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neuroscience

Jerome Kagan: the best predictor of depression is being poor

I’m a great fan of Professor Jerome Kagan, the eminent Harvard psychologist, who has done important work on the role of the amygdala in emotional disorders like social anxiety. I admire his humane appreciation for both the sciences and the humanities, and his awareness of psychology and psychiatry’s dangerous tendency to ignore the role of culture, values, language and context in human emotional experience.

Kagan, considered one of the finest psychologists ever, is clearly deeply concerned about the direction of western intellectual life, and in particular about “the dramatic ascent of the natural sciences in the years following World War 2, which intimidated the other two scholarly communities” – ie the social sciences and the humanities. He feels we in the West have become out of balance, overly fixated on a biologically materialist view of the human condition, with serious consequences for our societies.

He expresses his concerns about our culture’s tendency to simplistic scientific materialism in his new book, Psychology’s Ghosts, which he discussed last month on Radio Boston. He said that psychology and psychiatry focus too much on the symptoms of emotional problems, while ignoring the causes – and, in particular, ignoring the cause of poverty:

If you think about all the physical diseases, they are diagnosed not by the symptoms you tell your doctor, but by the cause. Malaria means not that you have a fever but that you have the malarial parasite. Psychiatry is the only sub-discipline in medicine where the diagnoses are only based on the symptoms. You tell your doctor you can’t sleep and you have no energy and he says that you’re depressed. You’re treated for depression on the basis of your symptoms when your depression could come on for a half a dozen different reasons and the reasons are important in how you treat the patient.

There is inadequate research being done on the life history causes. In medicine, if you have a disease, immediately several hundred or a thousand investigators start at once — take AIDS — to find out what was the cause. There is very little research going on on the role of class, on the role of life history, on the role of who you identified with, your religious identification, your ethnic identification. In other words, there’s a whole complex set of causes; they are not being studied.

The problem is that biology made extraordinary advances, both in genetics and in ways to measure the brain. Because that technology is available, people rushed over to that side and hoped that that would solve the problem, abandoning the other half. To put it briefly, biology says you’re likely to be vulnerable to this envelope of illnesses. Your environment, your setting, your class, your culture, where you live disposes and selects from that envelope the symptoms you might develop.

As I read the literature, and I have many people on my side — the best predictor today in Europe or North America of who will be depressed is not a gene and it’s not a measure of your brain; it’s whether you’re poor. And that makes sense.

If, in a country like ours with an enormous range of income, you’re poor and you’ve been poor since you were a child, which means that your medical care is less adequate, your diet’s less adequate, you’re probably fighting some low level infections and you’re poor — that’s a pretty good reason to be depressed.

That then is taken out because we’re looking for the genes. Now, in fact, there probably is 10 percent of depressed who do have a specific genetic vulnerability and then we’re missing the 80 percent who don’t have a specific genetic vulnerability — they have a very good reason for being depressed […]

We’re hoping that we will discover the biological causes and treat the biological causes and we won’t have to worry about the societal causes and the individual lifestyle circumstances that people deal with. That’s the hope. My own view — and I’m not alone — is that is denying the problem.

How can we make sense of revelatory experiences?

Yesterday I went to an excellent conference on revelatory experiences at the Institute of Psychiatry, which brought together neuroscientists, psychiatrists, psychologists, historians, theologians and members of the public (many of whom had revelatory experiences – turns out they’re pretty common!)

The conference tried to approach and talk about revelatory experiences from two main directions: history and neuroscience. So, first of all, we heard from two research teams – one led by Dr Quinton Deeley at KCL, the other by Professor David Oakley at UCL – who are studying the brain-imaging of hyponotised people. They’re trying to understand the phenomenon of ‘automatic writing’ – the feeling of some external being controlling one’s hand or even guiding one’s thoughts, as in the Caravaggio drawing of St Mark and the angel, on the right.

The researchers have done interesting work in finding the neural correlates of hypnotised and dissociative states. But I think there’s a difference between being hypnotised and having a revelatory experience. People who are easy to hypnotise are typically easily suggestible and socially conditioned, while people who have revelations are (to generalise) often quite socially dysfunctional, stubborn misfits. And of course, in the UCL and KCL experiments, we know where the suggestions are coming from – from the scientists. We don’t know where the external suggestions are coming from in revelatory experiences.

We then heard a fascinating presentation by a young neuroscientist called Dr Robin Carhart-Harris, who is working with Professor David Nutt at Imperial on the well-publicised research into the neural imaging of psychedelic experience (you can watch a video of Robin presenting his work here). Robin said the imaging suggests a decrease in filtering or connecting activity in the brain when people are on psychedelics – not opening the mind, so much as closing down some parts of it so that other parts of it can be released.

And his team also noticed an unusual relationship between the default brain network (DBN) – the system we are in usually, where our consciousness free roams inside our head, day-dreaming and introspecting – and the task-positive network (TPN), which we use more occasionally to focus on external stimuli. Usually these two systems are anti-correlated. But during psychedelic experiences, they appear to become correlated, aligned and synchronised – we are both externally focused and day-dreaming, so that the outer and inner worlds become fused. The ego boundaries are dissolved. We return to a state of infant wonder, projecting the shadows of our dreams onto the cave-walls of external reality.

Robin noted that, for many participants in the Imperial study, and in another project running now at John Hopkins, the psychedelic experience in the laboratory is one of the most meaningful and spiritual experiences of their lives. In the John Hopkins study being run by Roland Griffiths, for example, 70% of participants report mystical experiences, and 60% describe it as the most spiritually meaningful experience of their lives. That’s pretty remarkable.

We then had some historical perspectives on revelatory experience. Dr Jane Shaw, Dean of Grace Cathedral in San Francisco, presented her work on the Panacea Society – a religious community that sprang up in Bedford during World War I around the figure of Mabel Bartlerop, who announced one day she was Octavia, daughter of God, and who claimed to receive dictation from God every afternoon at 5.30.

And then Dr Phil Lockley, part of the same ‘Prophecy Project’ at Oxford as Dr Shaw, gave a useful talk outlining how recent historians have tried to contextualise revelatory experiences, in works like Barbara Taylor’s Eve and the New Jerusalem (1983), Phyllis Mack’s Visionary Women (1992), Diane Watt’s Secretaries of God (1997), and (going back a bit) Norman Cohn’s The Pursuit of the Millennium (1957).

Dr Lockley showed that historians can tell us interesting things about how revelatory experiences are culturally constructed and influenced by their time. For example, Dr Shaw told us how the language of inspiration in the Panacea Society was inspired by the invention of the wireless – the mediums talked of ‘tuning in’ to God – a phrase which was subsequently taken up and popularised by Timothy Leary and the LSD counterculture. The movement was also part of the ferment during World War I – it was fiercely patriotic, and members of it lobbied the Archbishop of Canterbury to open the ‘sealed box of prophecies’ left by the 18th century visionary Joanna Southcott, which she said should be opened in a time of national crisis by the 24 bishops of the nation (here’s the box on the left). I personally think the opening of the box should be the climax of the Olympics inauguration ceremony.

Both these approaches – the neuroscientific and the historical – tell us some fascinating stuff about revelations. But it seems to me that both approaches leave something out. There is the important question of the quality of the revelatory experience. Academia often leaves out such qualitative questions – for example, academics are so busy contextualising a novel, say, or a therapy, they won’t ask if it’s any good, which is really the most important question. They say it’s ‘interesting’, by which they mean it is useful for their particular line of research.

There’s a value judgement we have to make about revelatory experiences – both other people’s, and our own.

I come from a Quaker family, and I remember my great-grandmother telling a story about a woman standing up during a Quaker meeting, moved by the Holy Spirit, and proclaiming: ‘Raspberry ripple with a cherry on top’. Well, yes, I mean, absolutely, I’m all for raspberry ripples, particularly with a cherry on top, but that’s not a revelation I will spend much time studying or following, because of my own value judgement about its quality or meaningfulness.

I asked Dr Shaw why, if Mabel’s inspired poetry wasn’t much good in her estimation, had she spent years studying it. Did she think it was actually from God? She said she was a historian, so couldn’t answer that. But later on, she came back to the question, and said she thought Mabel did have a ‘spiritual authority’, which was apparent in her letters to her flock more than in her inspired writing. Dr Shaw made a value judgement about the quality of Mabel’s work – which involved an evaluation of Mabel’s relationship to God. That was at the foundation of her enduring interest in the Panacea Society.

So in general, can we make value judgements about revelatory experiences? I mean, besides going and asking God if he really did send this message or if we should put it in the spam folder.

Yes, I think we can.

Firstly, we can make judgements about truth-claims that prophets make. For example, Mabel of the Panacea Society claimed that members of the Society would never die. Turns out she was wrong. That, to my mind, reduces her authority and the authority of her experience. There’s that amazing scene in The Brothers Karamazov where the dead body of the inspired priest starts to decompose and smell, thereby conflicting with the spiritual tradition that the bodies of the inspired don’t decompose. Well, that undermines the spiritual authority of that charismatic tradition. It shouldn’t have made those claims.

Secondly, we can make aesthetic judgements about the quality of inspiration. Is it complete gibberish? Or is it incredibly beautiful? Rosemary Brown, an uneducated housewife from Balham, claimed in the 1960s to be a medium in touch with the spirit of Liszt and various other composers. The BBC went to interview her and asked ‘Liszt’ to come up with a composition. And eventually s/he did – and, according to a psychiatrist who was at the conference, the piece she wrote was incredibly complex, with the left hand playing in 5/4 and the right in 3/2 – far beyond Rosemary’s technical ability to play, and the sort of thing that scholars say Liszt might have written. The aesthetic quality of the composition makes her claims to inspiration more credible, in my view. Or at least, more interesting (there’s that academic word again).

Thirdly, can the person make sense of their vision, can they articulate it, can they defend it? Think of the young Jesus holding his own in the Temple against the elder authorities. Think of Socrates – inspired by his daemon, yet capable of rationally articulating his beliefs. I know Kierkegaard would argue that revelation is irrational, that the whole point of it is you can’t articulate it, you can’t make sense of it or defend it. Well, I think part of the challenge for someone who has a revelatory experience is to try and make sense of it and communicate it, to carry it down from the mountain. That also means you need to be able to defend its ideas, without simply saying ‘an angel told me’.

Fourthly, does it lead to human flourishing – your own, and other people’s. One of my friends is schizophrenic, and is sure the voices he hears are angelic. But the voices are very mean to him, they block his flourishing. Of course, he would say to me ‘how do you know? How can you tell the state of my soul or your soul?’ I’m not sure how to answer that question. But we can test out what the voices say and show they don’t always tell the truth, for example. In which case we grant them less authority.

And we can see if they cause us distress and suffering, or if they help us. Professor Philippa Geraty of the Institute of Psychiatry, who works with people experiencing psychotic episodes, presented some fascinating research (a lot of which was done by Dr Emanuelle Peters of KCL), which showed how common psychotic experiences are. Yet they’re not always distressing. In particular, research has shown people in new religious / evangelical communities are more likely to experience psychotic symptoms and beliefs than the general population, but less likely to see them as problematic or distressing than isolated individuals. In the words of Dr Quinton Deeley of KCL, they have constructed ‘a shared context and a shared meaning’. They have socially framed a psychotic experience in such a way as to recover from it, find meaning in it and even draw strength and joy from it. (On that subject, check out this support organisation – the spiritual crisis network.)

Both Geraty and Deeley spoke of helping people find meaning in their psychotic experiences, which apparently is central to the ‘recovery movement’ in psychosis treatment. One of the delegates told me about the work of Rufus May, a clinical psychologist in Bradford who was sectioned in the 1980s. Check out his website – it’s absolutely fascinating about how social support networks like Hearing Voices help people find meaning in psychotic experience. He writes: ‘Being given a diagnosis of schizophrenia was not helpful for me. It created a learned hopelessness in me and my family who resigned themselves to the established belief I would always be ill, unable to work and always need antipsychotic medication. There is a deeply held assumption that schizophrenia is a disease-like degenerative process. Thus the category of schizophrenia is associated with a failure to recover and a gradual deterioration in social functioning. It is more helpful to see each individual’s mental health as a unique and evolving story, which is importantly influenced by social and relational experiences.’

Perhaps it doesn’t matter where revelatory experiences come from, it’s what you do with them and what they lead to. What is the quality of the work you go on to do? How much does it help people? How much does it help you? It is difficult to evaluate this, in the absence of a scientific measurement device that measures godliness (a sort of spiritual Geiger counter). Yet as humans we do evaluate the quality of various revelations, and our evaluations decide what revelations we use to guide our life. I’m not into the Panacea Society, for example, while I am interested in Plato, Rumi, the Buddha and other inspired writings, because of my own qualitative evaluations about the writing and the organisations they inspired, evaluations which I am prepared to defend rationally.

Take Alcoholics Anonymous. It was inspired by a religious vision experienced by Bill W. when he was on belladonna, which he took as part of a radical psychedelic cure for alcoholism. OK, that’s interesting. But it’s more interesting what he did with it, the work he did, the movement he constructed, which I think is one of the most interesting and successful movements of the 20th century, in terms of the human suffering it reduced and the flourishing it increased. You can qualitatively evaluate the work without having to evaluate if Bill’s vision ‘really was’ from God.

The world is full of people who claim to have received messages from God. They often think they have been uniquely blessed with this message and get rather grandiose about it. Well, you’re not that special – many people have such experiences. Some of those messages seem useful, others less so. We need some kind of spam filter, and a way of evaluating the quality of the message without relying solely on the purported address of the sender (contact@God.org).