrases in Dispute, in which he attempted to answer the crucial question, "How can the reality of the referent be subordinated to the effectuation of verification procedures, or even to the instructions that allow anyone who so wishes to effectuate those procedures?" The answer, of course, is, "It can't." Luckily for the rest of us, it turns out that it doesn't matter. But it has taken 30 years or so to become fully confident about that fact. Only now, after living in the Postmodern condition for a full generation, have we stopped worrying about the reality of the referent and moved on to the simple act of referring.
This has taken a fair bit of learning: learning how to be, how to talk, how to think again. It has meant, at the very least, developing a new language, a new style. That style ought to personify much of what Lyotard was talking about while dropping his way of talking about it. It also means giving up the theoretical worries. Lyotard was always twisting himself into rhetorical pretzels trying to prove to the Modernist that Postmodernism is real. Second-generation Postmodernists are perfectly, perhaps painfully aware that Postmodernism is real. They want to know how to live in that reality, how to grasp it.
This brings us, finally, to David Shields' new book, Reality Hunger. It is a book of fragmentary thoughts and insights numbered 1 to 617 and divided into chapters with titles like "books for people who find television too slow." Shields calls it "A Manifesto." That's a little in-joke on his part since there couldn't be anything more Modernist than a manifesto, what with all the high-sounding pronouncements and meta-narratives kicking about. But Shields has written a 21st-century Manifesto, a manifesto in the minor key that follows the tone of one of the opening quotes by Graham Greene, "When we are not sure, we are alive." That aliveness and not-sureness are what Shields means by reality. It is that for which he hungers.
The first generation of postmodernists, Baudrillard for instance, were constantly at pains to show us that the new reality was manufactured and therefore, in a funny sense, not really real. Baudrillard called it the simulacrum. Reality had become simulation all the way through. To look for the underlying reality on which the simulation was based was to miss the point. Second-generation Postmodernists like Shields find such concerns boring. Here is Shields talking about what he calls the "American reality":It stupefies, it infuriates, and finally it is even a kind of embarrassment to one's own meager imagination. The actuality is constantly outdoing our talents, and the culture tosses up figures almost daily that are the envy of any novelist.Notice the subtle but profound shift in attitude. We have gone from worrying whether there is any reality at all to being overwhelmed by the sheer immensity of the reality we face. Shields is impatient simply to get out there into the swirling mess of the world. He dismisses the fumbly navel gazing of first-generation Postmodernists with a wave of the hand. "Don't waste your time," he says, "get to the real thing. Sure, what's 'real'? Still, try to get to it." Taking up the insights of Andy Warhol (a second-generation Postmodernist born far ahead of his time), Shields says, "Marilyn and Elvis are just as much a part of the natural world as the ocean and a Greek God are." That is the terrain of the new natural, the new reality. Shields defines it in one succinct line: "There's nothing and everything going on."
These are some of the claims Shields makes in Reality Hunger and they're satisfying as far as claims go. They jibe reasonably well with what Lyotard was talking about in his Postmodern Condition. The real excitement of Reality Hunger is in the way Shields talks about our relationship to reality, the language he uses. When it comes to Postmodernity, the prose is finally starting to match up with the condition. First-generation Postmodernists always wrote like they were standing outside Postmodernism looking in. The sentences came falling to Earth like bombs. And nobody likes getting bombed. David Shields isn't bombing anyone — he's here on Earth with the rest of us working from the inside. Your standard first-generation Postmodernist was a fan of collage, bricolage, and the rest, but tended to exhibit the stuff in a professorial manner. We were given theories of collage, beaten over the head with concepts. Shields makes the same point by saying, simply, "I am quite content to go down in posterity as a scissors-and-paste man." The entire book is a giant word collage, but not in the overly self-conscious look-what-I'm-doing sort of way. Most of the time, he just does it.
The success of Reality Hunger is in how often it lays out ideas you’re already inhabiting. It's a loose-fitting coat of thinking and behaving that we've all been gently slipping over our shoulders for the last two decades. Every once in a while, Shields will spend a paragraph simply blurting out a list of works:David Foster Wallace's A Supposedly Fun Thing I'll Never Do Again and Consider the Lobster. Leonard Michaels's Shuffle. Simon Gray's Smoking Dialogues, which dwarf his plays. Zadie Smith's Fail Better. The prologue to Slaughter-House-Five is the best thing Vonnegut ever wrote. Jean Stafford's A Mother in History. Samuel Pelang's The Motion of Light in Water. Rebecca West's Black Lamb and Grey Falcon.He doesn't need to say anything else. That's the confidence in the language and the mood of Reality Hunger. You read that list and you simply nod your head...yep. Anyone who doesn't get that list simply isn't playing the game. Shields has started a new list with this book. It goes like this:
Reality Hunger. • 18 February 2010
Morgan Meis is a founding member of Flux Factory, an arts collective in New York. Hehas written for The Believer, Harper’s, and The Virginia Quarterly Review. Morgan is also an editor at 3 Quarks Daily, and a winner of a Creative Capital | Warhol Foundation Arts Writers grant. He can be reached at morganmeis@gmail.com.
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