On psychedelic drugs as medicine.

On psychedelic drugs as medicine.

We are creatures of habit.

learning_to_walk_by_pushing_wheeled_toyLife would be excruciating if we were not.  Can you imagine: consciously remembering to breathe every few seconds?  Concentrating with the intensity of a toddler each time you stand and walk across a room?  Carefully considering the rules of grammar and conjugation when you stop to ask someone for directions?

Our brains zip through so much unconsciously.  Most of us can drift into reverie while driving and still go through all the motions correctly, stopping at red lights, making the appropriate turns, our mind set on autopilot.

We live, and we learn, and our brains constantly change – neurons reach out to form synaptic connections to one another.  Other connections wilt away.  The resultant network determines who we are.  More precisely, the pattern of connections determines which thoughts we are good at having.  Thoughts we’ve thunk before come easily.

But our propensity for habit can hijack our lives.  In David Foster Wallace’s Infinite Jest, viewers of the highly-addictive titular film are unable to think of anything but watching it again.  One taste and you’re hooked!

otto_wegener_vers_1895_2Or, in an example closer to most humans’ experience, Marcel Proust writes of the way our shared experience with a lost love causes the brain to ache each time a similar experience must be forded alone.  Over and over we hurt: going to sleep alongside her was a habit.  Chatting in the evening was a habit.  Walking to the store hand in hand was a habit.  The brain is still wired such that it could effortlessly zip through these tasks, but… she is gone.

In an example that is – unfortunately! – increasingly relevant today, William Burroughs writes that powerful opiates do not hook users right away.  It takes many recurrent episodes to rewire the brain.  In his (overly cavelier) words:

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Painting by Christiaan Tonnis.

The question is frequently asked: Why does a man become a drug addict?

The answer is that he usually does not intend to become an addict.  You don’t wake up one morning and decide to be a drug addict.  It takes at least three months’ shooting twice a day to get any habit at all.  And you don’t really know that junk sickness is until you have had several habits.  It took me almost six months to get my first habit, and then the withdrawal symptoms were mild.  I think it no exaggeration to say it takes about a year and several hundred injections to make an addict.

. . .

You don’t decide to be an addict.  One morning you wake up sick and you’re an addict.

And then, depression.  To perceive the world a shade darker than it ought to be comes easily… to someone who is depressed.  A depressed person’s brain has been rewired through perhaps a lifetime of rumination and pain.  Suicidal ideation gets easier and easier and easier… unless it goes too far, and then it becomes impossible.  Dead matter doesn’t think.

thenightmare
The Nightmare by John Henry Fuseli.

Cognitive behavioral therapy attempts to use the brain’s own habit-forming capabilities to battle depression.  Because today’s depressed thoughts enable tomorrow’s depression, a conscious effort to find joy and beauty today could ease tomorrow’s struggle.  Phrases like “virtuous cycle” are bandied about.

My wife, each evening, asks me to list four good things that happened during the day; if we forget the ritual through a harried week or two, it’s difficult to start again.  I lay in bed, pondering, “What was good about the day?”  Which should always be easy.  I have two loving children whom I am graced to spend time with.  I am not in jail.  I have a warm, safe place to sleep.  I have enough to eat.  I live near phenomenal libraries.

But the habit of depression digs the mind into a rut.

lsd-clinical-trial-bottleWhich has caused several researchers to wonder, “Would cognitive behavioral therapy work better if a patient could be jolted out of the rut first, then trained in a new virtuous cycle?”  We have access to several potent chemicals that wrest the brain out of its routines.  Psychedelic drugs like lysergic acid diethyl amide, dimethyl tryptamine, and psilocin are powerful beasts.

Which is not to say that, if you’re feeling sad, you should go find that raver dude you know and ask what he’s holding.  For one thing, most psychedelics are illegal in the United States.  This contributes to the dearth of high-quality clinical information about their uses – obtaining permission to run clinical trials with Schedule I compounds is difficult, and drugs can’t be downgraded from Schedule I status without reams of data from clinical trials.  Nonsensical bureaucracy at its best!

Plus, high-quality clinical trials must control for the placebo effect – neither patients nor doctors should know whether an individual is receiving the treatment or a control.  But I’m guessing most recipients recognize the difference between an injection of DMT or saline.  Did your visual field suddenly fragment into geometric patterns?  Did you feel an out-of-body sensation akin to alien abduction?  Did your memories begin to unfold like interlocking matryoshka-doll puzzle boxes?  Those are sensations I rarely experience from salt water.

LauretaAnd the sheer power of psychedelic drugs also makes them dangerous.  Dr. Lauretta Bender, whose least harmful contribution to science was the idea that emotional disturbances could be diagnosed by asking a child to reproduce pictures of geometric shapes, assumed that LSD would cure autism.  If she’d been right, this sort of baseless cognitive leap would’ve been heralded as brilliance.  She injected large doses into the muscles of children as young as five.  Daily.  When that “cure” proved insufficient, she combined it with electroconvulsive therapy: high currents to overwhelm their little brains.

Enforced acid trips in nightmarish environs of total control can ruin lives.

Especially since Dr. Bender was diagnosing autism in routinely-abused orphans based on symptoms like “avoids eye contacts” and “difficulty forming trusting relationships.”

5009548522_6701801dcb_oAcid trips can end lives, too.  At least one involuntary research subject ensnared in the CIA’s efforts to use LSD as mind-control reagent committed suicide.  And there are innumerable horror stories of murders committed by people mired in psychedelic trips.  Then again, most murders are committed by people who haven’t taken psychedelics.  In Ronald Siegel’s Intoxication he writes that:

Many bad trips are a function of personality; not everybody is a good subject for a mind-altering experience.  And even experienced users can have a bad day.  … Harold, a veteran of one thousand LSD trips, wanted to volunteer to be a psychonaut but he had a history of violence, both on and off the drug.  “Ever since I was small,” confessed Harold, “I go ape when I’m bothered.”

.. [a grim description of Harold murdering two hikers outside Santa Barbara in 1984 follows.  Yes, Harold had “drank some beer, smoked a little marijuana, and swallowed a few amphetamine tablets along with a full dose of LSD.”  But he’d also “been bothered by financial problems.  He was passing bad checks and had failed to make child-support payments to his ex-wife.”  So I’m not sure the drugs were at the root of his malaise.]

Cases like Harold’s tend to confuse the issue of intoxication and violence.  Violent people are often intoxicated but the violence is usually rooted in the personality, not the drug.  . . . What seems difficult for us to understand is that despite overt behaviors, the subjective experience can still be fun.  In other words, one’s inner feelings and sensations can be under the influence but such influence may not extend to outside acts in the real world that remain chillingly sober.  This is most difficult to accept if users are obviously intoxicated when they commit criminal acts.  The subjective intoxication can remain an enjoyable experience, despite our desire to blame the fires inside for the destruction outside.

Used incorrectly, psychedelic drugs are awful.  They disrupt habits, seeming to dissolve the mental filters that allow humans to function despite constant bombardment by thoughts and memories and myriad sensations from the world.  This newfound wonderment & reset can help, of course, but for someone in a bad place, it can be horrible.

mdma1Then again, for someone with post-traumatic stress disorder, the world might be horrible already – even if the chance that psychedelics could help were low, they’d be worth investigating.  Thankfully, the FDA finally granted permission for a trial to be run on the use of methylene dioxy methamphetamine (ecstasy – when I was a TA for undergraduate organic chemistry at Stanford, I wrote most of the quizes.  After they learned about acetal protection of ketones, all 200 or so pre-meds wrote out a partial synthesis for MDMA.  The reactants and products were unnamed, so I don’t think the students or the other TAs noticed) to treat PTSD .

In other experiments, LSD and psilocin seem to help terminal cancer patients overcome depression.  Ayahuasca is also being tested as a treatment for depression and those seeking to quit substance abuse (peyote has long been used for the latter), although these studies are far from the FDA clinical ideal.

Many people, as they live, drift into routine and no longer consider the implications of their actions.  I’m well aware that drugs can wreck lives, but sometimes we need a jolt.  I wish people weren’t shunted to jail for drug addiction – and obviously the dudes in there wish they were almost anywhere else – but a surprising number are grateful that something interrupted their habits.  Junkies don’t want to look back on a wasted life, either.

pills-750x400I’m not super keen on the rich & entitled using psychedelics for fun & games, and psychedelics certainly should not be used often.  But these molecules, treated respectfully, can heal damaged lives.

Even in the ostensibly healthy, psychedelics can do good.  Does the way you choose to spend your time benefit the world?

On Akerlof & Shiller’s ‘Phishing for Phools’ and the increasing heterogeneity of the United States.

On Akerlof & Shiller’s ‘Phishing for Phools’ and the increasing heterogeneity of the United States.

At the public library the other evening, N was playing trains alongside another child. In the chair-slumped way of parents too tired to fully engage with the world, that boy’s father and I began to talk. He was a bit older than me and sounded to be well traveled, having worked for a few years in many different countries, but he’d spent time in Bloomington when he was young and decided this would be a good place to raise his own kid.

I told him I liked our little town, too. I said that it seemed much better than where K & I were living in California. Silicon Valley is a bit expensive, for one thing, and I repeated K’s phrase: “Just because people eat yogurt and do yoga doesn’t mean they’re nice.”

I posited that people are friendlier in Bloomington than in northern California.

The boy’s father shrugged. He said, “There’s an old Chinese proverb about that. Two travelers walking different directions down the road, each passes by an old man sitting on a fence. The first traveler stops to talk, asks, ‘What are people like in the town ahead?’

“The guy on the fence says, ‘What’d you think about the people in the town you just left?’ And the traveler says, ‘Man, they were all assholes!’ So the old guy says, ‘The people in the town ahead, they’re pretty much the same.’ And the traveler keeps walking, looking bleak.

“Soon the next traveler, the one going the other way, reaches the old man and stops. He asks the same thing, says, ‘What are people like in the town ahead?’ And the old man says back to him, ‘What’d you think of the people in the town you just left.’ And the traveler says, ‘Those people were great!’ So the old guy says, ‘Well, the people in the town ahead, they’re pretty much the same.’”

It’s a charming little parable. Our attitude as we approach each new situation colors how we’ll perceive it, and that, in turn, changes how people will respond to us. The majority of people are pretty similar everywhere, so we may as well calm down and accept them for the flawed creatures they are.

At the same time, though … people certainly aren’t identical everywhere. If you read much about politics, it doesn’t take long to notice some stark differences between northern California and southern Indiana … I have to admit, northern Californians are nicer politically. It was only interacting face-to-face that they seemed unpleasant.

In the United States as a whole, the differences between people living in different regions have been steadily increasing. You can see this in many different ways, by looking at demographics, or voting records, or income distributions, or religious beliefs, etc.

k10534One consequence of this heterogeneous distribution of people across the United States came up while I was reading George Akerlof and Robert Shiller’s Phishing for Phools. If you enjoy pop economics, or if you’re simply frustrated with all the ways the world seems stacked against good decision-making, this is a charming book. The tone is light-hearted and self-depreciating. Not even economists are the unflappable rational decision-makers that their theories assume us all to be, and Akerlof & Shiller include several anecdotes about times they’ve been duped. It’s an easy book, too. Their analysis is lucid and accessible.

I could’ve used fewer explanatory metaphors, though. I’d like to think that most people can understand that an institution known for high-quality financial products can use that good reputation — once — to sell a whole bunch of crummy ones. But Akerlof & Shiller repeatedly mention that this is equivalent to a farmer known for high-quality avocados duping his customers into buying rotten ones. By the nth time a reference to a financial product was “clarified” by stating that agencies like Standard & Poor’s were rating rotten “avocados” (i.e. rotten derivatives) as triple-A, I found myself urging them to get on with it.

Maybe I’m just a curmudgeon. Maybe you’re less likely than I am to ‘zerk out at superfluous analogies. I assume part of my problem is that I’m a slow reader — because each word carries an appreciable cost, I like knowing that they all need to be there.

The basic premise behind Phishing for Phools is quite nice, though. The central idea is related to the “no arbitrage” condition in economics. “No arbitrage” means there’s no opportunity to make money by risk-free buying and selling. It means that in fantasy economics land, you won’t have situations like a grocery store selling avocados for a dollar each and people at an adjacent farmer’s market buying identical avocados for two dollars each. In that scenario, you could earn a profit by purchasing grocery store avocados and immediately re-selling them at the farmer’s market.

avo

In the world of stocks and bonds, “no arbitrage” means you won’t simultaneously find people selling a stock for five dollars a share and others buying it at ten. Their valuations should converge, eliminating the opportunity for a middleman to profit.

In economics, the fantasy is that everyone’s valuations converge instantly. In the real world, of course, that isn’t true. The “no arbitrage” condition still holds for most investors, but only because somebody else with a supercomputer adjacent to the stock exchange is placing automated orders moments before other traders, effectively taxing everyone else billions of dollars a year.

Flash Boys pbk mech.inddThis is a pretty big deal, actually. If you’re at all interested in the stock market, you should read Michael Lewis’s Flash Boys (or, if you’re too busy, the much-condensed version he prepared for the New York Times Magazine) about high-frequency trading. It’s an incensing and still-urgent story — the S.E.C. still hasn’t allowed IEX, the trading platform that uses a whole bunch of superfluous fiber optic cable to slow down everyone’s orders and thereby prevent high-speed traders from taxing other investors, to register as a national securities exchange.

A major problem is that members of the S.E.C. bounce back and forth from employment at the companies merrily taxing all the chumps (i.e., you and me). They have a strong disincentive to make things fair. In a fair world, they and their friends would be less able to siphon off other people’s money.

Anyway, the underlying principle of the “no arbitrage” condition is that, if there were an opportunity for easy profit, someone already would have taken it. In Phishing for Phools, Akerlof & Shiller argue that the world is full of traps — like unwholesome food engineered to be delicious — for a similar reason.

For instance, selling Oreos is a good way to make money. Oreos are delicious! They’re so easy to eat! If Nabisco hadn’t invented them, someone else would’ve. Because bad ideas vanish and the good ones persist, the world eventually fills up with insidiously enticing products like Oreos and french fries and smartphones. Which leaves us, the irrational emotional consumers of the world, beset by impulses we know we should resist … but often can’t.

Akerlof & Shiller’s combine behavioral economics (the study of consumers as irrational decision-makers) and a “survival of the fittest”-like idea about the steady enrichment of effective strategies for manipulating consumers. This is a lovely framework for understanding why, clever as we are, humans have created a world that suits our real interests so poorly. Nobody’s happy to be at a party where everybody is just staring at their phones.

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You should totally see Removed, a photography project by Eric Pickersgill, where phones are edited out.

Not all of Akerlof & Shiller’s reasoning stands up to close scrutiny, though. I want to highlight one example because, embarrassingly, as soon as I read it I realized that I had made the exact same misguided claim in a recent essay. Whoops!

From Phishing for Phools:

It is now estimated that one out of every nine school-aged children and adolescents in the United States has been diagnosed with attention-deficit hyperactivity disorder (ADHD). Ritalin, the drug that is most commonly prescribed, is powerful — its long-term side effects unknown. But we also know that many diagnoses are almost surely wrong, one way or the other, since the diagnosis rate for Kentucky (15 percent) is more than three times that for Nevada (4 percent); and among populous states, the diagnosis rate for Texas (9 percent) is half again as big as that for California (6 percent).

At first glance, their logic seems reasonable. Diagnosis rates are different between two regions, so either some doctors are missing cases or else other doctors are labeling too many kids as having ADHD. Or both.

This is quite similar to an argument I made about autism recently. I wrote that the difference in autism prevalence between states suggests we still aren’t diagnosing all cases.

oopsMy reasoning was flawed.

The United States is heterogenous, with people self-selecting where to live. More and more of us end up living near people who are similar to us, whether because that’s where jobs are or because it feels comfortable to be surrounded by like-minded individuals. So it’s actually quite reasonable for ADHD and autism to be heterogenously distributed as well.

Hans Asperger was right in that many of the traits associated with autism are beneficial. Attention to detail, mathematical acuity, innovative language usage … those are all good things. But there seem to be genetic correlates to autism (even some of the “environmental” factors, like high exposure to prenatal testosterone, are partially under genetic control), and although we don’t know what these genetic factors are, it seems that higher doses can increase autism severity.

A bit like sickle cell anemia that way. A low genetic dose protects you from malaria with mild drawbacks. A high dose leaves you chronically fatigued.

A low dose of the (unknown, but presumed to exist) autism genetic factors might help a child with logical thinking and puzzle solving. A high dose might make the barrage of sensory information from the outside world so overwhelming that it becomes difficult to speak.

If many people with low doses of those genetic factors decided to move to the same place and interbreed (you could say “start families” instead, but isn’t the word “interbreed” funnier?), more children born there should have autism than elsewhere.

You wouldn’t necessarily see this if the genetic factors had little effect on personality. Cystic fibrosis is genetic too, but because the carrier genes are mostly silent, and in any case don’t affect brains, there’s no reason why many people with cystic fibrosis genes would move to the same place. Or be exceptionally likely to fall in love with each other.

Genetic factors for autism probably do affect the brain, though. This is why children whose grandfathers were engineers are much more likely to be autistic.

In the United States, it’s reasonable to expect that genetic factors contributing to autism would be concentrated in regions with the best employment opportunities for engineers and other technically-minded individuals. In my erroneous previous post, I wrote that it was suspicious for New Jersey to have a much higher autism prevalence than Alabama … but there are many more jobs available for technically-minded people in New Jersey.

Not only might people with these genetic factors want to move to similar places, but they may be more likely to form relationships with each other than with non-carriers. There’s a lovely description of this phenomenon (“assortative mating”) in Simon Baron-Cohen’s Scientific American article, “Autism and the Technical Mind.”

As more people decide to marry someone they consider a friend, with whom they share interests (e.g. lawyers marrying lawyers, doctors marrying doctors, which has been lamented for its effect on income inequality but probably also leads to happier couples than pairings between a wealthy careerist and arm candy), it becomes more likely for both parents to carry a gene that influences the brain in a peculiar way.

Both K and I are the sort of people who became giddily happy when told that the math department at her high school would start photocopying the mathlete exams for us so that we could solve them on our own time. This sort of shared interest is part of why we’re good enough friends to have gotten married. And, if there were a gene that conferred a love of mathematics, our daughter would’ve had a high chance of getting two copies of it.

I don’t think Akerlof & Shiller’s example is as egregiously illogical as mine was, by the way. I think ADHD is probably also correlated with personality, and people with ADHD are probably better at some types of work than others, but (given our current imperfect understanding of both conditions) these effects are probably weaker than with autism. I wouldn’t be shocked if people with ADHD were concentrated in certain areas of the U.S., but I’d expect a heat map of autism genetic factors to show more dramatic geographic hot spots. I can’t think of a reason why a particular place would hoover up people with ADHD (do they have a cool name for themselves yet, like “the multifocused” or something?) the way Silicon Valley does with geeks.

On David Lancy’s The Anthropology of Childhood, and violence against women (again!), and proscriptive parenting advice.

On David Lancy’s The Anthropology of Childhood, and violence against women (again!), and proscriptive parenting advice.

Despite being my family’s primary daytime parent, I’ve read extremely few parenting guides.  Zero, as it happens, unless you count Everywhere Babies (if you’re interested, here is a previous post where I discussed this baby-wrangling treasure) or Far from the Tree.

51E2pM00dFLPersonally, I count Andrew Solomon’s Far from the Tree as a parenting guide.  I was very nervous about the prospect of having a kid.  I worried that I’d be a rubbish parent.  I worried that I’d have an unmanageable kid.  Then I read Far from the Tree, and I stopped worrying.  K & I decided to forgo prenatal genetic testing; Solomon had convinced me that we could love whomever we received.  And he taught me the one essential lesson I needed to set me on my journey to becoming at least a tolerable (I hope!) parent: relax.

I’d recommend that any parent-to-be (or parent, or person, honestly … it’s a lovely book) read Far from the Tree.  But for the moment, here’s my favorite passage from the book, one that both stresses the importance of accepting what happens and accepting people, including your own children, for who they are:

People of higher socioeconomic status tend toward perfectionism and have a harder time living with perceived defects.  One French study said baldly, “The lower classes show a higher tolerance for severely handicapped children.”  An American study bears out that conclusion, inasmuch as higher-income families are “more apt to stress independence and self-development,” while lower-income families emphasize “interdependence among family members.”  Better-educated more-affluent families are more likely to seek placement for their children, and white families do so more often than minority families, though disturbingly high numbers of minority parents lose children to foster care.  I did back-to-back interviews with a white woman who had a low-functioning autistic son, and an impoverished African-American woman whose autistic son had many of the same symptoms.  The more privileged woman had spent years futilely trying to make her son better.  The less advantaged woman never thought she could make her son better because she’d never been able to make her own life better, and she was not afflicted with feelings of failure.  The first woman found it extremely difficult to deal with her son.  “He breaks everything,” she said unhappily.  The other woman had a relatively happy life with her son.  “Whatever could be broken got broken a long time ago,” she said.  Fixing is the illness model; acceptance is the identity model; which way any family goes reflects their assumptions and resources.

A child may interpret even well-intentioned efforts to fix him as sinister.  Jim Sinclair, an intersex autistic person, wrote “When parents say, ‘I wish my child did not have autism,’ what they’re really saying is, ‘I wish the autistic child I have did not exist, and I had a different (non-autistic) child instead.’  Read that again.  This is what we hear when you mourn over our existence.  This is what we hear when you pray for a cure.  This is what we know, when you tell us of your fondest hopes and dreams for us: that your greatest wish is that one day we will cease to be, and strangers you can love will move in behind our faces.”

Once I had Solomon’s advice in hand (& re-typed & ready to share with you, dear reader!), why would I bother reading another parenting guide?  Any time I come to a situation that Solomon didn’t address, I simply close my eyes and imagine what a cave person attempting to raise a daughter to participate in our technologically-magical information-based economy would do.  Most of the time that imagined cave person (me, in fact) would simply feel perplexed (you’re telling me that your telephone is also a camera??), but sometimes cave dad would probably coo & pat his daughter’s belly, or else read her another book.

I love learning, though.  If I had access to a good book on parenting, I’d read it!  I simply assumed that I wouldn’t like most of the ones I could find at the bookstore.

onlybabybookThat’s why I was so excited when I read Michael Erand’s New York Times article earlier this year, titled “The Only Baby Book You’ll Ever Need.”  Here, let me quote a few lines from the introduction:

Professor Lancy, who teaches at Utah State University, has pored over the anthropology literature to collect insights from a range of culture types, along with primate studies, history and his own fieldwork in seven countries.  He’s not explicitly writing for parents.  Yet through factoids and analysis, he demonstrates something that American parents desperately need to hear: Children are raised in all sorts of ways, and they all turn out just fine.

That sounds exactly like what I’d enjoy reading!  A book about parenting that’s descriptive, not proscriptive.  And I’ve loved reading pop anthropology books ever since paying a quarter for a lovely hardcover edition of Desmond Morris’s The Naked Ape at a library book sale in Evanston, Illinois.

CaptureI have to assume that the first edition of the recommended book, David Lancy’s The Anthropology of Childhood: Cherubs, Chattel, Changelingswas very different from the current second edition, which was published in February of this year.  Because the book I read was intensely proscriptive.  Yes, Lancy documents a wide variety of parenting strategies.  But he also makes abundantly clear his opinion that those parenting strategies would not be appropriate in our culture.

I didn’t mind.  Lancy’s book is quite good, and his ideas about what makes good parenting align closely with my own.  But someone who’d read the Times article might expect the book to be very different from what it is.

As with Dorothy Dinnerstein’s The Mermaid and the Minotaur (would you count a work of feminist philosophy as a parenting guide?  If so, perhaps I’d read one after all.  My previous post about Dinnerstein’s book and parenting is here), Lancy’s foremost prescription is equality — most conspicuously, since not all cultures have multiple races, castes, or tiers of wealth, he’s referring to gender equality:

There is a world in which children almost always feel “wanted” and where “there is no cultural preference for babies of either sex.”  Infants are suckled on demand by their mothers and by other women in her absence.  They are indulged and cosseted by their fathers, grandparents, and siblings.  Children wean themselves over a long period and are given nutritious foods.  They are subject to little or no restraint or coercion.  Infants and toddlers are carried on long journeys and comforted when distressed.  If they die in infancy, they may be mourned.  They are rarely or never physically punished or even scolded.  They are not expected to make a significant contribution to the household economy and are free to play until the mid to late teens.  Their experience of adolescence is relatively stress free.  This paradise exists among a globally dispersed group of isolated societies — all of which depend heavily on foraging for their subsistence.  They are also characterized by relatively egalitarian and close social relations, including relative parity between men and women.**

  ** Thinking of Malinowki’s ethnography of the Trobriand Islanders, I’m tempted to argue that any society with conspicuous gender parity is likely to be a paradise for children.

And shortly thereafter, Lancy makes explicit that many of the parenting practices he’s documenting are horrible.  For instance, misogyny is rampant throughout the world, to such an extent that a significant fraction of female children are never even born.  This is rotten, & if enough parents choose to do this they’re even dooming their own (male, presumed heterosexual) children.  There parallels between this behavior and choosing not to vaccinate a child with a healthy immune system — in both cases, children are doomed if all parents make the same selfish choice, either because there won’t be enough women for the next generation to form families, or because the herd immunity relied upon to protect freeloaders will be lost.

Both China & India, where sex-selection of unborn children is rampant, are attempting legislative correctives.  In China, they’ve outlawed the practice, and in India they’ve instituted monetary incentives for female progeny… although that is conceptually problematic as well.  Here’s Jean Dreze & Amartya Sen from their book An Uncertain Glory:

j10175To illustrate, consider the recent introduction, in many Indian states, of schemes of cash incentives to curb sex-selective abortion.  The schemes typically involve cash rewards for the registered birth of a girl child, and further rewards if the girl is vaccinated, sent to school, and so on, as she gets older.  These schemes can undoubtedly tilt economic incentives in favour of girl children.  But a cash reward for the birth of a girl could also reinforce people’s tendency to think about family planning in economic terms, and also their perception, in the economic calculus of family planning, that girls are a burden (for which cash rewards are supposed to compensate).  Further, cash rewards are likely to affect people’s non-economic motives.  For instance, they could reduce the social stigma attached to sex-selective abortion, by making it look like some sort of ‘fair deal’ — no girl, no cash.  The fact that the cash incentives are typically lower for a second girl child, and nil for higher-order births, also sends confusing signals.  In short, it is not quite clear what sort of message these cash incentives are supposed to convey about the status and value of the girl child, and how they are supposed to affect social attitudes towards sex-selective abortion.  As mentioned earlier, the workings of social norms is critically important in this kind of area of values and actions, and it is important to think about the possible effects of cash transfers on social norms and their role, and not just about economic self-interest.

Paying parents for their misfortune of raising a girl still perpetuates misogyny.  And setting minimum standards on her care (you receive money if she’s vaccinated, if she attends school) likely results in that bare minimum being given.

And now, let me get back to Lancy’s horror:

More commonly, we find that the infant’s sex is highly salient in determining its fate.  Some years ago, I came across a United Nations report, on the cover of which was a picture of a mother holding on her lap a boy and a girl of about the same age, possibly twins.  The girl was skeletal, obviously in an advanced state of malnutrition, the boy robust and healthy.  He sat erect, eyes intent on the camera; she sprawled, like a rag doll, her eyes staring into space.  That picture and what it represented has haunted me ever since.

That’s not a value-less scientific description.  Which is fine.  I’m happy that Lancy’s book (the current edition, at least) is proscriptive.  Because Erand’s article, which included lines such as, “The book does not render judgments, like other parenting books we know,” also mentioned tidbits like, “In Gapun, an isolated village in Papua New Guinea, children are encouraged to hit dogs and chickens, and to raise knives at siblings.

Really?  David Lancy doesn’t judge parents who give their children unsupervised access to knives?

Oh, wait.  He does.  He thinks that letting kids play with knives is bad.  From The Anthropology of Childhood:

On Vanatinai Island in the South Pacific, “children … manipulate firebrands and sharp knives without remonstrance … one four year old girl had accidentally amputated parts of several fingers on her right hand by playing with a bush knife.”

And, later, Lancy is even more explicit.  Yes, different cultures use different parenting strategies.  To prepare a child for relatively simple life in an agrarian village — especially if you give birth to eight children and will be happy if only four of them survive — it’s fine to ignore them and expect them to learn what they need to know by watching their elders.  But attempting equivalent parenting strategies in our culture would, in Lancy’s opinion, invite disaster:

At the outset of this chapter, I set up a juxtaposition.  One view holds that, to succeed in life, children require the near-full-time attention of a mother who treats childrearing as a vocation and prepares herself assiduously.  A contrary view is that this is a task best shared among a variety of individuals, a village.  What can we conclude?  I would argue that, to prepare a child for life in the village, it is neither necessary nor an efficient use of scarce resources to put the burden on any one individual.  However, to prepare a child for the modern world, spreading the responsibility among a variety of individuals — none of whom is in charge — invites disaster.  Hillary Clinton, in It Takes a Village, tries to apply the village model to the modern situation.  She argues for improvements in schools and social service agencies, an increase in library and playground facilities, and after-school programs — among other things.  All these proposals are helpful, but all these agents — teachers, librarians, playground supervisors, Boys & Girls Club volunteers — cannot, collectively, substitute for a dedicated, resourceful parent.  They are not related to the child and, in our society, the village is not responsible.  The parent is.  At best, these agents can only assist the parent in fulfilling their plan for the child.

Having said that much, I want immediately to disavow any claim that this task requires the full-time ministrations of the child’s biological mother.  There is overwhelming evidence — not reviewed here — that fathers, adoptive parents, lesbian partners of the biological mothers, and grandparents can all do a fine job.  Any of them, or the child’s mother, can and usually do avail themselves of an array of supplementary caretakers.  A working mother, in particular, may well bring home cultural, intellectual, and, certainly, economic resources that a non-working mother cannot provide.

So parenting in contemporary society is at least somewhat like physics, as it is tough to insure the child’s future success and a close, lasting filial relationship.  But, ultimately, we come full circle in that, as long as a reasonably competent and caring individual is in charge, the more loving, intelligent, and dedicated helpers surrounding the nest, the better off the twenty-first-century child will be.

Lancy writes that those village children’s lives are often bad, and that imported practices from Western nations have made them even worse:

Numerous studies have shown the deleterious effects on children’s health in the agriculturalist’s pursuit of the “production” strategy.  However, as the land is brought fully into cultivation, population-limiting mechanisms (such as the post-partum sex taboo) should develop to curtail further growth.  And this seems to have happened in many, many cases.  However, Western influence in the past hundred years seems to have dismantled these mechanisms, including, especially, abortion and infanticide.  Improved nutrition and healthcare for mothers has no doubt brought benefits.  But missionary efforts to stamp out “pagan” practices like polygyny also undermined the post-partum taboo on intercourse, even while they simultaneously blocked the introduction of modern contraceptives.  Additionally, “fashion” and commercial interests pushing infant “formula” have drastically reduced the number of infants being breastfed [breastfeeding is often an effective contraceptive.  Also, my computer marks “breastfed” and “breastfeeding” as spelling errors.  Yeah paternalistic misogyny!].  The result has been, in many parts of the world, population growth outstripping opportunities for either employment or improved food production.

Lancy even ends The Anthropology of Childhood with a powerful statement about economic & medical ethics.  Indeed, it’s difficult to read this as being anything but proscriptive:

Even though we recoil from discussions of children as chattel, our current policies, in fact, turn children into commodities with a precise dollar value.  Effectively, we embrace the notions that anyone can have a child, everyone can have as many children as they want, infertility can be circumvented, and the fetus is human and deserves whatever measures are available to keep it alive, regardless of any handicaps or defects it may harbor.  The net result of our mindset is that the marketplace decides the fate of children.  In poor countries, food shortages mean many potentially sound children will suffer malnutrition and neglect.  Wealth in the “North” that might be sent “South” to vaccinate, educate, and feed these children is, instead, spent at home on expensive technologies and caretakers to keep alive children whose quality of life is non-existent.  While sick, premature babies born to the well-off will survive through “miracles” of modern medicine, the poor will lose their otherwise healthy children to preventable diseases.

To me, this is a sensible proscription to make — it is similar to my own reasoning for abandoning a career in biomedical research.  Medical spending will continue to spiral out of control if we focus on preserving life at all costs with no concern for quality of life, and by wasting that money we perpetuate egregious harm through economic hardship.

So, I was thrilled to read David Lancy’s book.  I assume you’d like it too, given that you still seem to be reading my post about it.

Just, don’t go into it expecting a descriptive work devoid of value claims.  Because that’s not what you’re getting, at least not if you read the current edition.

And I’m still trying to figure out why Erand had such a different impression.  Because, sure, it’s possible that the first edition was extremely different.  But I think the confusion is more likely related to a point I made at the beginning of this essay: when I imagine myself as a cave person trying to raise his daughter, I have to imagine that cave dad raising his daughter for our world.  Not his world.

It’s a common mistake when people discuss human evolution.  Like, paleo diets?  Seems like a reasonable idea, trying to eat what humans evolved to eat.  But humans also evolved for constant motion & early death.  If that’s the way you’re planning to live, then, sure, you’ve got a valid argument for eating that way.  If not, the argument seems much less compelling.

Here’s where the problem comes from in Erand’s piece.  He writes:

caIn the ‘pick when ripe’ culture, babies and toddlers are largely ignored by adults, and may not be named until they’re weaned.  They undergo what he calls a ‘village curriculum’: running errands, delivering messages and doing small-scale versions of adult tasks.  Only later are they ‘picked,’ or fully recognized as individuals.  In contrast, in ‘pick when green’ cultures, including our own, it’s never too early to socialize babies or recognize their personhood.

But, Lancy makes clear why “pick when ripe” cultures made the choices they did.  As in, huge infant mortality meant that high-investment parenting would probably be wasted: why should that parent care that a kid was on track for greatness if the kid then dies at three?  And the potential “greatness” that was perceived to be within reach was pretty meager anyway — even a neglected child could eventually catch up and learn to farm well enough.

Whereas a parent who expects his or her children to survive, and who will only attempt to raise one to three (instead of seven to ten, with 60% of them dying young), should invest a lot of time.  Especially if you’re hoping for some complex, modern version of “success,” something involving happiness, for instance, and money.

And, yes, Lancy also thinks you should teach your children to do chores.

On autism and vaccines.

The_cow_pock
Another vaccine in the news.

Let’s get one thing out of the way first, shall we?  Vaccines don’t cause autism.  If you’ve got a kid with a standard operating immune system, you oughta get that sucker vaccinated.  If you yourself have a standard operating immune system, and you’re considering living in a place where certain diseases that you aren’t immune to are prevalent, you oughta get yourself vaccinated.

But, okay, now that we’ve stated that much, there is an essay about vaccines and autism that I’ve been meaning to write.  Prompted, at the moment, by my turn in the queue for Eula Biss’s On Vaccination finally arriving.  Biss writes, with a lack of emphasis that I assume is ironic, though I am of course only a quarter of the way through her book at the time of this writing and so cannot know for certain, “Even so, the evidence reviewed by the committee ‘favors rejection’ of the theory that the MMR vaccine causes autism.”

Sure.  Let’s reject that theory.  There’s no evidence that vaccines cause autism; a scientist might use the word “hypothesis” to describe the idea that one might, but never “theory,” not given the data we have (by way of contrast, evolution is a theory.  Gravity is a theory; the next thing you drop, unless you’re on the space station, is probably gonna fall).  The conjecture that vaccines cause autism is a hypothesis, one that’s been tested and rejected.  Unless we accumulate a lot of new data that’s very dissimilar from the data we have now, rejected is how that hypothesis will stay.

And yet.  I wanted to write an essay about my favorite contemporary model for the cause of autism, and the idea that vaccination (or “mock vaccination,” actually, in which a child undergoes the ritual of vaccination but nothing is injected) might trigger the onset of autism.  This would happen only in children who were more or less guaranteed to have autism, but I can envision a compelling narrative in which the parents of many such children would all be able to point to an incidence of vaccination as the triggering moment.

There are, you may have noticed, many theories about what causes autism.  There’s the hippocampal under-pruning hypothesis; people with autism might have too many neural connections, trigger too many memories when it’s time to make decisions!  And of course there is also the over-pruning hypothesis; yup, the exact opposite idea has been proposed as the cause of autism, too!  It’s been proposed that autism results in underactivation of the fusiform gyrus, which is a part of the brain associated with processing faces and emotions.  And, yes, it’s been proposed that autism results in overactivation of the fusiform gyrus in emotional contexts, as though it’s hard to make eye contact, process emotions, etc., because they are perceived too strongly, not too weakly.  It’s been proposed that the condition is akin to a defensive response to stress, or that it’s linked to a deficit of oxytocin (the “cuddle molecule,” which K is planning to get a tattoo of once she’s done nursing), or that there are insufficient GABA-mediated inhibitory signals.

In short, many proposals, and nobody knows what’s correct.

Honestly, we don’t even how many people have autism.  You could read the CDC report and say, ah, 1 in 68 children have an autism spectrum disorder, but there are clear peculiarities in their numbers.  For instance, the huge increase relative to prior reports.  For instance, massive regional disparities; should we believe that autism is 4-fold more common in New Jersey than Alabama, or is there a difference in diagnostic capabilities?  And, as a point of contention near and dear to my own heart, the possibility that autistic children learn to mask their own condition.  If you asked K, for instance, she’d tell you that I have a mild autism spectrum disorder, but I’ve never been diagnosed.

And there are many proposed cures for autism.  Exogenous oxytocin (would hugs work instead, to promote endogenous oxytocin?); suramin, which reduces stress response (this hasn’t been proposed as a cure for humans, because the compound is toxic, but it seems to ameliorate autism-like symptoms in a mouse model); behavioral therapies …

… and my nomination for the all-time absolute WORST proposed cure, daily injection of massive doses of LSD. (This was first tested in humans, orphaned children, primarily, and was sometimes coupled with electroshock therapy.  But I should point out that our definition of the word “autism” has evolved somewhat in the time since these experiments were performed; if we go by modern usage, I think a more accurate description of these children would be “surly” rather than “autistic.” Still, reason enough to give them daily LSD. For months.)

All of which I’m mentioning so that you know to take everything I say about a possible “link” between autism and the practice of vaccination with a hefty dose of salt.  Clearly, nobody knows what’s up.

So, with all our caveats carefully stipulated, let’s get to it!  My current favorite model for the cause of autism, and how that might also relate to vaccines!

(Do I need to mention, here, that my use of the word model, singular, is somewhat silly since it seems very likely that there are multiple causes, perhaps multiple brain states that all get referred to as “autism” but which have differing neurological mechanisms?  I’m not sure.  I’ll mention it coyly, like this, in a parenthetical aside… that’s a good halfway approach, right?)

The model: maybe certain babies get too stressed out during birth, and that triggers autism (there is a nice summary of this model on the Simons Foundation Autism Research Initiative website).

A fetus’s brain activity is supposed to be suppressed during delivery, a process mediated by K’s favorite molecule. But something might be awry in autism, causing the suppression of brain activity to fail.  Seems there are suspicious clues speckled throughout the literature, like the fact that diazepam (Valium) often excites people with autism instead of calming them.  Indeed, my sister and I took an overnight bus ride through the mountains when I visited her in Ecuador (she was there for a three-year stint in the Peace Corps before medical school), and one of her friends lent us some Valiums.  My sister slept soundly.  I spent twelve hours chittering and jabbing her in the side with my elbow.

And, yeah, birth seems like it’d be incredibly traumatic… definitely seems like a good thing for babies’ brains to be conked.  Why not imagine that someone would be constantly musing “The horror, the horror” if there was any trace of memory about that whole ordeal?  There’s an increased percentage chance of autism after birth complications, though it’s difficult for me to say what types of delivery a baby would consider most stressful (like, would a baby think that a Cesarean delivery was easier?  Dunno, but Cesarean delivery is correlated with higher autism incidence, not lower like you might predict if your only working model were this highly speculative one I’m expounding upon).

In rodent models where pretreatment (either genetic or chemical) of fetuses tends to produce animals with some of the social disorders considered to be hallmarks of autism, it seems you can reduce the chance of producing an autistic-like animal by giving the birthing mothers a drug that stills the mind of the fetus.  Conk the baby chemically, it won’t remember its own birth, it grows into a neurotypical adult.

Within this framework, it seems possible that any episodes involving extreme stress could trigger autism onset in highly-susceptible individuals.  Vaccination, typically involving a shot, is stressful for some children.  So, there you go.  If you want to believe that there is *any* correlation between vaccination and autism beyond a coincidence in timing (i.e. when it’s first possible to diagnose autism and the standard vaccination schedule) this speculative hypothesis is the best I can come up with.  And it suggests that even if you believe there’s a link between autism and vaccination, there’s a strategy you could employ other than refusing vaccination, which endangers your own child and others.  You can simply make vaccination not stressful.

It’s not that hard, actually.  Yes, your kid is getting jabbed with a needle.  And it hurts, a little bit.  Not that much.  About as much as a hard pinch, which is crummy, and makes most kids cry, but easily fixable.  I’d say N has cried on average for about three seconds with each of her vaccinations, then we cuddle her some, she nurses, she’s happy again.  Part of why this works so well is that K stays calm and placid and cheerful throughout (I wish I could say the same about myself, but I have that thing where my blood pressure drops and I feel faint around needles.  K doesn’t; she performed thousands of injections on frogs during her doctorate and that experience washed away her needlephobia for good).  And our pediatrician is great.  And we sing, before, during, and after shots.

In summary… vaccinate your kids, kids.

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p.s. Was this all too chipper?  I do want people to be vaccinated against preventable diseases.  But, here, let me throw in a brief passage that I had to cut from an early draft of my novel to show that I understand why people are afraid of doctors; obviously bad things have been done.  Bad enough that any reasonable human would feel distrustful.  It’s just that, as regards contemporary pediatric vaccination, I don’t think the mistrust needs to be acted upon.  But, here you go, a little bit of horror to mitigate the preceding essay’s good cheer.

In early vaccine trials, orphaned children drank the pureed spinal chords of smallpox-infected monkeys.  Doctors put it in their milk.  The initial vaccination attempts failed: the virus was “insufficiently inactivated.”  Some of the children got sick.  Some were crippled for life.

Of course, they were living in an orphanage.  Not the most sanitary of conditions: some number of them were going to get sick anyway.  And for that study, the intent was therapeutic.  The drink might have been a vaccine.  Much more respectful toward what might’ve been the children’s wishes than, say, the hepatitis studies, in which orphans were deliberately infected so that attending doctors could track progression of the disease.  In that study, they were fed a slurry of pooled feces from other already-sick children.  Also in their milk, although for that study the noxious agent was blended into chocolate milk.  Probably seemed like a special treat.