Friday, May 07, 2010

Pre-Workout Nitric Oxide Supplements Are Worthless

http://www.muscle-shop.co.uk/images/products/ms-600/eas/nitric-oxide-booster.jpg
A lot of guys in the gym have bought the hype that nitric oxide supplements do more than just give them a good "pump" - they think they get stronger, leaner, or whatever else the ads tell them.

Suckers.

Just so you know, the three supps tested against GlycoCarn were SP250, NO Xplod, and Nano Vapor.

I've been telling the guys who ask me to save their money. Now the research confirms what I have been preaching for a couple of years. And they used men who were already trained to eliminate the "newbie" response - very cool.

Comparison of pre-workout nitric oxide stimulating dietary supplements on skeletal muscle oxygen saturation, blood nitrate/nitrite, lipid peroxidation, and upper body exercise performance in resistance trained men

Richard J Bloomer email, Tyler M Farney email, John F Trepanowski email, Cameron G McCarthy email, Robert E Canale email and Brian K Schilling email

Journal of the International Society of Sports Nutrition 2010, 7:16doi:10.1186/1550-2783-7-16

Published 6 May 2010

Abstract (provisional)

Background

We compared Glycine Propionyl-L-Carnitine (GlycoCarn(R)) and three different pre-workout nutritional supplements on measures of skeletal muscle oxygen saturation (StO2), blood nitrate/nitrite (NOx), lactate (HLa), malondialdehyde (MDA), and exercise performance in men.

Methods: Using a randomized, double-blind, cross-over design, 19 resistance trained men performed tests of muscular power (bench press throws) and endurance (10 sets of bench press to muscular failure). A placebo, GlycoCarn(R), or one of three dietary supplements (SUPP1, SUPP2, SUPP3) was consumed prior to exercise, with one week separating conditions. Blood was collected before receiving the condition and immediately after exercise. StO2 was measured during the endurance test using Near Infrared Spectroscopy. Heart rate (HR) and rating of perceived exertion (RPE) were determined at the end of each set.

Results: A condition effect was noted for StO2 at the start of exercise (p=0.02), with GlycoCarn(R) higher than SUPP2. A condition effect was also noted for StO2 at the end of exercise (p=0.003), with SUPP1 lower than all other conditions. No statistically significant interaction, condition, or time effects were noted for NOx or MDA (p>0.05); however, MDA decreased 13.7% with GlycoCarn(R) and increased in all other conditions. Only a time effect was noted for HLa (p<0.0001),>0.05); however, GlycoCarn(R) resulted in a statistically insignificant greater total volume load compared to the placebo (3.3%), SUPP1 (4.2%), SUPP2 (2.5%), and SUPP3 (4.6%).

Conclusion: None of the products tested resulted in favorable changes in our chosen outcome measures, with the exception of GlycoCarn(R) in terms of higher StO2 at the start of exercise. GlycoCarn(R) resulted in a 13.7% decrease in MDA from pre- to post-exercise and yielded a non-significant but greater total volume load compared to all other conditions. These data indicate that 1) a single ingredient (GlycoCarn(R)) can provide similar practical benefit than finished products containing multiple ingredients, and 2) while we do not have data in relation to post-exercise recovery parameters, the tested products are ineffective in terms of increasing blood flow and improving acute upper body exercise performance.

The complete article is available as a provisional PDF. The fully formatted PDF and HTML versions are in production.

Take home: Malondialdehyde is a marker for lipid peroxidation, a process by which polyunsaturated fats become oxidated, resulting in oxidative stress. The GlycoCarn(R) supplement reduced MDA by 13.7%, which is significant. The NOx supplements actually caused a slight increase in malondialdehyde.

On the other hand, the makers of GPLC-GlycoCarn funded the study. This is their description of the product:
GlycoCarn® (GPLC) is glycine propionyl-L-carnitine hcl, USP a propionyl ester of carnitine that includes an additional glycine component. Compared with other forms of carnitine, GlycoCarn® exhibits a special affinity for muscle tissues, such as the heart, is a powerful scavenger against superoxide radicals and it protects against lipid peroxidation.
They provide a lot of apparent support for their product:

GlycoCarn®, (Sigma-tau HealthScience brand of glycine propionyl-L-carnitine hcl, USP (GPLC), is a next generation member of the L-Carnitine family, with a particular focus on skeletal muscle, cardiac tissue, and the vascular system. Carnitine in general is known to be involved in fatty acid metabolism, and GlycoCarn® is a patented compound that has been shown to result in an increase in blood levels of nitric oxide (NO), as well as delivering potent antioxidant properties. Ongoing research also indicates that this compound may be associated with improved high intensity exercise performance. The performance effects of GPLC may be a result of both the nitric oxide stimulating and antioxidant activity, ultimately leading to increased blood flow and enhanced ATP energy production.

The applications for GlycoCarn® continue to be revealed, as funded research with this compound is presently ongoing at universities within the United States.



Glycine propionyl-L-carnitine produces enhanced anaerobic work capacity with reduced lactate accumulation in resistance trained males

Recent research has indicated that short term administration of glycine propionyl-L-carnitine(GPLC) significantly elevates levels of nitric oxide metabolites at rest and in response to reactive hyperaemia. However, no scientific evidence exists that suggests such supplementation enhances exercise performance in healthy, trained individuals. The purpose of this study was to examine the effects of GPLC on the performance of repeated high intensity stationary cycle sprints with limited recovery periods in resistance trained male subjects... (read more)



Glycine Propionyl-L-Carnitine Increases Plasma Nitrate/Nitrite in Resistance Trained Men

We have recently demonstrated that oral intake of glycine propionyl-L-carnitine (GPLC) increases plasma nitrate/nitrite (NOx), a surrogate measure of nitric oxide production. However, these findings were observed at rest, and in previously sedentary subjects... (read more)



GPLC Performance-Recovery Study

Recent research has indicated that short term administration of glycine propionyl-Lcarnitine (GPLC) significantly elevates levels of nitric oxide metabolites at rest and in response to reactive hyperaemia. However, no scientific evidence exists that suggests such supplementation enhances exercise performance in healthy, trained individuals. The purpose of this study was to examine the effects of GPLC on the performance of repeated high intensity stationary cycle sprints with limited recovery periods in resistance trained male subjects... (read more)



The Efficacy of Dietary Supplementation for Enhanced Nitric Oxide Synthesis: The Scientific Evidence

Approximately twenty years ago, it was discovered that a particular factor produced within endothelial tissue specifically relaxes the adjacent smooth muscle of blood vessels thereby allowing vasodilation and increased blood flow to various tissues including skeletal muscle. This factor was initially referred to as endothelium-derived relaxing factor but is now known as nitric oxide... (read more)

Based on everything I have read, the benefits of this supplement have nothing to do with NOx production, but they market it that way to tap into the ignorant supplement users who buy into the NOx propaganda.

The smarter, and less profitable, approach would be to tell the truth about its lipid peroxidation protection. In fact, it this product does target muscle tissue directly, it might be a useful supplement for treating fat deposits in diabetics, which decreases insulin sensitivity significantly.

Oh yeah, vitamin C and vitamin E have the same benefits in terms of reducing oxidative stress, but they do not target muscle tissue so precisely.

Anyway, now you know.


Cool Site - Open source cognitive science

Excellent. I am a fan of all things open source, especially research - we need to move beyond the competition model of research and toward a collaborative model. I just wish they could post more often.

Open source cognitive science

About

In the cognitive sciences, experimentation, analysis, and dissemination are becoming cheaper, easier, and more open. Researchers can produce results more accurately, reproducibly, and collaboratively.

These articles range across the cognitive sciences, and over a suite of techniques that are coming to be known as Science 2.0.

________

Bio

Based in Ottawa, Worldchanging Canada editor Mark Tovey is completing his Ph.D. in Cognitive Science in the Advanced Cognitive Engineering Lab at Carleton University. He is studying, among other things, human response to change, and how to accelerate and catalyze societal change.

He recently edited a book which looks at how the space of Web 2.0, mass collaboration, and open source methods can be used to gain traction on global problems, Collective Intelligence: Creating a Prosperous World at Peace. (648 pp., EIN Press).

For more information on Mark, see his website at marktovey.ca.

Here are a couple of recent posts - the only on open source psych research makes me giddy.

Cognitive Science Dictionaries and Open Access

September 22, 2009

There are some quick reference applications in the cognitive sciences for which Wikipedia is not yet fully adequate. I notice this especially when I’m trying to understand a difficult paper. Usually, one of the reasons a paper is difficult to understand is because it contains unfamiliar terminology.

My own experience, and I suspect that this will be a fairly uncontroversial claim, is that the level of technical coverage provided in paper-only specialist dictionaries is currently greater than that provided by either Wikipedia or most other free online reference sources. Three paper reference works I find particularly helpful are the APA Dictionary of Psychology (which seems to be one of the most extensive available), David Crystal’s A Dictionary of Linguistics and Phonetics, and the Dictionary of Cell and Molecular Biology.

When I am fortunate enough to be reading a paper in the library, what I sometimes like to do is pull from the shelves not just one, but several dictionaries relating to the subject at hand. Each time I come to a word I don’t understand, I will look up that term in all of the dictionaries. In many cases, there are pieces missing from one definition that are neatly filled in by another.

If I am reading a psychology paper, I will assemble several dictionaries of psychological terms. In reading a linguistics paper, I will take down multiple dictionaries of linguistic terms. And so on.

There are a few problems with this approach. First, if I am using a set of dictionaries, no one else in the library can use them. Second, I must actually be sitting in a reference library, with a stack of dictionaries in front of me, to do my reading. Third, it is time-consuming to look up each of the definitions one by one.

Single library copies are less of a problem as publishers create online editions of their reference works, and libraries subscribe to them. My institution, for instance, allows me to access the Routledge Encyclopedia of Philosophy (REP) and the MIT Encyclopedia of Cognitive Science (MITECS).

This is useful to the academic researcher, but not all institutions subscribe to all publications. And not all researchers have institutional access. Even when they do, it does not fully help with the third problem—which is that it is time consuming to look up a single term in multiple dictionaries at once.

There are a lot of metacrawler search engines out there, with various levels of customizability. None of them, that I know of, allows you the flexibility to be able to work with your library’s proxy server to be able to query multiple subscribed dictionaries at once.

I started wondering: when it comes to reference works in the cognitive sciences, are there strong open access alternatives? Is it possible to produce a reference work which approaches the depth and specificity of those mentioned above, in a cost-effective, open access format?

It is possible, because at least one example already exists.

A model reference work in this space is the Stanford Encylopedia of Philosophy (SEP). It’s peer-reviewed, revised quarterly, and each entry is maintained by a single expert or team of experts. Reading the SEP’s Publishing Model is highly instructive. They have carefully automated a great deal of their workflow to keep costs down. Designated areas for authors, subject editors, and the Principal Editor each have functionality designed to make that role easier to perform. Reminders, quarterly archiving (to create unchanging, citable references), cross-referencing and link-checking are all automatic, reducing the editorial burden. This approach, which the SEP bills as a scholarly dynamic reference work, seems to be unique to the Stanford Encyclopedia of Philosophy, but could clearly be applied elsewhere.

What other Open Access reference works exist in the cognitive sciences? Are there other Open Access reference works with the depth of MITECS or the range of the APA? Could the scholarly dynamic approach (peer-reviewed, single-author, regular fixed editions), work across the cognitive sciences? What other models exist that might be tried?

Lastly, are there tools I have missed that might be useful for looking up multiple definitions simultaneously?

I welcome your thoughts.

______

About the Stanford Encyclopedia of Philosophy’. The Stanford Encyclopedia of Philosophy, Edward N. Zalta (ed.), URL = <http://plato.stanford.edu/about.html#pubmod>.

Craig, E. (2003). Routledge encyclopedia of philosophy online. London: Routledge. http://www.rep.routledge.com/index.html.

Crystal, D., & Crystal, D. (2008). A dictionary of linguistics and phonetics. Malden, MA: Blackwell Pub.

Lackie, J. M., Dow, J. A. T., & Blackshaw, S. E. (1999). The dictionary of cell and molecular biology. San Diego: Academic Press.

Wilson, RA. & Kiel FC (eds.). MIT encyclopedia of the cognitive sciences. (1999). Cambridge, Mass: MIT Press.

This is the one:

Open data for online psychology experiments

April 13, 2010

The research activities in cognitive science are usually limited to a single lab, or to a small group of collaborators. But they need not be. A key problem in encouraging wider collaboration is finding ways of sharing data from human subjects in ways that do not compromise the privacy and confidentiality of the participants (DeAngelis, 2004), or the legal and ethical norms designed to protect that privacy.

Bullock, qtd. in DeAngelis (2004), notes other difficulties: Psychology traditionally has not built large data systems for storing or sharing large data sets, and, has not developed a culture of sharing data as seen in other disciplines.

The challenge in brief: what would it take to build a general purpose internet-based experiment presentation and data collection system where the resulting data is automatically and anonymously shared after a suitable embargo period? This could be done by individual researchers self-archiving data, or be sent to a repository. One of the advantages of such an an automated data publishing system would be a reduction in the costs in publishing properly formatted raw psychological data.

This is a practical project, the contemplation and building of which is entirely feasible with today’s technology. The charm of this project is that it requires three issues to be worked out in order to succeed.

One of these issues has to do with the internet: how do we offer reasonable guarantees that data collected remains anonymous, and is not compromised in transmission back to the experimental server or on the server itself? Although this varies by institution, in order to make human subjects data publicly available, the main requirement is that the data be presented so that it is anonymous. The name, and any personally identifying information, must not be stored with the data.

This simple practice of separating data from identifying information can be complicated by the fact that the data is being sent over the internet, where data can be intercepted, and servers can be compromised. Some solutions to this problem could include the use of strong encryption or IP anonymization. They could also include discarding potentially identifying data on the client machine before it is even transmitted, or discarding some of the received information after summary calculations are made, but before it is stored.

A second issue is societal: under what circumstances do we have the right to share human subjects data? This question particularly includes challenges that can vary by institution. It also involves aligning the policies and interests of different stakeholders. University oversight on these matters can include ethics committees, privacy officers, and legal departments. There may also be assertions of intellectual property by either the institution or the body funding the research. It may be that one or all of these groups would need to be consulted, depending on the location of the researcher and/or repository. This is an issue that would need to be explored carefully and sensitively with the relevant stakeholders at the repository institution.

A third issue is experimental. There are no shortage of online experiments on the web. Psychological Research on the Web lists hundreds. As the Top Ten Online Psychology Experiments points out, it’s a little hard to assess the validity of these results because of variations in the speed of the hardware. (This post also notes that we also don’t know who is taking these tests, or whether they have understood the instructions properly). How can we offer reasonable guarantees that data collected on different hardware will be valid? This can include timing accuracy for both input and output (Plant, RR & Turner, G., 2009), and adjusting stimuli to ensure similarity of size, colour, or volume.

An embargo period is important for three reasons: (a) to protect participant privacy, (b) to protect the integrity of the experiment, and (c) to protect, to the extent they desire, the researcher’s work. In particular,

(a) it is important not to release data immediately upon collection because anyone with a knowledge of when that person had conducted the experiment might be able to trace the data back to them. A standard (known) period of embargo would have the same property. A better approach may be a randomized period of embargo, or a set period of embargo for all collected data.

(b) usually when online experiments are conducted, the data will not be made available until after the experiment is run so that there is no way a potential participant could look at the results and be influenced by them.

(c) some researchers may not wish to release their data until they have published, but would be happy to release the data afterwards.

The online-experiment-runner could, of course, be made open source, as could the experiments that run on it, but these are separate issues.

Does my account include problems that don’t exist in practice? Are there places where it is actually more complicated than I’ve sketched out here? Are there examples of open data collected on the internet? Do you know of other references on the ethics and practice of making human subjects data available in various context (for psychology or otherwise)?

Acknowledgements: Terry Stewart for many illuminating conversations on open models, and open modelling, and to the folks at ISPOC for their model repository. Thanks also for stimulating questions and feedback to Michael Nielsen, Greg Wilson, Jon Udell, Andre and Carlene Paquette, Jim McGinley, and James Redekop.

______

DeAngelis, T. (2004). ‘Data sharing: a different animal‘. APA Monitor on Psychology. February 2004. 35: 2.

Plant, RR & Turner, G. (2009). Millisecond precision psychological research in a world of commodity computers: New hardware, new problems? Behavior Research Methods, 41, 598-614. doi: 10.3758/BRM.41.3.598. [Thanks to Mike Lawrence for pointing me at this]


James Curcio - Initiation, Part 1: The Masks of Identity

This is part one of three parts to this series on initiation - it looks like this could be an interesting book if these are the excerpts. I waited until all three parts were up to post this, so if you like this entry, the next two parts are linked to at the beginning of the article.

This is from Reality Sandwich, by the way, a great site for those interested in a wide range of ideas and explorations. You can check out James' blog, where all of these sections and a lot of other material are posted.

Initiation, Part 1: The Masks of Identity

curciobig.jpg

The following is the first part of a three-part series. These are in-progress excerpts from the upcoming Immanence of Myth anthology. Read Part 2 here; Part 3 here.

"I tell you: one must have chaos in one, to give birth to a dancing star." -- Frederich Nietzche.

Initiation is such a constant in the cultural body that it is evident in one form or another in nearly every human culture that has ever existed before the industrial age, at which point it became notably absent, at least on the surface. This absence has produced a very real psychological crisis on a cultural scale, although as we will see in many ways the initiatory impulse has merely transferred itself, oftentimes to behaviors and beliefs which only shallowly fulfill that impulse. (Or perhaps it is a symptom of a psychological crisis; it is probably the same, either way.)

There are many works available that systematically explore the vicissitudes of initiation within tribal and so-called primitive or archaic cultures. At the forefront of the works that deal with this subject within archaic culture is Mircea Eliade's Rites and Symbols of Initiation, which covers the various functions which initiation can serve, and provides elaborate examples of all of them, from the shamanic process of rebirth to that of the men's rites whereby a boy becomes a man. Similarly, his tome Shamanism goes into even greater depth of the specifically shamanic current of the cultural trend of initiation, Though a sketch of these ideas will serve us in regard to dealing with the main issue of this chapter, I will avoid elaborate restatement for the sake of brevity. In fact, much of the picture I'm going to create for you is generalized: the point here is to cut to the heart of what initiation is, what the proposed "initiatory crisis" is in modern life, and explore issues tied directly to that. It is not to compare the slightly different practices of Tungus or Yakut shamans.

This impulse is not merely the need to belong to a social group, although that is one of its exogenetic outcroppings. Lying submerged under such conscious needs is its prefiguring function: to forge our being, almost like a tool, for a specific purpose. It is a tool that in equal amounts -- depending on the nature of the initiation -- indoctrinates and confers meaning and knowledge appropriate with that transformation. Regardless of the specifics, initiation is always a tool of psychological transformation.

For instance, one of the most common forms that the initiatory ceremony takes is that of the adolescent transformation. Before the ritual, whatever it might be, one exists in the world of childhood concern, and afterwards, the initiate is both individuated, in a specific, culturally prescribed manner, and consigned to the service of a particular role, offered by the symbolism of the ceremony. "Indoctrination" has a certain feeling-tone to many of us, especially in light of the dystopian future so many seem to predict and fear, but devoid of intent it is essentially neutral. Feral children are rarely able to be brought back into the fold, if found too late. On pg. 86 of Masks of God: Creative Mythology, Joseph Campbell has some very interesting things to say on this subject,

"The intent of old mythologies to integrate the individual into his group, to imprint on his mind the ideals of that group, to fashion him according to one or another orthodox stereotype, and to convert him thus into an absolutely dependable cliché, has become assumed in the modern world by an increasingly officious array of ostensibly permissive, but actually coercive, demythologized secular institutions. A new anxiety in relation to this development is now becoming evident, however, for with this increase, on one hand, of our efficiencies in mass indoctrination and, on the other, of our uniquely modern Occidental interest in the fostering of authentic individuals, there is dawning upon many a new and painful realization of the depth to which the imprints, stereotypes, and archetypes of the social sphere determined our personal sentiments, deeds, thoughts, and even capacities for experience."

There are actually several general types of initiation: those that arrange ones role in society, those that confer knowledge, and the similar but slightly unique phenomenon of shamanic initiations. However, they all share many things in common, so I will speak at times of all three, hopefully without causing too much confusion.

One can be transformed by way of initiation into a soldier, into a priest, or into most anything else that a culture dreams up not just as a profession but as a way of life. To really be a soldier one must be a soldier. Such ceremonies are only truly effective when they make such a shock on the organism that the psychology is quite literally transfigured. In these cases, the symbolism usually involves death and rebirth: death to the old life, and the birth of the new. This must occur for transference of roles and models to occur. In some cultures, children are ripped away from their parents, tortured, or otherwise terrified in the name of the transformation. A boy enters a cave a boy, and leaves a man. This is simply a matter of attaining the social status that accompanies such a transformation; they are enacted instead for the very real, long lasting psychological shift that must result for it to be truly called an "initiation." This comes along with the archaic recognition of the sacrifice: the need to lose in order to gain. Death and rebirth is the formula of initiation. We'll look at that more closely in a moment.

Such transfiguration can hardly be a possibility for most modern individuals. For one, we are already individuated, even at the expense of our own in-born needs. Our submission to the needs of the society tend to be more through the guise of necessary concessions -- "I must work this job to pay the bills" -- rather than such a conscious, concerted dedication of ones self to a role in life or society. The initiatory ceremonies that persist are, by and large, pale imitations of those that came before. Modern baptism does not truly re-consecrate the individual, neither does the bar mitzvah or induction ceremony when joining an academy or a new career. Strangely, the closest thing that most Americans experience to the adolescent initiation are the bastardized rites of the fraternity. Yet, though they may approach the extremes requisite for psychological transformation, these pranks are so devoid of effective symbolism that at best they can only hope to enhance a feeling of belonging to the group, which as we already discussed is a mere outcropping of the initiatory complex.

Though many are able to find "initiations" in their own experience, which mark the transition from one phase of life to another, we are as a whole stumbling about in the dark. Those of us willing to actively consecrate ourselves to a spiritual or social task may not feel this absence, but those psychologies which require the imposition of an external force to bring about this change are likely to be forever lost, adrift from situation to situation, ever struggling to find a truly elusive meaning or purpose. These are the very types who are most at risk for indoctrination in cults, in the military, etc. because that psychological need can be so great that it strangles out the voice of reason. Because of all of this, an initiatory formula more appropriate as a model for the "modern psyche" as a whole is the heroic or shamanistic initiation. (Although it isn't universal, one general distinction between the otherwise similar shamanistic and heroic initiations come in whether that quest is rendered internally, or externally. The hero has the symbols rendered upon the external world, the shaman, the interior. Yet, dealing as we are with symbols in either case, it is difficult to say if this distinction is a truly worthwhile one, and if there is, in the final evaluation, a distinction between the shaman and hero in this regard.)

Joseph Campbell was well aware of this, and dedicated a majority of his life to clothing this message in various forms and disseminating it. For this, he has received a lot of flak in the academic community, yet I would suggest that often the academic insistence on restraint is in fact a symptom of a form of creative sterility, which could never effect an initiation of any kind. In my humble opinion, we need more teachers like Joseph Campbell, and fewer scholars.

Be that as it may, the model of heroic or shamanistic initiation is more relevant because it is either willed by the individual, taken on as a task or a test, or it is conferred by the very energies of life -- one is thrust into the initiatory crisis and must either muddle through it, or drown. In the case of the shamanistic mode, it is well recognized that a psychological illness, or "otherness," is requisite. However, the shaman gains the title precisely because he has been rendered whole by the trials and ultimate re-consecration of the self as a shaman. In this way the shamanistic worldview and experience, though superficially similar to what we consider mental illness, is in fact its diametrical opposite. It might be considered no different than molding of the self into a policeman, soldier, etc. as but of course, in a sense it is - and in our society, it is an entirely moot point as we have no such profession, and no such societal role as "shaman." And while it is inarguable that all the mentally ill of our society are most certainly not would-be shamans who never gained the training and insight that would have made them beneficial members of society in their queer way, it is equally unlikely to say that none of them would.

Let's distill, or simplify, this initiatory formula as it relates to our exploration here: first, crisis and the plunge into the "sub-conscious," then self exploration, and ultimately self knowledge or mastery. The nature of the crisis differs from individual to individual, however the first two steps of this process are easiest to express as the ancient Greek aphorism: "know thyself."

For most, this is easier said than done. It has been acknowledged by many social scientists that most Westerners are almost neurotically afraid of self analysis. The inner world, to many of us, is a complete mystery, terrifying and absolute darkness. There are some of us, to be sure, who can't help but go spelunking in there, fewer still who live there all the time.

There are no absolute guides in this path, and without any sort of shamanic or heroic tradition, there are few true mentors or teachers. Psychologists of past generations began to open these doors, only to have them slammed shut when the institution, indeed the industry, went pharmaceutical. The experiential practitioners went private. Many went underground, and consequently we are forced to sort the wheat from the chaff by trial and error or word of mouth alone. Artists, too, are natural explorers of the interior psychological spaces, but in our mass market culture, many of them are forced to either pander to the outside, surface world of fashion and appearance, or languish in dark caves themselves. When an artist expresses psychological truths, they commonly seem to fall on deaf ears with an audience so obsessed with plot, action, and everything else external.

To many other cultures, this "fear of the mirror" is more than a psychological affliction: it is a spiritual one. It is a condition that shamans, yogis and the like have long served to help cure. Yet to the indigenous practitioners of these arts, how strange we must seem -- coming to their lands in khakis, asking for a brief tour of ourselves, so that we can return to the Village and tell our friends about our Ayahuasca visions over sushi. We obsess, and ask whether the contents of such visions could be "real." Cracking open our heads must be a true challenge for them when dealing with us. As a civilization, we have come so far in terms of capability in the outside world, and as a result have left ourselves far behind.

Thankfully, we needn't merely resort to the tribal method of shamanism: it is fairly likely that those songs and symbols no longer truly reach us, and if they do, it can have a regressive result. The true value is in the formula, which -- I know from personal experience -- can be effective and transformative without requiring a trip to the Amazon.

Another element of the shamanic initiatory formula is that ecstacy becomes a transformative tool, and in many ways fear becomes that which must be overcome, rather than a tool unto itself. Truly, many of the trials faced in this sort of initiation are terrifying; but in the shamanic mode, success, (in the form of transformation), is acquired through overcoming fear, whereas in many adolescent rites the fear is in fact the transformative force.

As we move into personal mythology, we will see some examples of how initiations can and do occur within even a culture such as ours, devoid of a singular mythic fabric or initiatory system. The fact is that this absence is also a great boon: we get to choose, to a far greater degree, what course to take. However, none are offered to us, and for the majority of us, we aren't even made aware that the possibility for such psychological transformation even exists. Without a tradition, without a social mechanism for training let alone sustaining the individuals that would keep such a tradition alive, we are all on our own; and more often than not it is the charlatans, motivated by personal greed or ego, that are the most likely to attempt to peck around the edges of the initiatory traditions of other cultures, in an attempt to further their own ends. Worse yet, others experiment with the pieces of these traditions that they can glean from National Geographic, with potentially dangerous results.

An example from my own life pops to mind the moment I say this. I was at a Psytrance Festival somewhere just outside of Pennsylvania. As many of these events are, it was a mashup of neo-hippy, trans-humanist, and other neo-this and post-that movements in music, art and culture; most with good intentions, and many (though not all) without any clear sense of where to go with those intentions. I noticed someone standing next to me had tribal scarring, all up and down his legs. So without thinking much about it, I asked him what tradition he had been initiated into: regardless of the specific culture, these scars are almost always a symbol of having gone from one stage of life to another, within the context of a particular tribe. He seemed confused, and then talked for many minutes about how much it hurt, and about how proud he was to have gone through that level of excruciating agony. "How did you change?" I asked. Again, he seemed perplexed, as if the question had never entered his mind. "The point of an initiation is that you come into it from one phase of life, and leave it another -- it's an external way of symbolizing an internal transformation," I said. Or something along those lines. He explained that he had done it because he had seen other people doing it, and he wanted to go through something that intense.

I can't think of a more clear example of the initiatory crisis now facing the youth of today. Yearning for intensity of experience, born from a culture that allows them more freedom than most other cultures in the history of mankind, and yet absolutely no idea to do with it, and no idea why they feel so damn listless. I say this not from a position of superiority but more, if anything, of understanding and pity. My friends and I were a great deal more likely to research what we were doing than most, but aside from a sort of intellectual predilection, we were subject to the exact same conundrum as we grew up in the suburbian haze of the United States in the 1990s. I can only imagine that the situation is worse, rather than better, today.

Initiation is directly connected to the primary phases of transformation in life. Some are arranged for by the society: marriage, for instance. But most of them are ongoing processes that are set in motion by forces far greater than ourselves. Death. Sex. The recapitulation of life through the cycles of time. These are the things that it attempts to put us back into accord with.

The dismemberment of the God or hero, and spreading of his remains into the water is a re-occurring theme in myths with an initiatory quality. We see it with Orpheus, torn asunder by Dionysus' Bacchante long after the relative failure of his journey into the underworld; we of course see it with Osiris, slain by his brother and re-assembled like some kind of Vegetative Frankenstein by his wife, Isis; we see echoes of it in the myth of Jesus on the Christ and his rebirth, and on, and on, and on. Entire books have been dedicated to exploring the subtle elements of these connections; it is sufficient to say that they are a common, indeed an essential, quality to the initiatory myth. So we can move forward and say why? What does it mean?

The initiatory ritual is an attempt to enter sacred time and space, to recapitulate the death and rebirth of personified by these symbols, so that we can attain a psychological unity ourselves. This is admittedly a very Jungian reading of the initiatory formula -- to Jung the purpose of psychotherapy is individuation and unity -- but in my experience this is the right, which is to say the most useful, reading of these myths. In a successful initiation, the elements of the ritual reference events within ones own life; that of the dismemberment of the animal nature or ego, a hope for rebirth through redemption from those "binding" forces, the demons that we cling to, which keep us stuck in the "karmic rung" that we presently exist within.

This brings some of the ideas from the Bardo Thodal, the Tibetan Book of the Dead, to play. This book was ostensibly written as something to be read as an individual lies dying, to help them let go of their attachments to this world and ascend to the plane most properly aligned with their own psychological stage of development. I do not challenge this interpretation, but offer that it is an ongoing process. That is, it isn't limited just to a death and dying process, unless if you want to take the step and say that all of our life is a process of letting go of attachments, until that point when they are ripped from us if we haven't yet learned to live with them without clinging. The initiation attempts to prepare us for this -- it attempts us to recognize our true condition in life as transient beings, to let go, open up, and hopefully experience some of the true bliss and joy that is only allowed to the Gods simply because they are not tethered to the world of the senses which we, falsely, think of as the totality of the world. Far from forcing us to renounce these things, a successful initiation attempts to allow us to live with them without being controlled by them, and to be able to see beyond them. There is only so much that can be said about this because words simply aren't powerful enough to create the break necessary to truly come to this realization. Thus, the need for initiation.

Some paths attempt to steer us along a more ascetic path of renunciation, but I believe this is more because they simply feel that we are not strong enough to take the other path -- the path of initiation and moksha within the world, whether through the "blissful participation in the sorrows of the world" of a Bodhi-Satva path, the extremism of the Aghori's, or really any other path which allows an individual to attain liberation from the world while remaining within it. This smacks somewhat of the Zen koan, "How do you get the goose out of the bottle?" (An example of this can be found in The Book of Serenity, translated by Thomas Cleary, Lindisfarne 1990, case 91: "Nanquan's Peony." However, it is an oft repeated koan.) How can we be liberated from the elements of participation in the world that bind us to it, without simply renouncing it? A question worthy of consideration, and one that is more connected to initiation than most might at first assume -- but certainly not a question that can be answered in an essay!

Moving on, the exact meaning of the death and rebirth symbol is disputable, and thus the nature of this redemption differs somewhat from tradition to tradition. It is mutable. In the standard Christian interpretation that we are familiar with, it is a redemption in the hereafter, as these symbols are taken more or less as signs of historic facts. Heaven is a place that will happen at a specific time. In the mythology of Dionysus, the dismemberment occurs to Pentheus at the hands of the Bacchante. (And to Orpheus as well, at another point.) Pentheus, being the stand-in for the patriarchal, domineering, male ego, the dismemberment can be interpreted as the conflict between the systems of the mind and the needs and energies of the body. When the mind comes out of accord with the body, when it insists, like Yahweh, that "I AM IT," the other organs revolt. The sword turns upon itself.

Without going through a case-by-case analysis, an overview of Gnostic and Orphic cults demonstrate that the death and rebirth occurs in a series of ritualized stages which are meant to bring the neophyte into contact with his eternal nature. The same is seen in Masonic rituals and symbolism, and in fact most of the rituals that have become the core of Western Esotericism. Yet again, a side-by-side comparison of the variety of initiatory rights presented by the several thousand years of history which runs, either broken or unbroken, from ancient Egyptian mystery schools to the present would lead us very far off task, even though it is precisely what most scholars would insist that we do.

A single example of the rites of Eleusis is given in Arkon Daraul's History of Secret Societies which serves as a good model of what might occur at such an event,

"...the candidate had to undergo fasting and abstinence from certain foods. There were processions, with sacred statues carried from Athens to Eleusis. Those who were initiated waited for long periods of time outside the hall in the temple where the rites were being held. Eventually a torchbearer led them within the precincts. The ceremonies included a ritualistic meal; one or two dramas; the exhibition of sacred objects; the ‘giving of the word'; an address by the hierophant; and oddly enough, closure with the Sanskrit words ‘Cansha om pacsha.' The elements included the clashing of cymbals, tensions and a certain degree of debilitation, eating something, plus conditions which were awe-inspiring, strange. The candidate was in the hands of, and guided by, the priesthood. Other factors were: drinking a soporific drought; symbolic sentence of death; whirling in a circle... The effect of certain experiences was a carefully worked program of mind training which is familiar in modern times as that which is used in certain totalitarian states to ‘condition' or reshape the thinking of an individual... This process produces a state in which the mind is pliant enough to have certain ideas implanted: ideas which resist a great deal of counter-influence... the orgiastic side of the mysteries, too, has a place in the sphere of psychology. The catharsis which the secret cult of the Cathari experienced after ecstasy is paralleled by the modern therapist's procedure in bringing his patient to a state of excitement and collapse before implanting what he considers to be more suitable ideas into his mind."

Rather than belabor the comparison of various initiation practices, I want to help you cut to the quick in regard to the function and apparent cultural necessity of initiation. Just a few examples will do. In the myth of Orpheus, he is slain by the women of Dionysus. As the tale relates, his head, severed from his body, floats away to sea, still singing. Much could be made of this symbolically, as we think of Orpheus, patron of the artists, who attempted to resurrect the past (his beloved Euridyce) with his art, destroyed by women that serve a divinity who in many ways is a symbol of the present; the head, the rational function, floating off downstream, into the water, the unconscious, still singing... However, the point of initiation is experience, not analysis. One cannot know what the symbol refers to without having lived through it, at least in ritualized form, and only if the ritual was actually successful at creating the psychological shock or arrest necessary to generate the kind of intense experience we need to truly begin anew. The symbols are guides, but they won't take us there alone.

There's another element of death and dying worthy of considering in light of myths of initiation. Death is forgetting. A central motive in myth-making is the creation of meaning that counters both the meaninglessness of boundless existence, (literally existing without meaning, not as a reaction to meaning), and also the forgetfulness which is a symptom of the passage of time, of entropy -- death, which reduces the very edifices of meaning recollection to ash. Myth is an agent of an-entropy, all myth-making is in some sense heroic and Promethean, though perhaps also in the long run ultimately futile, as boundless existence and endless time is a realm where the eternal continuity of thought and meaning itself seems unthinkable. Initiation seeks to deal with this very dilemma, whether it is through a participation with what are seen as eternal principles, becoming a member of a sacred or immortal brotherhood (or, more rarely, sisterhood), or any of the other countless examples of secret society or mystical rite initiations that claim to provide experiential knowledge of immortal life. It is not surprising that, for instance, Hermes in his role as psychopomp is a very common image within the Greek-influenced Gnostic mysteries. (A psychopomp is a mediator or guide between the realms below and those above, which is to say, between consciousness and the unconscious, between life and death, and so on. Shamans, in their role as initiators, are psychopomps themselves.)

There are two general paths one may take to bring about this kind of experience. These opposites are fear / abstinence, and pleasure / excess, presented alongside symbolic representations of the transformation that is taking place. These methods of excess or trial are used to bring the mind, and the energies of the body as well, into direct contact with those energies referred to by the symbols. The symbols in themselves are powerless to create this change, and so we see so many devotees of traditions, as well as academics of these subjects who haven't at all opened themselves up to the references, at which point it seems almost a futile joke. Mythic symbols are only meaningful when they are connected with, not when they are collected and annotated, and the powers they represent are only powers at all if they are unleashed through that connection.

Of course, there are many levels of cultural difference between even the camps that might be seen as more less the same; for example, as Eliade comments on pg. 388 of Shamanism, "The Dionysiac mystical current appears to have a completely different structure; Bacchic enthusiasm does not resemble shamanic ecstacy." However, Eliade's comment relates more towards distinguishing variants of shamanistic practice, rather than identifying the initiatory complex as a whole. It remains fact that the dual current to initiation remains fear, pain, and or abstinence on one hand, and pleasure, ecstacy, and other forms of sensory overload on the other.

A powerful initiation allows us access to a new model of the world which may, based on our intentions and character, be experienced as heaven or hell. These are the kinds of experiences that most mythic artists I know work so very hard to bring about in a public that have been so trained to experience art with a sense of distance, that even the most extreme shock techniques often no longer work. It is somewhat ironic that, while the tools available to create these kind of mythic experiences nowadays certainly outpace the simple drug and light show of the Greek oracles, for instance, it is far more difficult to actually bring about some kind of psychological transformation in an audience fixated so firmly in the "myths of modernity" that we will be looking at in a moment. The challenge of creating such a personal experience in the audience remains the biggest challenge to artists such as myself, those that I regularly work with, and the many other thousands of mythic artists world-wide. It is my present opinion that sometimes what cannot be accomplished with a sledgehammer may be arrived at with a tuning hammer. But time will tell.

Rather than belabor the symbolic intricacies of rituals in times past, I would like to take a look at a movie that came out over a decade ago now that used the Bardo Thodal, and the interpretation of initiation that I've been talking about, to create an experience that was, in my opinion, a perfect example of what I am talking about here. To the general public it was a horror movie, that made them feel uncomfortable in a way they couldn't quite place. And to those a little more familiar with psychological symbols and the idea of non-linear narrative, it was something much more: a road-map of the final, eternal moments of all of our lives, and how an understanding of that can help us really appreciate just how vital, and just how fragile our e-ternal moment here on Earth truly is. The movie I'm referring to is Jacob's Ladder.


Auditory Hallucinations and Psychiatric Illness

http://jonkeegan.com/images/nyt_audio_hallucination.jpg

Interesting article from Psychiatric Times. I actually stumbled upon this article through a response to it from another author staking his ownership of an idea claims Chris Firth has essential stolen from him - if that is the case, it sucks.

This article from Flavie Waters, PhD, Auditory Hallucinations in Psychiatric Illness, offers an excellent overview of auditory hallucinations in mental illness - I am particularly pleased to see in the conclusion the following lines:
The combination of personalized contents and interpretational processes contributes to a dynamic and emotionally charged experience that can be better described as a belief system rooted in a perceptual experience. Auditory hallucinations are most likely to arise because of an interaction between perceptual, cognitive, and biological vulnerability as well as affective factors and contextual influences.
Great article.

Auditory Hallucinations in Psychiatric Illness

By Flavie Waters, PhD | March 10, 2010

Acknowledgments: Many thanks to Professor Assen Jablensky for comments on a draft of this article.

Throughout history, auditory hallucinations have been construed as evidence of communication with divine powers, although contemporary medical models often view them as undesirable and a sign of mental illness. In psychiatry, auditory hallucinations carry considerable weight in the diagnostic process, so there is a clear need for clinicians to have a greater understanding of the multiple facets of this phenomenon.

Auditory hallucinations are false perceptions of sound. They have been described as the experience of internal words or noises that have no real origin in the outside world and are perceived to be separate from the person’s mental processes.1 Auditory hallucinations have veridical perceptual qualities in the sense that individuals are often convinced of the objective reality of the experience. In most cases, auditory hallucinations are unintentional, intrusive, and unwanted. Affected individuals may or may not have insight into the hallucinations. A person with insight will acknowledge that the experience is abnormal and will report less interference with daily activities than a person with no insight.

This article provides an overview of the characteristic features of auditory hallucinations in psychiatric illness. The assessment and differential diagnosis of auditory hallucinations, recent theoretical frameworks, and treatment options are also briefly discussed.

Auditory hallucinations in diagnosis

Auditory hallucinations feature prominently in many psychiatric disorders. It has been estimated that approximately 75% of people with schizophrenia experience auditory hallucinations. These hallucinations are also relatively common in bipolar disorder (20% to 50%), in major depression with psychotic features (10%), and in posttraumatic stress disorder (40%).2

Not all auditory hallucinations are associated with mental illness, and studies show that 10% to 40% of people without a psychiatric illness report hallucinatory experiences in the auditory modality.3,4 A range of organic brain disorders is also associated with hallucinations, including temporal lobe epilepsy; delirium; dementia; focal brain lesions; neuroinfections, such as viral encephalitis; and cerebral tumors.5 Intoxication or withdrawal from substances such as alcohol, cocaine, and amphetamines is also associated with auditory hallucinations.

Hypnagogic and hypnopompic hallucinations are especially common in healthy individuals and occur during the period of falling asleep or waking up. The frequency of these experiences in the general population may be evidence of the existence of a symptomatic continuum, which ranges from subclinical experiences of psychosis to full-blown psychotic episodes with severe, unwanted, and intrusive symptoms.6

The phenomenological characteristics of auditory hallucinations differ on the basis of their etiology, and this can have diagnostic implications. People without mental illness tend to report a greater proportion of positive voices, a higher level of control over the voices, less frequent hallucinatory experiences, and less interference with activities than people who have a psychiatric illness.7,8

There is also evidence that delusion formation may distinguish psychotic disorders from nonclinical hallucinatory experiences.9 In other words, the development of delusions in people with auditory hallucinations significantly increases the risk of psychosis when compared with individuals who have hallucinations but not delusions.

By contrast, characteristics of auditory hallucinations that are thought to be more indicative of psychosis include8,10:

• Higher frequency of hallucinatory experiences

• Localization of voices outside the head

• Greater linguistic complexity

• Greater emotional response

• The extent to which patients believe that other people share this experience

Because of the multiple causes of auditory hallucinations, physicians must take care to obtain detailed histories from the patient, to assess for mood and psychotic symptoms, and to obtain collateral information. Laboratory tests and brain scans can also offer further clues to the underlying cause of the hallucinations.

Clinical assessment of auditory hallucinations

Patients are usually able to describe their hallucinatory experiences. The Schedules for Clinical Assessment in Neuropsychiatry1 provides a standard question that can be used in assessing symptoms: “Do you ever seem to hear noises or voices when there is nobody about, and no ordinary explanation seems possible?” A description of the experience in the patient’s own words is required for a positive rating.

Patients will often underreport their hallucinatory experiences because of the possible implications of further treatment action. Collateral information can be helpful, as is repeated interviewing. True auditory hallucinations must be differentiated from:

• Auditory illusions (misinterpretations of real existing stimuli)

• Vivid auditory imagery (under volitional control)

• Abnormal beliefs (such as a delusion of reference, when individuals report that other people are talking about them)

To help distinguish hallucinations from abnormal beliefs, ask whether the experience is closer to a real external voice than to a thought. Patients are usually able to make this distinction.

Characteristics, forms, and content of auditory hallucinations

The phenomenological complexity of auditory hallucinations was demonstrated long ago. A number of researchers have clustered the multiple phenomenological dimensions of hallucinations into a number of variables.10-12 The Table presents a characterization of the main phenomenological variables in auditory verbal hallucinations, as described by Stephane and colleagues.10

In summary, auditory hallucinations may be experienced as coming through the ears, in the mind, on the surface of the body, or anywhere in external space. The frequency can range from low (once a month or less) to continuously all day long. Loudness also varies, from whispers to shouts. The intensity and frequency of symptoms fluctuate during the illness, but the factor that determines whether auditory hallucinations are a central feature of the clinical picture is the degree of interference with activities and mental functions.

The most common type of auditory hallucinations in psychiatric illness consists of voices. Voices may be male or female, and with intonations and accents that typically differ from those of the patient. Persons who have auditory hallucinations usually hear more than one voice, and these are sometimes recognized as belonging to someone who is familiar (such as a neighbor, family member, or TV personality) or to an imaginary character (God, the devil, an angel). Verbal hallucinations may comprise full sentences, but single words are more often reported.

Voices that comment on or discuss the individual’s behavior and that refer to the patient in the third person were thought by Schneider13 to be first-rank symptoms and of diagnostic significance for schizophrenia. Studies show that approximately half of patients with schizophrenia experience these symptoms.14

A significant proportion of patients also experience nonverbal hallucinations, such as music, tapping, or animal sounds, although these experiences are frequently overlooked in auditory hallucinations research. Another type of hallucination includes the experience of functional hallucinations, in which the person experiences auditory hallucinations simultaneously through another real noise (eg, a person may perceive auditory hallucinations only when he hears a car engine).

The content of voices varies between individuals. Often the voices have a negative and malicious content. They might speak to the patient in a derogatory or insulting manner or give commands to perform an unacceptable behavior. The experience of negative voices causes considerable distress.12 However, a significant proportion of voices are pleasant and positive, and some individuals report feelings of loss when the treatment causes the voices to disappear.15

CASE VIGNETTE

Joel is a 46-year-old man who had been given a diagnosis of schizophrenia when he was 25. He reports hearing constant voices that command him to kill himself. He hears 5 different voices, all unfamiliar and male, that comment on his thoughts and actions. He also hears singing voices and has functional hallucinations through machinery and radio. Joel thinks some of the voices may come from his body (near his stomach). The voices interfere significantly with his life, but their frequency has decreased with medication.

The content of voices is usually highly personalized. The voices frequently express what the person is feeling or thinking and speak about his or her fears or worries. Psychiatric patients view the content of voices to be meaningful and to have personal relevance. The voices are interpreted to be the manifestation of real people or entities, and this experience contributes to the intense emotional response to the voices. The personalized content and subjective reality of voices play a role in the development of strong beliefs about the intent and power of voices, and a complicated and intense relationship frequently ensues between patients and their voices.16

CASE VIGNETTE

Mary is a 40-year-old woman with mild intellectual impairments and a long history of psychosocial stressors that include sexual abuse from the age of 10 and the loss of her children to state care. Mary reports hearing voices from the age of 11—“I thought it was normal.” There are 2 male and 2 female voices, primarily coming from inside her head. The voices command her to commit suicide and homicide, and she has difficulty in resisting—she once tried to jump in front of a bus. The voices are abusive and derogatory (“you are a pig,” “you’re worthless,” “why don’t you go kill yourself?”) and wake her up at night. Functional (through music) and nonverbal (birds chirping, glass smashing) hallucinations are also present.

Studies in cross-cultural psychiatry show that auditory hallucinations occur in similar forms in all societies around the world but that there are cultural differences in the content and interpretation of voices.17 In cultures where they are understood in the context of local beliefs and practices, auditory hallucinations have a positive value. This arises because the interpretation is embedded in a strong cultural framework that there is less emphasis on the distinction between imaginary and real experiences.

Occasionally, the semantic meaning plays a greater role than the acoustic characteristics of the voices. For example, some people may know what is being said even though the auditory hallucinations may only consist of nonverbal sounds.

Stress and other negative emotions

Stress has been implicated in provoking episodes of auditory hallucinations. For instance, the frequency of auditory hallucinations is particularly high in the context of bereavement and sensory deprivations. Studies that have examined auditory hallucinations in real-life situations using experience sampling methods show that negative emotional states contribute to the modulation of hallucination intensity. In a study by Delespaul and colleagues,18 participants with schizophrenia were asked to report experiences of hallucinations as well as negative mood states throughout the day for 1 week. In that study, self-reported anxiety levels were associated with, and often predicted, increased intensity of hallucinations. These findings suggest a causal association between levels of anxiety and hallucinatory experiences.

Auditory hallucinations, in turn, cause high levels of stress. The content and the experience of intrusive and personal voices can cause distress. Patients may feel that they are unable to escape from the experience, and this feeling is persistent and beyond voluntary control. Affective symptoms, including depression, anxiety, fear, and anger, have been found in 25% to 40% of patients.18-21 Some patients have committed suicide to escape from the voices.22 Further evidence for the role of negative mood comes from studies that show that the development of a depressed mood can predict the onset of a psychotic disorder and can increase the risk of transition from subclinical auditory hallucinations to a psychotic episode.20

Theoretical frameworks of auditory hallucinations

The exact processes that underlie auditory hallucinations remain largely unknown. There are 2 principal avenues of research: one focuses on neuroanatomical networks using techniques such as positron emission tomography and functional MRI. The other focuses on cognitive and psychological processes and the exploration of mental events involved in auditory hallucinations.

A common formulation suggests that auditory verbal hallucinations represent an impairment in language processing and, particularly, inner speech processes, whereby the internal and silent dialogue that healthy people engage in is no longer interpreted as coming from the self but instead as having an external alien origin. There is support for this language hypothesis of auditory hallucinations from neuroimaging studies. These show that the experience of auditory hallucinations engages brain regions, such as the primary auditory cortex and Broca area (Figure), that are associated with language comprehension and production. This suggests that hallucinatory experiences are associated with listening to external speech in the absence of external sounds.23,24

An explanation of why these experiences are not perceived as self-generated posits that audi-tory hallucinations arise because persons who have the hallucinations fail to distinguish between internal and external events. According to Frith’s self-monitoring theory,25 this arises because of deficits in internal self-monitoring mechanisms that compare the expected with the actual sensations that arise from the patient’s intentions. This abnormality also applies to inner speech processes and leads to the misclassification of internal events as external and misattribution to an external agent.

By contrast, Bentall and Slade26 have proposed that individuals with hallucinations use a different set of judgment criteria from healthy people when deciding whether an event is real, and they are more willing to accept that a perceptual experience is true. This bias essentially involves a greater willingness to believe that an event is real on the basis of less evidence.

According to the context memory hypothesis of auditory hallucinations, the failure to identify events as self-generated arises because of specific deficits in episodic memory for remembering the details associated with particular past memory events. These specific deficits in memory cause confusion about the origins of the experience.27-29 In support of this hypothesis, findings indicate that patients with auditory hallucinations tend to misidentify the origins and source of stimuli during ongoing events and during memory events.27-30 In addition, imaging studies have shown abnormalities in brain regions associated with memory integration in individuals with schizophrenia.31-33

The lack of voluntary control over the experience is a key feature of auditory hallucinations, which might explain why self-generated inner speech is classified as external in origin.33 According to this proposal, hallucinations are experienced when verbal thoughts are unintended and unwanted. Because deficits in cognitive processes, such as inhibitory control, are thought to render people more susceptible to intrusive and recurrent unwanted thoughts, studies have linked auditory hallucinations with deficits in cognitive inhibition.29

From a neuroanatomical point of view, deficits in the prefrontal cortex of patients with auditory hallucinations are consistent with the hypothesis of cognitive inhibitory deficits. Functional disconnectivity between the frontal and posterior areas of the brain in hallucinating patients may result in a lack of modulatory control of the frontal cortex over activities generated by the posterior brain areas so that events that arise from the temporal/parietal areas are not regulated normally.32,34

Recent advances in the neurosciences provide clues to why patients report an auditory experience in the absence of any perceptual input. Spontaneous activity in the early sensory cortices may in fact form the basis for the original signal. Early neuronal computation systems are known to interpret this activity and engage in decision-making processes to determine whether a percept has been detected.35 A brain system that is abnormally tuned in to internal acoustic experiences may therefore report an auditory perception in the absence of any external sound. Ford and colleagues36 recently suggested that patients with auditory hallucinations may have excessive attentional focus toward internally generated events—the brains of persons who have auditory hallucinations may therefore be overinterpreting spontaneous sensory activity that is largely ignored in healthy brains.

Cognitive impairments are not the only factors responsible for auditory hallucinations. Psychological factors such as metacognitive biases, beliefs, and attributions concerning the origins and intent of voices also play a critical modulatory role in shaping the experience of hallucinations.16,19,37 The role of environmental cues and reinforcement factors through avoidance strategies must also be incorporated in any explanations of auditory hallucinations. These factors do not explain how hallucinations occur in the first place, but they have strong explanatory power when accounting for individual differences in how the voices are experienced.

Treatment of auditory hallucinations

The presence of hallucinations does not necessarily imply a need for medical treatment if the experience is not intrusive and does not interfere with everyday activities. When treatment is required, antipsychotic medication is usually the treatment of choice in organic and psychiatric conditions. Clinicians should provide information and discuss the benefits and adverse effects of each drug, including a drug’s potential to cause symptoms that include the extrapyramidal syndrome and metabolic syndrome. In view of such adverse effects, clinicians need to monitor the physical health of patients regularly.

Few studies have compared the efficacy of different neuroleptic treatments, and hallucinations often persist despite intensive and prolonged psychopharmacological treatment.38 Another biological method that has been researched in recent years is repetitive transcranial magnetic stimulation (rTMS), which plays a role in altering neural activity over language cortical regions. Used as an adjunct to antipsychotic medication, studies show that rTMS can reduce the frequency and severity of auditory hallucinations in treatment-resistant cases.39,40

Many psychological treatments target the idiosyncratic ways that individuals respond to an abnormal perceptual experience, based on the understanding that this influences their coping strategies and emotional response.16,19,37 Studies show that some patients respond well to cognitive-behavioral therapy, where the focus is on evaluating and monitoring one’s perceptions, beliefs, and reasoning; promoting alternative ways of coping; and reducing distress. Anxiety reduction strategies are particularly effective in reducing the impact of voices.41-43 Evidence also suggests that a combination of family and psychological interventions, as well as medication, may be the most beneficial treatment for auditory hallucinations.44

There is increasing evidence that peer support groups (voice-hearers networks; http://www.intervoiceonline.org) can help alleviate the impact of voices. Self-help groups often encourage patients to take responsibility for their hallucinatory experience, to accept the voices, and to cope with them. A series of investigations showed that accepting hallucinations as an aspect of the normal human condition is one of the most difficult steps to take, but that the acceptance process and lack of resistance lead to successful adaptation to hearing voices and a change in the relationship with the voices.45

Because cognitive dysfunctions have been shown to underlie auditory hallucinations, cognitive deficits are becoming targets of treatment with cognitive remediation strategies, although these interventions are at a very early stage of development. By focusing on deficits found to be linked to auditory hallucinations, recent trials have focused on the convergence between theory and practice.46-48 For example, in their study, Favrod and colleagues48 taught patients techniques to help them recognize the source of the voices; beneficial outcomes were maintained at 1-month follow-up.

Conclusion

Auditory hallucinations are much more than false perceptions. The combination of personalized contents and interpretational processes contributes to a dynamic and emotionally charged experience that can be better described as a belief system rooted in a perceptual experience. Auditory hallucinations are most likely to arise because of an interaction between perceptual, cognitive, and biological vulnerability as well as affective factors and contextual influences. In addition, the interpretation of these experiences combined with delusional elaboration makes auditory hallucinations a complex and truly individualized phenomenon. Understanding their complexity can lead to useful insights for therapy.


Quinn O'Neill - Priorities, Evidence, and Integrity: A Plan for Humanity



At least one commenter called this the worst article ever on 3 Quarks Daily - that's pretty serious. Maybe I am also insane, since I actually took this article seriously and thought about what O'Neill's article. His suggested shared values are good, although I think 20 people would produce 20 different lists - (in order) human equality and sustainability, autonomy, collective well-being, and individual well-being.

I'm not sure the haters read the article - but O'Neill offered a summary of his basic points in an attempt to clarify his intent:

Just to clarify...

I'm not suggesting that devising a prioritized list of shared values would be easy, and I'm not proposing a plan for utopia.

I am making the following claims:

We need to know what our priorities are in order to make good decisions.

Evidence provides the most reliable foundation for decision making.

Integrity is important. There's no point in having values if they don't guide our behaviors.

Our decisions have important consequences. The choices that we make shape our circumstances.

Posted by: Quinn O'Neill
I agree with each of his points, maybe you will, too.

Priorities, Evidence, and Integrity: A Plan for Humanity

We humans have serious problems. Thousands of us starve to death every day, the planet is becoming progressively less habitable, and we're killing each other on a regular basis. Our way of life is detrimental to our well-being, and current trends don't bode well for posterity. It's time for change. I propose the following three-part plan.

Part 1: The Establishment of Clear Priorities

Our priorities guide our decision making, and our choices shape the world we live in. Every day, individuals, groups, organizations, and governments make decisions. We choose between what's healthy and what's easy, between what's kind and what's profitable, and between what's best for everyone and what's best for us. If optimizing collective well-being were most important to us, our decisions would lead us in this direction.

Our choices reveal priorities that we might wish to deny. It would appear that convenience is more important to us than sustainability, that our happiness is more important than that of future generations, and that people in our country are more important than people in other countries.

Selfish behaviors may serve the interests of individuals in the present, but they lead to a society that is undesirable for the majority. These behaviors can be attributed to a lack of integrity and the absence of clear priorities. If our priorities aren't clear to us, then our decision making will be undermined. So, we need to establish clear priorities.

What do we, as a society, value the most? Well-being? Reason? Autonomy? It's not just our values, but the way we prioritize them that will guide ethical decision making. For example, if we value well-being more than autonomy, making helmets mandatory for cyclists would be a good idea. If we place greater value on the freedom to choose, we might keep helmets optional, but take steps to promote their use. The prioritization dictates the strategy.

I suggest the following as shared values (in order): human equality and sustainability, autonomy, collective well-being, and individual well-being.

Equality and sustainability are linked. Sustainability can be considered equality over time, or among present and future generations. Both pertain to access to the determinants of well-being. However, establishing equality need not improve collective well-being. In order for everyone on the planet to enjoy the same standard of living, and have it be sustainable, people in the West would have to make sacrifices. We might have to temper our well-being, or adjust our notions of what constitutes well-being, for the sake of equality and posterity.

I put collective well-being ahead of individual well-being because the collective suffers when we all put our individual needs first. When we put the collective first, individuals generally benefit.

Many of us use plastic and other environmentally harmful materials because they're convenient. Our individual contributions to pollution make the environment less habitable and lead to environmental illnesses and cancers. If sustainability and well-being are important to us, then these convenient individual choices are indefensible. Small things, like turning off the water when we brush our teeth or using our own bags for groceries may make us feel like we're doing our part; but these things don't compensate for the damage we do when we routinely put our own needs ahead of sustainability whenever we have to choose between the two.

If we agree that convenience is more important than sustainability, then we should accept that humanity will eventually run out of essential resources, and we should stop complaining about environmental ills. If we agree that sustainability is more important to us, then we should be prepared to make sacrifices. We should acknowledge our true priorities and make choices that reflect them.

I've placed autonomy ahead of collective and individual well-being because I think that people should have the right to make choices that affect their own well-being. It's debatable whether free will truly exists, but the perception of autonomy, at least, is important to most of us. Efforts to encourage healthy choices shouldn't destroy this perception. Public health campaigns, marketing, and persuasion tactics are fair game, but force is not.

An important clarification must be made on the point of autonomy. Just as individuals can make decisions that affect themselves, autonomous groups can make decisions that affect their constituents. As long as a consensus is established, the collective can ethically make decisions that will affect its members. Obviously, we can and should establish rules. We can't apply them to people who are outside our own collective.

If we hold autonomy as one of our core values, then we have to respect the autonomy of others. We can't choose other nations' democratic leaders for them. We have to respect the consensus decisions of other nations even when we disagree with them. This applies to morality as well. Suppose we decide that abortion should be legal if performed prior to 20 weeks of gestation. And suppose another nation decides that abortion constitutes murder and bans the practice entirely. A third nation decides to allow "abortion" and sets a maximum age of one year, stipulating that the child must be anesthetized for the procedure. If we expect the nation that has banned abortion to respect our decision, then we have to respect the other nation's decision. We can't expect our autonomy to be respected if we aren't prepared to respect that of others.

International organizations provide a way of managing moral outliers while respecting autonomy. If the moral outlier was represented in the decision making process, a consensus on the issue allows for ethical intervention. If we happen to be the outlier, however, we need to respect the decision of the international community. We can't go riding over other countries on our moral high horse in violation of international law.

Respecting others' autonomy may be a bit frightening. People are capable of despicable acts and it would seem that, given particular circumstances, whole cultures can behave in despicable ways. But acts of great enormity have been committed by such a wide variety of peoples and cultures that the behaviors themselves can't be attributed to a specific race, culture, or religion. True sociopaths are much rarer than the perpetrators of these crimes, which are often nurtured by circumstance. Where desperation, violence, and oppression are the causes, they won't be the solutions.

Human beings have the same basic needs and desires. Even when it seems that we want different things, we want these things in order to meet very similar fundamental needs. Despite our tendencies to organize ourselves into groups, and form group and cultural identities, we really aren't all that different.

The prioritized list of values that I've suggested may not be perfect or complete. What's more important is that we give some thought to what our priorities should be and that we reach a consensus. Until this happens, we'll be like a group of people trying to row a sinking boat in different directions.

Part 2: Evidence-Based Decision Making

Once we've established priorities, consistent evidence-based decision making will help us to reshape our circumstances. The use of empirical evidence mitigates various forms of bias that can cloud our judgments. We'd never evaluate drug efficacy by simply asking a few people if they think the drug works. Similarly, we wouldn't want our leaders implementing programs and policies on the basis of their gut feelings. When making important decisions that affect everyone, reason and evidence are our best guides.

To optimize decision making we need to make a few changes in the way we use evidence. First of all, evidence-based practice needs to be more widely embraced. In the field of education, for example, many practices are rooted in tradition and theory, with little empirical support. Education is too important to be based on unsupported opinion and untested theory. Greater reliance on evidence would lead to more effective practices.

The relative strengths of different kinds of evidence are often conceptualized in a hierarchy, with less reliable, anecdotal evidence at the bottom and the double-blind, randomized controlled trial at the top. Other kinds of evidence (observational studies, for example) fall somewhere in between. This hierarchy is useful, but we can adhere to it too rigidly. The data from a single, poorly designed, randomized, controlled trial may not be as reliable as the data from multiple, well designed observational studies. The hierarchy is a guide. It doesn't replace the need for careful evaluation of study design and quality.

For complex decision making, the scope of evidence should extend beyond the quantitative paradigm. The hierarchy of evidence deals mostly with quantitative study designs, which emphasize objectivity and generate numerical data that can be analyzed statistically. There are other important kinds of evidence.

As Einstein said, "everything that can be counted does not necessarily count; everything that counts cannot necessarily be counted." If we aim to understand a foreign culture, statistical data and facts won't be nearly as helpful as living in the culture for a few years. If somebody else spends time immersed in the culture and wishes to share his or her understanding, statistics and empirical data won't be the best way to do this.

The complexity of relationships, the meanings of gestures and cultural practices, and the power of human emotions are best understood through lived experience, and best communicated through qualitative means. Qualitative studies tend to be subject to a greater variety of biases and may be less reliable in some ways. However, these methods constitute the best ways to generate knowledge in some very important areas. Their value should not be under-appraised.

Researchers from quantitative and qualitative backgrounds need to gain a better understanding of the methods and value of the other paradigm. We can't expect to get as complete an understanding of a complex issue if we limit the kinds of evidence we'll consider. A broader scope of evidence will provide a more reliable foundation for decision making.

Ideally, decision making should integrate evidence from multiple disciplines. The complexity of the factors that influence the things that we value demands the synthesis of knowledge from different fields. If we aim to develop strategies to optimize well-being, then we need to consider all of the determinants of well-being; they are numerous and interdependent. They include things like income, education, and access to health care.

Consider the case of dentistry, which in North America, is one of the most expensive professional programs. Inability to finance dental education excludes applicants from lower socioeconomic groups. Upon graduation, new dentists may carry debts exceeding $200, 000. The associated financial strain may impair their psychological health. The high cost of education demands a high salary, which translates into high fees and reduced access to care for lower income individuals. If individual and collective well-being are priorities, then an array of evidence would suggest that current practices need to be revised.

While evidence-based decision making is best, we do need to recognize the shortcomings of our evidence. Even the pinnacle of the hierarchy of evidence, the double-blind, randomized, controlled trial, is subject to bias. This is a good reason to generate and consider evidence about our evidence.

Studies have shown that industry-funded research is more likely to yield results that are favorable to the industry. This should shape the way we view such research. We ought to be a bit skeptical of industry offerings, particularly if independent studies point to a different conclusion. Evidence about evidence can also inspire new policies relating to funding (a requirement for disclosure, for example), or to modification of publication practices, like improvements in the peer review process.

Evidence not only enables us to identify choices that are consistent with our priorities, but prevents disastrous choices that we might make otherwise. Actions that are guided by incorrect assumptions and prejudices can be damaging. Too often, decisions are made on the basis of assumptions that are very wrong.

Part 3: Leadership and Integrity

We typically think of leaders as individuals who possess certain traits, like charisma, savvy and 'people skills'. They are the 'faces of change' and the people we follow. I argue that leadership is simply the force behind a desired change, with the change being determined by the priorities of the leader.

With clear priorities and optimal use of evidence, the changes that need to be made become both clear and possible. The kind of leadership that will bring about the changes that we want to see must come from us. We need to demand that our governments make choices that are consistent with our priorities, we need to lead by example, and we need to champion integrity.

Since it is tempting to put our own immediate needs first, we also need to devise strategies to instill and reinforce our priorities, and to reward integrity. It is crucial that these strategies be consistent with our priorities. When it comes to implementing a system for guiding ethical behavior, the end doesn't justify the means. The means is the end.