Wikileaks: Dominant and subjugated narratives

There seems to be international condemnation of Wikileaks. The founder, Julian Assange, is at the centre of intense media speculation and a hate campaign against him in, particularly in the US, following the leak of 250,000 US diplomatic cables.

It is clear that most governments, particularly those closely involved with the US, are acutely embarrassed by the leaks. The leaks reveal the duplicitous nature of many governments and the lies and deceptions that characterise governments’ relationships with each other and their own populaces.

Of course, the dominant story from any government is that they are as transparent as possible and that politicians are honest people trying to do the best for their countries.

But the populations of these counties are, to a greater or lesser degree, aware of a subjugated story; this is a story where corruption is rife in many parts of the world, including wherever we happen to live. This story is where politicians routinely lie.  This is the story of our leaders thinking of themselves, not the greater good. This is the story where business deals and politics are blurred, where giant corporations lurk behind decisions to send troops to war. This is the story of atrocities commited in the name of democracy and freedom.

Julian Assange and Wikileaks have thickened this alternative story, and at the same time, thinned the dominant narrative of ‘honest government’.

As the Wikileaks cables are being revealed, there has been a general cynicism evident regarding the process used by FIFA to select the host nations for the 2018 World Cup. Whilst this might be regarded as a joke, it nevertheless casts light on the dubious activities and horse-trading that seems commonplace in international relations.

It is going to be interesting to see how this pans out.  What will the implications be if Assange is silenced?  I think the context is rapidly changing; people are becoming surer of their cynicism of governments, and if Assange is arrested or murdered, this will only serve to thicken the subjugated story and cast even more doubt on the dominant story. It may even prove to be the tipping point and the stories will flip; and this will have serious consequences. People are going to demand something better.

Male and female brains, complexity and objectification

Recently I was teaching a group of MSc students about chaos and complexity theories and how they might be relevant to leading organisations. One of the things that struck me is that working with complex self adaptive systems requires a focus on relationships between the parts of the system rather than on the component parts themselves. Of course, to a systemic therapist, this is nothing new, but the implications for leadership and management in our economy are huge.

Unfortunately, the dominant ways of thinking (especially in the West) are reductionist and lineal, and while this is fine for dealing with and managing simple systems or problems, relational, systemic thinking is required for dealing with the complex, non-lineal systems that would include nations, corporations, services (such as the NHS), hospitals, or even small and medium enterprises.

Simon Baron-Cohen (who is a Professor of Psychology at Cambridge University and researches on the autistic spectrum) notes that people with ‘male brains’ tend to be good at what he calls ‘systemising’, which he describes as the drive to analyse and explore and extract the underlying rules that govern the behaviour of a system as well as the drive to construct systems. I would argue that this is very much thinking about systems, rather than thinking systemically and being able to include self within a given system. This ‘male’ type of thinking is characterised by more focus on detail, components and parts, rather than relationships.

While the male brain tends towards logic, and the female brain towards empathy, neither are actually exclusive to each gender; in fact most of us are somewhere in the continuum between both extremes. Of course, manifestations of the extremes of either might range from ‘mindblindness’ and autism on the male side to ‘logicblindness’ and attributing mind, thoughts and feelings to inanimate objects, on the female side.

The male brain focus fits in very much with the reductionist, lineal thinking associated with science since Descartes, and though this type of thought is useful, is may be less helpful when thinking about and managing complex systems. Generally, women tend to be more relationally orientated and empathic, which suggests that leading and managing complex adaptive systems might be more suited to women than men. To get more women into roles where they can use their skills in dealing with complex, relational issues will require a massive shift, and the effort required to get more women into leadership roles at all levels of society is not just about equality – it is a necessity.

William Hamilton, an evolutionary biologist said “People divide roughly, it seems to me, into two kinds, or rather a continuum is stretched between two extremes. There are people people, and things people.” It would seem that women are more likely to be ‘people people’, and men are more likely to be ‘things people’.

These same differences in thinking might also go some way to understanding why men are more likely to ‘objectify’ women. If ‘male brainedness’ is less relational and more about things, or objects, perhaps for some men, women are simply that – objects. I was staggered by the lifelike ‘love dolls’ manufactured in Japan, which seems to me to be an extreme and literal form of the objectification of women by men.

Evidence based medicine: Selective use of evidence and the role of drug companies

Recently I was talking to my daughter Hannah about the work she was doing for one of her modules. Although her degree is in Marine Biology, for some reason she was looking at National Institute for Clinical Excellence (NICE) guidelines, and how they work.

We had some interesting discussions about what evidence is accessed by NICE, about randomised controlled trials (RCT’s) and the consultation process. What emerged from her review confirmed my suspicions regarding the use of evidence, particularly by drug companies who have a vested interest in their products being recommended in guidelines.

In 2003, the Department of Health agency responsible for ensuring that medicines meet appropriate standards of safety and effectiveness (the Medicines and Healthcare products Regulatory Agency—MHRA), released data regarding the risks and benefits of newer antidepressants used to treat depression in children and young people.

The information published on the MHRA's website included both previously published and never before published data obtained directly from the manufacturers of the SSRIs ("selective serotonin reuptake inhibitors") and other newer atypical antidepressant drugs. These data were collected after earlier work had raised concerns about the safety of paroxetine (Seroxat) and venlafaxine (Efexor, Efexor XL) in children and young people with depression.

Based on their review of the data, the MHRA concluded that all of the newer antidepressant drugs, other than fluoxetine (Prozac), carried serious risks that outweighed any benefits. The MHRA, therefore gave warning of the potential that these drugs could increase the risk of suicide-related behaviour (rather than decreasing it—as would be expected of an antidepressant) when using these drugs in the treatment of depression in childhood and adolescence.

The National Collaborating Centre for Mental Health (NCCMH) had been commissioned by NICE to produce national guidelines for the whole of the NHS on the treatment of depression in children and young people. NCCMH is an evidence-based guideline development unit jointly run by the Royal College of Psychiatrists and the British Psychological Society and funded by NICE.

However, the NCCMH only had access to published data, so, when the MHRA verdict on the SSRIs became public, it became evident that the MHRA had access to information about a total of 11 trials, of which the NCCMH had only seen 5.

Because of the inconsistency between the MHRA's findings and the published literature, several members of the NCCMH committee (Whittington et. al. 2004), decided to compare and contrast the published data with the unpublished data. This work was designed as an experiment to test out what the difference might (or might not) be if, in producing a guideline, the committee had access to the unpublished as well as the published literature.

They concluded that the published evidence was more favourable than the unpublished evidence, and most importantly that it was only when all evidence was examined that it was clear that the risks (particularly the increased risk of suicidal behaviour and thinking) outweighed the benefits.

They also found evidence to suggest that at least one of the drug companies who had undertaken trials of an SSRI in the treatment of childhood and adolescent depression had withheld publication of trial data on the grounds that it contained evidence that the drug was unlikely to be effective in treating depression in this age group.

A UK psychiatrist, David Healy, has been raising similar concerns for a while. He has general concerns about influence of pharmaceutical companies and the way that they don't mention the problems in the way that academics are expected to do so. He has evidence of one paper being written by a pharmaceutical company, but where academics appear to be the main authors. He has a particular concern about this influence on bipolar disorders, particularly since NICE guidelines quote one of the articles in which very young children are given the diagnosis of bipolar disorder and prescribed medication as part of a 'trial'.
You can access one of Healy’s papers here: http://www.furiousseasons.com/documents/healybp.pdf

In June this year, the New York Times published an article identifying that a world-renowned Harvard child psychiatrist, Dr. Joseph Biederman, whose work has helped ‘fuel an explosion in the use of powerful antipsychotic medicines in children’ earned at least $1.6 million in consulting fees from drug makers from 2000 to 2007 but for years did not report much of this income to university officials, according to information given Congressional investigators.

In my earlier article about Champix I didn’t mention that the manufacturers did not trial the drug with patients who have a history of mental health problems at all, and the drug was released on evidence that was derived from an ungeneralisable sample of the population.

Drug companies can afford to fund trials into their newly developed products. They may, as seen above, be selective in the evidence that they see fit to publish. The vast resources to fund for research into other therapies, for example talking therapies, are simply not available. Funding this type of research is down to practitioners on a local level, or perhaps interested University faculties. This means there is a huge disparity in what evidence is available for NICE (or those advising NICE) to base their decisions upon.

And the evidence is skewed.

Reference
Whittington C, Kendall T, Fonagy P, Cottrell D, Cotgrove A, Boddington E. Selective serotonin reuptake inhibitors in childhood depression: systematic review of published versus unpublished data. The Lancet, 24 April 2004; Volume 363: Number 9418, 1341-45.

Stopping smoking and the danger of Champix (varenicline) and alcohol

I have helped a lot of people stop smoking over the past few years, although my own struggle with cigarettes continues to be tempestuous!

I used a medication called Champix (varenicline) successfully in 2007, and gave up for seven months, but unfortunately started again. I used Champix a second time in June 2008, and have discovered some serious side effects, so much so that I can no longer recommend its use.

I was aware of the depersonalising effects of Champix, and associated these with the sleep disturbance, but while we were on holiday, one evening when we’d all been enjoying a few drinks, I experienced what can only be described as a psychotic episode. I could not explain this episode at all; up until then I had been pretty happy, enjoying a much needed break.

As you might imagine, I was pretty upset about what happened, but discovered by chance when doing some research for a teaching session on suicide that the mix of varenicline and alcohol can be extremely dangerous.

Recently there has been some discussion over the death of the musician Carter Albrecht, who was shot by a neighbour following his use of alcohol with Champix (known as Chantix in the US). Albrecht, best known as a member of Edie Brickell and the New Bohemians, started taking Chantix in late August 2007. He was well liked in the community, and had no prior history of violence. Immediately, Albrecht began to complain of vivid, hallucinatory dreams (a Chantix side effect). One night about a week after he started taking Chantix, Albrecht had a violent encounter with his girlfriend.

The episode occurred after Albrecht had consumed a couple of alcoholic drinks. Albrecht’s girlfriend reported that he was confused, and did not recognize her. Before the night was over, Albrecht had been shot dead by a terrified neighbour on whose property he had trespassed. After Albrecht’s death, many other Chantix users complained of similar episodes of violent or suicidal behaviour, especially when they had consumed alcohol. The Chantix label does caution against alcohol use, but it does not warn that drinking alcohol while taking Chantix could lead to violent or suicidal behaviour. Furthermore, Chantix’s reaction with alcohol has not been studied in clinical trials.

This page shocked me. Read some of the stories, and you might begin to imagine what might have happened while we were on holiday.


UPDATE: There is now accumulating scientific evidence that varenicline is associated with thoughts and acts of aggression/violence see these articles - 

Thoughts and Acts of Aggression/Violence Toward Others Reported in Association with Varenicline

Prescription Drugs Associated with Reports of Violence Towards Others

The context of crime, neglect and ill health

In the news recently has been coverage of the story of the sad death of seven year old Khyra Ishaq, who may have died of starvation. Her mother and stepfather will be charged with neglect, a criminal offence.

Several sources recognise that poverty and neglect are linked, and it can be argued that poverty is not a matter of choice, but neglect is. Also linked to poverty are issues of crime, drug and alcohol use and obesity, all of which are considered major topical social issues, and all of which have an element of choice to them. But is it that simple?

I have often considered that crime and ill-health are linked by wider contexts, yet politically, both are treated as very different issues.

In the UK our jails are full; the population bulletin for May 16th 2008 states the population in prisons in England and Wales stands at 82,682. This represents around 148 per 100,000 of the national population. In contrast, the United States has the highest prison population rate in the world, some 738 per 100,000.

Some people argue that we should be increasing our capacity to incarcerate criminals, for example Stephen Pollard writing in the Spectator suggests: “Britain certainly imprisons a higher percentage of its population. But this is a meaningless measure, since it takes no account of the proportion of the population who commit crimes. Allow for the extraordinary proportion of the UK population which commits crimes, and Britain has a low imprisonment rate. Whereas Britain imprisons 12 people per 1,000 crimes, Spain imprisons 48 and Ireland 33”

Taking Pollard’s argument further, we would need to quadruple the amount of incarceration, having spaces for a third of a million inmates, representing around 590 prisoners per 100,000 of the national population.

This raises a question for me. If it is true that such a large proportion of the British population commits crimes, why is this so?

Our understanding of crime itself may lead to problems. Crime is not the name for an action – it is the name given to a class of actions performed in a particular context. Some of these actions are directed at the authorities who forbid them. The punishment of the actions will not remove the context that characterise those actions. You can’t stop someone from being a criminal by punishing what he or she does. If that was the case, we wouldn’t need larger prisons. If punishment was a viable solution, crime would have ceased thousands of years ago. In the film KPAX, when the character Prot is asked by his psychiatrist why they don’t have laws on his planet, he replied ‘Because every sentient being in the universe knows the difference between right and wrong’.

Most humans know the difference between what is right and what is wrong, so why do so many choose to do what is wrong? More importantly, what is the context that these actions take place in? I would argue that it is the same context that gives rise to drug and alcohol problems, obesity and neglect. Nacro’s 2006 briefing paper suggests crime impacts upon health, which may be true, but they miss the point that crime is a symptom, as is poor health, of a wider contextual problem. And the context isn’t simply inequalities, social exclusion or poverty; in fact, these are as much symptoms as crime or illness.

What then, is context is it that gives rise to the symptoms I have described? Part of the context is our way of thinking, characterised by ideas that ‘more is better’ in terms of money, material possessions and power. To begin to challenge the global high rates of crime and illness we urgently need to think differently about ourselves and the worlds we inhabit, and, as Bateson put it, make steps towards an ecology of mind.

In the United States at the end of 2001, 10% of the population owned 71% of the wealth, and the top 1% controlled 38%. On the other hand, the bottom 40% owned less than 1% of the nation's wealth. Similar distribution patterns are found in other countries. Those people that control the wealth also control the media, at the very least have a major influence upon governments, and they control the prices we pay for everything, from food to petrol.

Unfortunately, those with power tend to want to retain it. They have absolutely no reason to change the way they think; after all the current mind-set works for them. This is western democratic society and it is the context that inculcates crime and preventable illness; a combination of our epistemology, one that values power, and a society that manifests power through wealth.

Putting myself in opposition with Gregory Bateson who was an atheist (I would call myself agnostic), I also believe that as spiritual beings (even atheists might appreciate the sacred), we may be able to challenge this context through a quiet revolution, a revolution of showing love, kindness and forgiveness. The wealthy cannot take their money or their power with them on the next stage of their journey, and I doubt that any of them will be much happier; that is assuming that they are happy at all.

Surveillance Medicine

In 1995, I came across an article that really made me stop and think. It was my first introduction to Foucauldian ideas, and related very much to the theme of Health Promotion, a subject that I was teaching back then. As I think back, this paper had a huge influence on my subsequent thinking.

The article was David Armstrong’s The Rise of Surveillance Medicine, published in The Sociology of Health and Illness 17:3, and you can access it here.

Armstrong discusses how medicine evolved from ‘Bedside Medicine’, located in the patient’s home and where the focus was on the symptoms described by the patient, to ‘Hospital Medicine’ located in the neutral hospital setting, where the focus is less on patients identified symptoms, but on signs detected by the doctor and laboratory tests performed by the medical staff.

He goes on to talk about how the focus of medicine has moved now, and that the focus is on the normal population – locating illness outside of the body. This is ‘Surveillance Medicine’ where illness is a permanent, nascent potential within and between us all and is managed by screening the population and mass immunisations.


What is ‘normal’ is defined by centile charts that define normal weight, height and so on for the population. This medical gaze is on all aspects of our lives – the entire continuum from birth to death has become medicalised.

Another manifestation of medical power is in our accepting and internalising surveillance medicine, the medical gaze is performed by ourselves in self-monitoring our lifestyles, including diet and weight, sexual behaviour, exercise and smoking.

Armstrong might not be surprised to find now that ordinary foodstuffs are becoming medicalised, for example yoghurts with ‘friendly bacteria’ and spreads with sterols to reduce cholesterol.

What our benevolent, paternalistic medical friends might not have appreciated is how harmful to people all this worry about being normal and healthy actually can be.

Perhaps, though, they do…

Conscious purpose and the environment

Most people who enjoy natural history series such as Planet Earth will appreciate the incredible balance that is found in nature between different species that depend on each other for survival. This balance has evolved through thousands of years. Yet this balance is not conscious; blackbirds don't think 'It's going to be a poor summer so we'll lay fewer eggs'. Gregory Bateson, the English anthropologist appreciated that this balance reflected an inherent wisdom. Mind, he suggested, was an integral apsect of this interrelationship. A multitude of diverse creatures have survived, as part of the environment, for millenia. This graceful and unconscious balancing act between the parts of the larger system comprised of species and the environment has been incredibly successful.

But now we are threatened by our own conscious purpose. As a species, we don't live in unconscious harmony wth the environment, in fact, we tend to think of ourselves as separate from the environment; having 'dominion' over the whole of creation. Perhaps this has worked for a few thousand years. However, I doubt anyone affected by the effects of global warming would agree that we still have dominion over the earth.

As a species we are dependant on exploiting the resources of the planet to maintain the lifestyles we have become accustomed to. In a sense, we are addicted to these finite resources, resources that when used create carbon dioxide and other pollutants that are contributing to global warming. To be blunt, most of the things that governments are doing to address this problem are inadequate. Whilst I have railed against speeding fines that seem inconsistent, I would not object to speed limits being imposed to reduce emissions. But changing a society through taxes is hardly adequate considering the potentially disastrous global effects of climate change.

What is required is something more drastic than carbon taxes. We urgently need to think about how we think. One of the first things we can do is begin to appreciate that we are part of the environment, not separate from it.

We need to begin to appreciate that perhaps there is a wisdom inherent in nature that is greater than ours. Some might even wonder if some kind of deity may be discerned in this ecological wisdom.

We can begin to think more systemically. Bateson called this a cybernetic epistemology. "The individual mind is immanent but not only in the body. It is immanent also in the pathways and messages outside the body; and there is a larger mind of which the individual mind is only a subsystem. This larger mind is comparable to God and is perhaps what some people mean by 'God,' but it is still immanent in the total interconnected social system and planetary ecology."

Bateson saw the problems we were heading for overy 40 years ago. In his words (From Brockman) "Perhaps all exploration of the world of ideas is only a searching for a rediscovery, and perhaps it is such rediscovery of the latent that defines us as "human," "conscious," and "twice born." But if this be so, then we all must sometimes hear St. Paul's "voice" echoing down the ages: "It is hard for thee to kick against the pricks."

I am suggesting to you that all the multiple insults, the double binds and invasions that we all experience in life, the impact (to use an inappropriate physical word) whereby experience corrupts our epistemology, challenging the core of our existence, and thereby seducing us into a false cult of the ego—what I am suggesting is that the process whereby double binds and other traumas teach us a false epistemology is already well advanced in most occidentals and perhaps most orientals, and that those whom we call "schizophrenics" are those in whom the endless kicking against the pricks has become intolerable."

Is it too late to change our ways of thinking? Perhaps the technological advances charactaristic of our 'false epistemology' may help to forestall climate change, but will they buy our species enough time to ensure our survival?