The problem of comorbidity

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I once suggested that Objectivism is a form of demonic possession.

My unusual suggestion was not well received. One of the usual suspects had this to say.

Richard, your speculation is not a legitimate scientific theory … because demons do not exist, neither do gods, fairies, Santa’s-little-helpers or harpies. You’ve never seen one, heard one, touched one, smelled one nor tasted one, neither can you provide an iota of rationale that there exists such a spirit in the universe.

What was called “demon possession” by religionists is mental illness. You’re giving a psychiatric condition a superstitious definition. You call that scientific?

What is called mental illness by psychiatrists is demonic possession. I don’t call the American Psychiatric Association’s Diagnostic and Statistical Manual of Mental Disorders scientific, and neither do many clinical neuroscientists.

Diagnostic Classification Needs Fundamental Reform

The problem with the DSM-IV, our current shared diagnostic language, is that a large and growing body of evidence demonstrates that it does a poor job of capturing either clinical [or] biological realities. In the clinic, the limitations of the current DSM-IV approach can be illustrated in three salient areas: (1) the problem of comorbidity, (2) the widespread need for “not otherwise specific (NOS)” diagnoses, and (3) the arbitrariness of diagnostic thresholds.

Both in clinical practice and in large epidemiological studies, it is highly likely that any patient who receives a single DSM-IV diagnosis will, in addition, qualify for others, and the patient’s diagnostic mixture may shift over time. There is a high frequency of comorbidity—for example, many patients are diagnosed with multiple DSM-IV anxiety disorders and with DSM-IV dysthymia (chronic mild depression), major depression, or both. Many patients with an autism–related diagnosis are also diagnosed with, obsessive-compulsive disorder and attention-deficit/hyperactivity disorder. The frequency with which patients receive multiple diagnoses far outstrips what would be predicted if co-occurrence were happening simply by chance. Researchers who have made careful studies of comorbidity, such as Robert Krueger at the University of Minnesota, have found that co-occurring diagnoses tend to form stable clusters across patient populations, suggesting to some that the DSM system has drawn many unnatural boundaries within broader psychopathological states.

If the concept of mental illness does “a poor job of capturing either clinical [or] biological realities” then how, exactly, is it an advance over the concept of demonic possession?

Two thousand years ago the Gospel authors were well aware of the problem of comorbidity and, in fact, mention it no less than twice.

In the introduction to the Parable of the Sower in the Gospel of Luke we read

Jesus traveled about from one town and village to another, proclaiming the good news of the kingdom of God. The Twelve were with him, and also some women who had been cured of evil spirits and diseases: Mary (called Magdalene) from whom seven demons had come out (NIV)

and in the Gospels of Matthew, Mark and Luke we read (variations of) the story of the Gadarene Swine. It’s one of my favourites.

They sailed to the region of the Gerasenes, which is across the lake from Galilee. When Jesus stepped ashore, he was met by a demon-possessed man from the town. For a long time this man had not worn clothes or lived in a house, but had lived in the tombs. When he saw Jesus, he cried out and fell at his feet, shouting at the top of his voice, “What do you want with me, Jesus, Son of the Most High God? I beg you, don’t torture me!” For Jesus had commanded the impure spirit to come out of the man. Many times it had seized him, and though he was chained hand and foot and kept under guard, he had broken his chains and had been driven by the demon into solitary places.

Jesus asked him, “What is your name?”

“Legion,” he replied, because many demons had gone into him. And they begged Jesus repeatedly not to order them to go into the Abyss. (NIV)

A large herd of pigs was feeding on the nearby hillside. The demons begged Jesus, “Send us among the pigs; allow us to go into them.” He gave them permission, and the impure spirits came out and went into the pigs. The herd, about two thousand in number, rushed down the steep bank into the lake and were drowned.

Those tending the pigs ran off and reported this in the town and countryside, and the people went out to see what had happened. When they came to Jesus, they saw the man who had been possessed by the legion of demons, sitting there, dressed and in his right mind; and they were afraid. Those who had seen it told the people what had happened to the demon-possessed man—and told about the pigs as well. Then the people began to plead with Jesus to leave their region.

As Jesus was getting into the boat, the man who had been demon-possessed begged to go with him. Jesus did not let him, but said, “Go home to your own people and tell them how much the Lord has done for you, and how he has had mercy on you.” So the man went away and began to tell in the Decapolis how much Jesus had done for him. And all the people were amazed. (NIV)

We all have demons and we often refer to them in animistic terms.

Me, I’m intimately familiar with the Black Dog. Depression’s a bitch, for sure. Thank God, she’s been sent packing and I haven’t seen her in a while. But my mind’s still holiday home to a menagerie of monkeys.

Psychiatric counselling and psychiatric drugs can and do help those afflicted by so-called mental illnesses … somewhat. So I’m not knocking psychiatrists and psychiatry … much.

So, what about exorcism? I’ll leave that to another psychotic episode.

Cannabis should be given interim product approval

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Cannabis should be given interim product approval

Herbal cannabis should be given immediate interim product approval under the Psychoactive Substances Act says Dr. Richard Goode, Vice President of the Aotearoa Legalise Cannabis Party.

His call follows the Ministry of Health’s admission that finalising the safety rules for the legal highs market was “taking longer than expected.”

In 2012 former Associate Minister of Health, Peter Dunne, speaking on behalf of the current National government, promised that “if [manufacturers] cannot prove that a product is safe, then it is not going anywhere near the marketplace. None of these products will come to market if they have not been proven safe.”

“Instead, we are now six months into a an interim period, during which time a dozen or so different synthetic cannabinoids have been approved by the Ministry of Health. And now that interim period looks to stretch to up to a year,” Dr. Goode said.

“The point is that none of these products has yet been properly safety tested. We know nothing of their long-term, chronic health effects. How long do we continue to test these products on consumers before we find out?

“However, we know a great deal about the long-term effects of cannabis, which is the most popular illegal drug in New Zealand. These synthetic highs are specifically designed to emulate natural cannabis, which we know is a benign, low-risk plant substance.”

The ALCP exists to legalise cannabis for recreational, spiritual, medicinal and industrial purposes.

“Let’s legalise cannabis now, so the Ministry of Health can have all the time it needs to get its act sorted, and cannabinoid connoisseurs can continue to get high on the real deal,” Dr. Goode said.

“God made cannabis before man made synthetic cannabinoids. In whom do you trust?”

Dr. Richard Goode
Vice President of the Aotearoa Legalise Cannabis Party
Email: vp@alcp.org.nz
Phone: 021 340057

Aotearoa Legalise Cannabis Party – Truth, Freedom, Justice
www.alcp.org.nz

ENDS

Peak Rand

I was saddened to read that Lindsay Perigo’s forum Sense of Life Objectivists (SOLO) has gone down.

Here‘s my SOLO blog. I posted and commented there between November 2007 and February 2013.

In the end, SOLO’s proprietor succumbed to GDS. (He may yet succumb to something momentous.)

I had two main gripes with SOLO and SOLOists.

They misrepresented me. From the outset.

And they misrepresented themselves as advocates and champions of Reason. Typically, SOLOists have no interest in, and no aptitude for, Reason. As my posts here, here and here amply demonstrate.

Anyway, Perigo insists that SOLO is down but not out. It will be back from the dead, perhaps even as soon as next month. I look forward to the resurrected SOLO.

Meanwhile, in other news from beyond the grave …

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Philosopher contemplates ACT leadership role

A former lecturer in philosophy at Cambridge University wants to save the ACT Party and take over John Banks’ Epsom seat.

He’s Jamie Whyte, a management consultant, writer and committed advocate of the free market who has been living in Britain.

With Mr Banks on the way out, ACT is in the worst shape it’s ever been in and history hasn’t been kind to the party.

Now Mr Whyte wants to captain the sinking ship.

“Jamie Whyte does well to save himself, but he’s going to do his best to save ACT,” says Mr Whyte.

“I believe in the principles of ACT.”

A philosopher leading a libertarian party? It’s the best news I’ve heard all year!

A free PDF of Jamie Whyte’s Free Thoughts is available from the Adam Smith Institute here.

From what I’ve read so far, Whyte is surely the man to lead ACT back from oblivion.

(He makes some points with which I disagree, e.g., his Times column, I don’t believe that believers really believe, contains a number of egregious errors. Perhaps I’ll point them out to him and explain why they’re errors. I’m sure he’ll listen to Reason.)

Peak Prohibition

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There are two kinds of recreational drug in this world.

Illegal ones and “legal highs”. (Once upon a time, New Zealand had a working, regulated “legal highs” market—in opium.)

In the year 1900 there were no illegal drugs in New Zealand but lots of anti-Chinese racist sentiment.

Here’s the story of the ascent of prohibition. (Partly told by the government funded Law Commission in Chapter 4 of the Law Commission’s Issues Paper on Regulating and Controlling Drugs.)

4.7 [The Opium Prohibition Act 1901] contained New Zealand’s first prohibition on drugs. It seems to have been directed primarily at Chinese immigrants. The Government at the time was concerned that the practice of opium smoking by Chinese migrants would spread if it was not banned. The Opium Prohibition Act prohibited the smoking of opium. It also prohibited the importation of opium in a form that was suitable for smoking. Although it did not prohibit other imports of opium, a permit issued by the Minister of Customs was needed before any opium could be imported or exported.

4.8 The Opium Prohibition Act discriminated against Chinese. Firstly, they could not obtain permits to import or export any opium at all. Secondly, the Act allowed the police to search premises occupied by Chinese without a warrant if they had reasonable cause to suspect that opium was being smoked in those premises. In contrast, the police had to obtain a search warrant before they could search other premises. After 1910, a Chinese person could not lawfully buy any opium at all without a doctor’s prescription or an authority from the Minister of Customs, while other people were still free to purchase opium without these restrictions.

4.9 The development of New Zealand’s drug law during the 20th century has largely been shaped by international drug conventions. International action aimed at controlling the distribution of opium and later other drugs began with the Shanghai Declaration in 1909 and the first Opium Convention at The Hague in 1912. New Zealand, along with many other countries, acceded to the Opium Convention after the First World War. The Opium Convention required parties to regulate the importation and distribution of opium and certain other drugs. New Zealand had already consolidated earlier legislation relating to opium in the Opium Act 1908, and implemented the Convention by extending the controls in the Opium Act to the importation and distribution of morphine, heroin, codeine and other opium preparations, and cocaine.

4.10 Later New Zealand also acceded to the International Convention relating to Opium and Other Dangerous Drugs 1924 and subsequent amending protocols. These required parties to impose controls on the manufacture, importation and exportation, sale and distribution of a growing range of drugs. In 1925, cannabis, which was known then as Indian hemp, was added to the list of drugs which countries adhering to the 1924 Convention agreed to control. Further international agreements and conventions during the subsequent years extended the range of substances that parties were required to control.

“The development of New Zealand’s drug law during the 20th century has largely been shaped by international drug conventions” is a very good summary, and so is “a growing range of drugs.”

New Zealand followed the International Convention relating to Opium and Other Dangerous Drugs 1924 by enacting the Dangerous Drugs Act 1927. New Zealand followed the Single Convention on Narcotic Drugs 1961 by enacting the Narcotics Act 1965. New Zealand followed the United Nations Convention on Psychotropic Substances 1971 (and an amendment to the 1961 Single Convention) by enacting the Misuse of Drugs Act 1975.

We’ve suffered under the Misuse of Drugs Act 1975 ever since. The trend in the number of prohibited drugs has ever been to increase.

1901 – 1 prohibited drug (opium)
1908 – 5+ prohibited drugs (opium and its derivates, cocaine …)
1925 – 10+ prohibited drugs (opium and its derivates, cocaine, cannabis …)
1965 – 100+ prohibited drugs
1975 – 140+ prohibited drugs

The Misuse of Drugs Act 1975 lists illegal drugs in three main schedules, the First Schedule (Class A), the Second Schedule (Class B) and the Third Schedule (Class C). As new recreational drugs came to market, they were added to the schedules. The number of prohibited drugs continued to increase.

The intent of the schedules to the Misuse of Drugs Act was to classify recreational drugs according to their harm. Penalties for possession and supply were set accordingly. For example, the maximum penalty for supplying Class A drugs is life imprisonment. For supplying Class B drugs it is 8 years inside, and for supplying Class C drugs it is a merely draconian 5 years in the clink.

However, the scheduling of drugs in the Misuse of Drugs Act bears little relationship to their actual risks.

4.31 As has been noted, the Blake-Palmer Committee recommended that drugs controlled by the Act be allocated to schedules that broadly reflect their relative potential to cause harm. Accordingly, drugs controlled by the Act have been classified as Class A, B or C and listed in Schedules 1, 2 or 3 respectively. An amendment to the Act in 2000 clarified that substances classified as Class A drugs are considered to pose a very high risk of harm, while Class B drugs pose a high risk, and Class C drugs a moderate risk. Another amendment in 2000 established the Expert Advisory Committee on Drugs, with the mandate to evaluate substances, assess their potential for harm against criteria set out in the Act, and recommend appropriate classifications.

4.32 Despite the changes in 2000, the classification of most controlled drugs already under the Act has never been reviewed. Only drugs that have been classified or reclassified since the Act was amended in 2000 have been assessed against the criteria for determining harm. Consequently the current classifications of a number of drugs may not accurately reflect current knowledge and understanding about their risks.

The last sentence is an understatement. There is little rhyme or reason to the scheduling in the Misuse of Drugs Act. For example, one of the safest known drugs is psilocin. It’s Class A.

Let’s be clear. Our political masters have never scheduled drugs according to their potential for harm. We know this, because no drug whose harms are known has ever been classified as posing less than a moderate risk of harm. No drug that poses a demonstrable low risk of harm has ever been classified as such. (Except, briefly, BZP.) Our political masters’ intent in the past has always been to schedule drugs – as A, B or C – regardless of their harm.

In 1986, the designer drug MDMA (the original “ecstasy”) was added to Class B. MDMA was by no means the first designer drug, but it became popular during the mid-’80s when the term ‘designer drug’ was coined. But, with the upsurge in the number of new designer drugs becoming available, legislators realised that they couldn’t keep up.

4.41 Another important amendment in 1988 introduced the concept of a controlled drug analogue. An analogue was defined as a substance that had a structure substantially similar to that of any controlled drug but was not itself listed in Schedules 1 or 2 or in Parts 1–7 of Schedule 3. Analogues were specifically listed in Part 7 of Schedule 3 and were consequently Class C drugs. However, only those analogues included in Part 7 were Class C controlled drugs under the Act. …

The Law Commission has this slightly wrong. Analogues were not specifically listed in Schedule 3. Rather, a formula was provided. For example, amphetamine analogues were covered by listing a number of chemical groups, such as bromo-, iodo-, methyl- and methoxy-. Attaching any of the specified groups at any position on the benzene ring of the amphetamine backbone automatically creates an amphetamine analogue. But what about unusual groups that aren’t listed?

… A subsequent amendment in 1996 amended the definition of Class C drug to include all controlled drug analogues, which dispensed with the need to list them in Part 7.

4.42 This amendment was made to address the emergence of new synthetic designer drugs that had been developed by subtle chemical changes to prohibited drugs as a way of avoiding the provisions of the Act. The definition of analogues has caught a number of substances that would otherwise have had to be separately scheduled.

The molecule below is 2-CT-7.

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There are two methoxy groups attached to the benzene ring, but also a propylthio- group which wasn’t specified in the 1988 amendment. So, is 2-CT-7 a scheduled amphetamine analogue, or not, according to the 1988 formula? Is it a controlled drug analogue, or not, according to the 1996 amendment? 2-CT-7 certainly seems structurally similar to amphetamine, but is it really? In 2007, the Ministry of Health

suggested that it would be useful to amend the Misuse of Drugs Act by adding “and/or alkylthio radicals” to sub-section (d) under “Amphetamine Analogues”. Such an amendment would include 2C-T-7 in the definition of an amphetamine analogue.

Why go to the trouble of doing that? Just to make sure? The amendment was made.

4.43 While the inclusion of analogues addresses the issue of subtle changes in a drug’s chemistry, it does not address the emergence of new synthetic drugs with distinct chemistry. Such substances need to be separately assessed and classified before they come under the Act.

Peak prohibition. Are we there yet? You’re no doubt familiar with the concept of peak oil.

Peak oil, according to M. King Hubbert’s Hubbert peak theory, is the point in time when the maximum rate of petroleum extraction is reached, after which the rate of production is expected to enter terminal decline.

Peak prohibition is the point in time at which the maximum rate of prohibition (drugs per year) is reached … or it’s the point in time at which the maximum proportion of drugs (number of illegal drugs to number of legal highs) is reached … or it’s the point in time at which the rate of prohibition surpasses the rate at which new designer drugs are invented.

By any yardstick, New Zealand reached peak prohibition in July 2013 with the passing of the prohibitionists’ ultimate wet dream, the Pyschoactive Substances Act. This Act criminalised the importation, manufacture and sale of all recreational drugs not otherwise already prohibited (or otherwise regulated)—thereby addressing “the emergence of new synthetic drugs with distinct chemistry.” In one fell legislative swoop, such substances no longer need to be separately assessed and classified before they come under legislative control.

9 Meaning of psychoactive substance
(1) In this Act, unless the context otherwise requires, psychoactive substance means a substance, mixture, preparation, article, device, or thing that is capable of inducing a psychoactive effect (by any means) in an individual who uses the psychoactive substance.

The legal definition of psychoactive substance pretty much covers everything—including any “article, device, or thing”—that gets you high. Including brain implants, iPods and Bibles.

For about a week in July 2013, the only legally available non-prescription drugs in this country were

tobacco
alcohol
kava (a food)
caffeine (a food)

and a tiny handful of obscure foods that can get you high (e.g. nutmeg).

About a week after the Pyschoactive Substances Act passed, the first interim product approvals were granted. (See here for more.)

Are you still doing the same this year?

What have you achieved now you’re old?
Did you fulfill ambition, do as you were told?
Or are you still doing the same this year?
Should I give sorrow, or turn ’round and sneer?

I know that the prospects weren’t all that good
But they improved, and I’d have thought that you could
Have strived for that something we all have deep inside
Not let it vanish, along with your pride

Now with the aid of your new walking stick
You hobble along through society thick
And look mesmerized by the face of it all
You keep to the gutter in case you fall

Zero the Hero

A vulgar variant of concept stealing, prevalent among avowed mystics and irrationalists, is a fallacy I call the Reification of the Zero. It consists of regarding “nothing” as a thing, as a special, different kind of existent. (For example, see Existentialism.) This fallacy breeds such symptoms as the notion that presence and absence, or being and non-being, are metaphysical forces of equal power, and that being is the absence of non-being. E.g., “Nothingness is prior to being.” (Sartre)—“Human finitude is the presence of the not in the being of man.” (William Barrett)—“Nothing is more real than nothing.” (Samuel Beckett)—”Das Nichts nichtet” or “Nothing noughts.” (Heidegger). Consciousness, then, is not a stuff, but a negation. The subject is not a thing, but a non-thing. The subject carves its own world out of Being by means of negative determinations. Sartre describes consciousness as a ‘noughting nought’ (néant néantisant). It is a form of being other than its own: a mode ‘which has yet to be what it is, that is to say, which is what it is, that is to say, which is what it is not and which is not what it is.’” (Hector Hawton, The Feast of Unreason, London: Watts & Co., 1952, p. 162.)

(The motive? “Genuine utterances about the nothing must always remain unusual. It cannot be made common. It dissolves when it is placed in the cheap acid of mere logical acumen.” Heidegger.)

— Ayn Rand, Reification of the Zero

https://www.youtube.com/watch?v=3YiVVpughTM

Accept the fact that you’re second rate life is easy for you
It’s all served up on a gold plated plate
And we don’t even have to talk to you
Your face is normal that’s the way you’re bred
And that’s the way you’re going to stay
Your head is firmly nailed to your TV channel
But someone else’s finger’s on the control panel

What you gonna be, brother? – Zero the hero?
Don’t you wanna be, brother? – Zero the hero?
When you gonna be, brother? – Zero the hero?
Impossibility impissibolity mother really a hero!

You sit there watch it all burn down
It’s easy and breezy for you
You play your life to a different sound
No edge no edge you got no knife have you
Your life is a six lane highway to nowhere
You’re going so fast you’re never ever gonna get down there
Where the heroes sit by the river
With a magic in their music as they eat raw liver

You stand there captain we all look
You really are mediocre
You are the champion in the Acme form book
But I think you’re just a joker
Your freedom life ain’t so much of a pity
But the luv-a-duckin’ way you’re walkin’ around
The city with your balls and your head full of nothing
It’s easy for you sucker but you really need stuffing

How many holes?

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How many holes are in this bucket?

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Non-existence is not a fact, it is the absence of a fact, it is a derivative concept pertaining to a relationship, i.e., a concept which can be formed or grasped only in relation to some existent that has ceased to exist. (One can arrive at the concept “absence” starting from the concept “presence,” in regard to some particular existent(s); one cannot arrive at the concept “presence” starting from the concept “absence,” with the absence including everything.) Non-existence as such is a zero with no sequence of numbers to follow it, it is the nothing, the total blank.

— Ayn Rand, Introduction to Objectivist Topology

Give me Liberty, or give me Death!