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Sacrificing Neoliberalism to Save Capitalism
By Ximena de la Barra
International Development Consultant and Public Policy Analyst
Former Public Policy Advisor, United Nations Children’s Fund (UNICEF)
Is Justice just?
Why does the World reward those who plunder it?
Why is Justice blind only in one eye?
(Galeano 2009)
Sacrificing Multilateralism and Democracy to Maintain Privileges in the Hands of the Few
While increasing business profits based on cheaper inputs, globalization resulted in overproduction and a demand crisis. Externalities such as poverty, pollution, and environmental depletion were ignored while profits were invested in financial speculation.
Consumption and production patterns remained unchanged and effects reached the whole of humankind. Even as we speak, social and environmental effects of world crises are intentionally being overshadowed by financial effects.
Formidable rescue plans funded by the powerful countries have concentrated on saving the very same institutions and individuals who caused the speculative debacle. In order to re-establish credit, banks have been rescued selectively by injecting them with liquidity when buying their toxic assets. But banks opted for using the taxpayer’s bailout to improve their financial records, to buy other banks and to reward their executives lavishly.
Speculators continue speculating, businesses refuse to lower their demand for profits, and banks refuse to lend to desperate customers. Colossal financial flows have been directed towards rescuing transnational corporations in the productive sector. But what has been ignored is the futility of refloating production in a context of overproduction without expanding demand capabilities. Lack of political will to look for real solutions is evident. Measures adopted have meant no rescue whatsoever for ordinary people while social public expenditures shrink and taxes grow. Rather than guaranteeing jobs and decent salaries to restore consumption, the financial crisis is seen as an opportunity to further exploit workers as if they were causing it. On the other hand, little has been regulated, so speculators have no obstacles. A more efficient system is impossible where impunity prevails for corrupt regulators. In fact, what has been perpetrated is a massive transfer of public funds to the financial oligarchy (Martínez 2009).
While forgetting its role in fostering Third World dependency and impoverishment, the World Bank has announced a development emergency and the probability of a lost generation with predictions of additional 1.5 to 2.8 million child deaths before 2015. It also warns that Third World countries, after having faced speculative increases in food, fuel and fertilizer prices, would now need to prepare for a drastic reduction in trade, credit, remittances, direct foreign investment and development cooperation as well as for increases in agricultural subsidies and protectionism in developed countries. The poor in the Third World, it adds, need to prepare for fewer jobs, reduced salaries, less public expenditure, and worsening of opportunities to emigrate (World Bank 2009). Those who already emigrated can only expect to be the first to lose their jobs, experience increased xenophobia, criminalization, and deportations, and to return to a worse poverty than the one they escaped.
The reality is that all over the world, recession either is hovering, has arrived or is deepening. The financial crisis has impacted the real economy, and as a result workers and their families (ILO 2009). Negative impacts will spread across social sectors as pre-crisis bonanzas and rescue operations benefit only a few. This means that the majority will be paying for the sins of others. The consequences of this will be more severe on the poor and those who lack safety nets, and will be transmitted to future generations as well.
Women, who are often the first to get fired, will be the most affected since their precarious labor insertion tends to exclude them from social benefits. Additionally they supplement with their own effort any resource reductions at home, as well as social services reductions within their communities. Most probably there will also be an increase in domestic violence against women deriving from generalized frustrations within families.
Children and the elderly whose welfare rests on women’s laps are equally vulnerable. This explains why during the Belem World Social Forum in 2009, women declared:
We are not interested in palliative answers based on market logic in response to these crises; this can only lead to the perpetuation of the same system. We need to advance in the construction of alternatives…and confront the capitalist and patriarchal system that oppresses and exploits us. (WSF 2009)
Even though the crises would be an opportunity for investments in ‘green’ technologies, this has not been the orientation of rescue packages. Worse yet, many governments will decide to postpone action on climate change till they see an end to the economic and financial crises. The best example is the political resistance of the industrial lobbies represented by the USA blocking any such progress (World Watch Institute 2009).
It is not that there is a lack of ideas or resources. UNEP2 has developed a proposal for a Global Green New Deal that would direct fiscal stimulus to energy-efficient buildings and investments in sustainable transport, renewable energy, agricultural productivity, freshwater management and sanitation. Achieving environmental objectives would come hand in hand with employment creation and savings in energy costs. They could be funded by eliminating fossil fuel subsidies and strengthened by a change in public policy at national and international levels pointing towards that same direction (UNEP 2009).
In April of 2009, Alberto Acosta, former President of the Ecuadorean Constitutional Assembly forcefully argued that we could eliminate some military expenditure, eradicate certain tax havens, and establish Tobin taxes on financial transactions and Daly taxes on crude oil extraction. These measures, as well as additional measures on other environmentally sensitive products, would make enough resources available for overall redistribution to satisfy the most pressing needs of humankind, including improving both the environment and living conditions. Were current reckless production and consumption patterns to become socially and environmentally responsible, and were politics able to acquire primacy over the economy, we would be able to witness the end of the civilization of inequality and the birth of a new civilization of democracy and equality (Acosta 2009).
The financial crisis is being utilized as an excuse to ignore commitments related to Third World development finance and to prevent climate change. UNEP claims that with one quarter of the bailout funds, and with the appropriate policies, an excellent green stimulus package could be funded (UNEP 2009). The Institute for Policy Studies reported at the end of 2008 that the funds committed by the USA and the Europeans to rescue financial institutions ($4.1 trillion at that point) are 45 times larger than what is committed for development cooperation and 313 times larger than what is to be spent on climate crisis mitigation in poor countries during that same period (Anderson and Cavanagh 2008). The Millennium Campaign makes similar claims (United Nations Millennium Campaign 2009). The wrong priorities have continued to intensify since then.
Miguel d’Escoto, President of the United Nations General Assembly, was not going to stand idly by while the most powerful states were set upon dismantling multilateralism and global democracy in order to retain their hegemonic power. He was outraged at their attempts to debate solutions to the global financial crisis by themselves, behind closed doors. Considering the G-203 authorization to do so illegitimate, he gave the call for a High Level Conference to deal with this issue a special impulse and orientation. In so doing he re-established the principle that transcendental global decisions need to be considered by the General Assembly of the United Nations, that is to say, by the G-192,4 rather than only by groups of countries with vested interests. Aside from global democracy, a main objective would be to protect the poor and the developing countries, and to avoid a repetition of the situation in the long run.
A Panel of Experts led by Joseph stiglitz developed a draft proposal with a series of neo-Keynesian measures to counteract the crisis. Among them: the replacement of the dollar as the global reserve currency, the creation of a Global Economic Coordination Council, financial innovations to avoid risks, etc. The document was bolder in its diagnosis than its proposals. What was missing, according to François Houtard, one of the co-authors, was the fundamental purpose of the reforms beyond returning to the precrisis situation. Also missing was the ethic of the common good for the planet and for humanity, nor does it call for solidarity and cooperation as D’Escoto did in his inaugural address (D’Escoto 2009).
The Conference5 took place on 24 to 26 June in New York, in spite of the boycott of G-20 members who continued to scoff at multilateralism, either with their absence or with their very low profile delegations. The major relative success was the insistence on multilateralism as the right forum for decision-making in what affects the whole of humankind. Also important was recognizing the need to confront not only financial problems but also their human and environmental costs, especially in less developed countries. Unfortunately the final document (United Nations 2009) as approved was severely watered down by the negotiation process. It does not threaten the hegemony of the dollar nor of the dominant economic powers when restructuring the international financial system. It includes no statement against tax havens or in favor of global taxes.
According to Houtard, the most severe confrontations were between North and South and between those who defended capitalism and were only seeking to regulate it and those who proposed steps towards a post-capitalist approach (Zaldivar 2009).
The participation of some Latin American countries in the meeting, especially of ALBA members,6 is worth highlighting for their innovative contributions. Nevertheless, the huge democratic deficit and the reluctance to comply with international commitments within the United Nations could frustrate any significant breakthrough that this Conference could have meant. The final result remains, therefore, with the social movements and their capability to build up pressure.
The G-20 Reacts by Sacrificing Neoliberalism in Order to Rescue Capitalism While Abandoning Peoples and the Environment
With the interests of the USA and Europe predominating over other G-20 members, resolutions center on financial market and financial institutions reform. Serious differences emerge regarding the priority to be assigned to regulatory aspects vis-a-vis economy energizing aspects. Nevertheless, none of these issues seems to be present when leaders adopt protectionist measures back in their own countries. The self-selected participants are precisely those who are most responsible for the crises. Their inclusion of a handful of emergent countries helps fulfill their purpose of obtaining endorsement on resolutions. By being made to feel like members of the club of the powerful, these emergent countries are bribed and deterred from attempting to join any post-capitalist initiative.
Aiming at rescuing capitalism, the G-20 has turned its back on neoliberalism – earlier described by Margaret Thatcher as ‘the only possible alternative’ – and has opted for a new regulatory doctrine, returning rhetorically to Keynesianism. Thus, capitalism can happily head towards its next cyclical crisis, not without lining some prominent pockets beforehand. Whether the guilty get punished, whether the system gets regulated, whether protectionism becomes acceptable, turns out to be of lesser importance. Countries so quick in rescuing banks show no interest in rescuing the planet, nor humankind. Plummeting employment indicators mean generations may be lost to poverty, which could be reversed if there were a political will to do so. The environmental crisis, on the contrary, is nearing its point of no return while the G-20 resorts to blaming the Third World. The G-20 ignores the agreed upon principle of shared but differentiated responsibilities. From this point of view, resolutions turn out to be monumentally myopic.
The senseless decision to refloat the moribund, non-democratic International Monetary Fund (IMF)8 by trebling its resources so it can take over the economic rescue plan, is a vivid example of rewarding the guilty and pretending that the causes of failure can turn into solutions. In reality it means adding fuel to the fire. Even though the crisis developed within the financial system (Soros 2008) the IMF did not foresee or prevent it. On the contrary, the IMF was one of the strongest promoters of free markets and said nothing regarding overproduction or over-indebtedness. The neoliberal conditionalities the IMF imposes on the ThirdWorld guarantee South-North resource flows and the destruction of the capacity of developing states to reign in the markets. The IMF’s role continues to be a main cause of the structural crisis in the developing world (de la Barra and Dello Buono 2009). In this sense, the IMF’s ‘solution’ will also guarantee that both the new and the old poor on the periphery will help foot the bill, even though they were the very least contributors to the crisis.
True Keynesianism would mean not only more public regulatory capabilities but also more public action to fund activities paying decent salaries, generating full employment, guaranteeing universal healthcare, education and housing and stimulating demand (Cademartori 2009). To make this possible, strong public institutions are needed, the same ones that the IMF destroys. It is also evident that new proposals are far from being Keynesian. Therefore, in order to avoid confusion, it is best to refer to them as neo-Keynesian.
Both neoliberalism and neo-Keynesianism are based on the market as the principal production, distribution and consumption mechanism, although the latter aims at regulating it. Both are technocratic proposals devoid of social participation. Both strengthen the private control of the means of production, deriving profits from the exploitative extraction of surplus value from labor and from nature (Bello 2009).
The USA Reacts by Taking from the Poor to Line Pockets among the Rich
The US, historically responsible for the financial crisis,9 bases its hegemonic power on its military strength and on the advantage of being the only country that can print unlimited amounts of the international reserve currency. This has enabled it to siphon resources from the rest of the world. Shooting itself in the foot, the administration of George W. Bush amassed a huge commercial and fiscal deficit forcing it to resort to the sale of strategic assets and to turn to sovereign debt funding (other countries’ savings invested in US Treasury bonds).
As the financial crisis became evident, unbacked dollar printing, lowering interest rates and taxes, and selective bank and financial institution bailouts with taxpayers’ money became the solution. But credit did not become available and financial institutions continued to speculate. The rich did not spend their tax savings in reactivating the economy, but in more speculative activities. Big corporations continued to close domestic operations, continued to relocate them abroad in order to benefit from cheap labor and lax regulations, and took their profits to fiscal safe havens.
Leading progressive economists criticized Bush’s ‘Troubled Asset Relief Fund’ (TARP) program, which had been supported by then candidate Obama, because it did not rescue small and medium-sized businesses. Those are the ones that can create employment. TARP has since been plagued by mismanagement and fraud, as reported by the US Treasury Department, because it expected self-regulation by its beneficiaries who are experts in doing precisely the opposite. Naomi Klein has labeled this fraud, perpetuated on taxpayers with full impunity, as ‘crony capitalism’ (Klein 2008). The Bush administration also pretended to prove global warming was not an issue, opening the door to even more reckless consumption and pollution emissions. Any proposal to curtail them has been frozen in a Congress that is held hostage to powerful corporations. Proposals to soften the impact on the vulnerable have suffered a similar fate.
The Obama rescue package of buying bank toxic assets has also been the target of Treasury Department criticism, alleging that the program will only benefit those who impoverished the poor and the middle class (Dunbar and Donald 2009). The Center for Public Integrity has denounced the rescue plan because the banks benefiting from it are the same ones that funded the subprime market. The Center points an accusing finger at both political parties in this fraud (Aaron 2009). The fact is that this plan devised by Treasury Department Secretary Geithner benefits buyers with public funds by guaranteeing 90 percent federal insurance should there be losses and allows them to keep 100 percent of the gains.
There is even more brutal criticism targeting Geithner and Summers, Obama’s closest financial advisors, alleging that the Administration belongs to banks and big corporations and that there is a revolving door between them (Greenwald 2009; Klein 2009; Moyers and Winship 2009). Summers is a well known de-regulation champion and Geithner, from his former position as head of the New York Federal Reserve (Fed), was one of the main provocateurs of the financial crisis. Both religiously favor free markets and public subsidies for banks. Which helps explain why the Obama administration conditions bank rescue on self-auditing. This is enough to prove that Obama has repeatedly placed the fox in charge of the henhouse. paul krugman calls this plan a fraud and labels it as ‘trash for cash’ (Krugman 2009). Stiglitz defines it as a program where one partner (the banks) robs the other (the state and taxpayers) while socializing losses and privatizing profit (Stiglitz 2009a).
The Obama administration continues printing currency and increasing the foreign debt, therefore weakening both the dollar and the economy. Bankers resist regulations and the support to the financial sector creates a false recovery on Wall Street, setting the scene for the next financial bubble and continued speculation. As the financial crisis deepens, selective public interventions are made that are squarely against neoliberal principles.
While of questionable effectiveness, bankrupt banks or private entities are placed under public control and massive investments to stimulate the economy are made. A new wave of Keynesianism emerges even though Republicans in Congress are demagogically calling it socialism.
New initiatives emerge, such as those rescuing ‘institutions too big to fail’ or ‘too big to be restructured’. Stiglitz denounces these institutions as having had the political clout to impose de-regulation and later to get taxpayers to pay for cleaning them up (Stiglitz 2009b). Rather than splitting them up so that they stop being ‘too big’, they are rewarded with Fed funds and are protected in their impunity. To top it off, this ‘solution adds new power to the Fed, an institution that never used its authority to prevent the crisis and that is not accountable to the public’.
Many glaring omissions regarding derivatives and tax havens, for example, may be found among the new proposals. What is perhaps the most positive aspect is the creation of a Consumer Protection Agency. If there were a political will to do so, this Agency could extend its consumer protection to financial products, diminishing the Fed’s power.
Also positive is the proposal to limit leverage that allows banks and financial institutions to undertake extremely risky speculative actions. However, ‘too big institutions’ are exempt from this limitation, which paves the way for colossal leverage. The Obama administration has no intention of ending the prevailing culture of incentives and impunity among financial sector executives, or increasing their taxes. Neither separation of commercial banking from financial institutions, nor prohibition of the most dangerous financial instruments, is considered. Nevertheless, Wall Street prepares to counteract whatever positive elements are contained in these proposals and has all the power to do so (Weissman 2009).
Parallel to rescuing big speculators, promoting the impunity of financiers, and keeping financial regulations in the rhetorical realm, a big public work plan has been announced with the intention of generating jobs and stimulating demand. Its effectiveness fully depends upon what investments are made, how they are undertaken, and if they consider the vital needs of the population and environmental limitations. Often, crisis related actions ignore economic disparities that helped make the poor hostage to their mortgages and their credit cards in the first place. Meanwhile the rich invent new financial instruments in which to invest their huge profits. The dismantling of the public social service sector is now causing longer lines in soup kitchens. And all this continues in spite of the evidence that economic reactivation will not be possible without rescuing workers and their families.
In the midst of entrenched individualism, heroic actions emerge from groups defending labor and environmental rights. Finance must serve the real economy rather than command it, they warn. Unfortunately they are yet to coalesce into larger movements in order to build up the necessary momentum to change current destructive tendencies and confront repressive action.
On the side of organized labor, the AFL-CIO11 denounces Wall Street influence over politicians defending big business. And they denounce the ‘corporate agenda’ (AFL-CIO 2009) of keeping salaries low, forcing workers further into debt and homelessness, even while productivity skyrockets. They fight instead for their Agenda for Working Families, seeking to build up union power and decent working conditions and benefits for working families. They also seek fair trade agreements to improve workers’ conditions throughout the world. This is a heartwarming endeavor but one that fails to mitigate the negative impact of free trade agreements (FTAs) in the Third World. It certainly contradicts the ‘Keep it built in America’ campaign of US automakers. Obama’s rescue plan did, in fact, include ‘Buy American’ provisions. Also, none of these campaigns deals with their environmental impacts.
Despite impressive mobilization campaigns by different groups within the USA, the vast majority of the public remains subject to a skillful disinformation campaign that keeps them far apart from any idea of organizing to fight for their rights. The USA still wields vast military and economic power. And the USA is still the only country able to continue both borrowing and printing currency. But the times of US hegemony are passing, and we are currently transiting towards a multipolar world.
In the Europe of the Merchants, the Reaction Is Increasingly Neoliberal and Anti-Democratic
The global financial crisis reaches Europe while it is already under the effects of its own structural crisis. It is a time when Europe intends to refloat, with a different name, a constitution that was already rejected. Prevailing neoliberal policies are limiting European capabilities to weather the crises and jeopardizing the welfare of its peoples and the environment, especially in the newly integrated countries of Eastern Europe. The Brussels Consensus12 has meant tax and public budget reductions, labor flexibility, high credit costs and fiscal deficit curtailment, all of which bring increased unemployment and worsening of labor conditions. As with other parts of the neoliberal world, capital profit continues to increase while labor participation in national wealth decreases.
Late in 2008, Europe reacted with a European Economic Recovery Plan and a new system of European financial supervision. However, lack of agreement with their specific content has forced open an ‘every man for himself ’ policy, evidencing the lack of cohesion within the European Union (EU). A common vision tends to emerge only when placing the weight of the crisis on workers’ shoulders,13 when criminalizing and repressing migrants,14 when enlarging military budgets to support American wars, and when strengthening the IMF so that it will continue to foster neoliberalism and imperialism.
Consensus can also be found in the Global Europe strategy which aggressively imposes European transnational interests on the Third World under the cover of Association Agreements which are as perverse as FTAs are (de la Barra forthcoming).
Social movements and unions have reacted. Massive protests have emerged all over Europe. Governments have collapsed inHungary, the Czech Republic and Belgiumand the governments that remain frequently resort to restructuring. Alternative agendas proposing a solidarian Europe emerge, where democracy, participation and social justice prevail.
Demands build up for a basic salary and social benefits regardless of labor, gender or migratory status, aiming at a Europe free of poverty, disparities, and environmental distress. Capitalism is blamed for its responsibility in bringing about the crises and a new financial system to be developed with social participation is proposed (ATTAC 2009).
The main features would be:
• Taxes and regulations for financial transactions and capital movements as well as their control so that they would only respond to socially and environmentally sound objectives.
• A public fund devoted to those same objectives.
• Democratic control over the banking system, limiting bank rescue to those supporting socially and environmentally fair production and that do not establish headquarters in fiscal havens.
• Eradication of fiscal evasion, tax cuts and tax havens.
• Hedge fund and any other speculative investment prohibition.
Lack of trust in European institutions was made evident during the 2009 elections to the European Parliament, where unprecedented abstentions allowed the extreme right to obtain the majority of the few votes cast. Some analysts blamed it on the left being right wing look-alikes and unable to present an alternative. It also became evident that Europeans have no interest in a Europe that disregards their opinions. Many think the European integration process is terminally ill and that Europe has lost its clout on the international scene.
Eastern Europe and the Baltic Republics face an explosive situation. Ever since they integrated with Europe or became close to it they have been plagued by the volatility of foreign capital, by public and private debt in foreign currencies, and by the devaluation of national currencies. The consequences have been bankruptcy, political instability and the exacerbation of neoliberal and austerity measures. A group of former Stalinist bureaucrats in alliance with Western corporative interests have amassed huge fortunes by plundering public resources while the population faces poverty and unemployment. Corruption and desperation at all levels of society have prepared the scene for political instability, public unrest and fascism (Salzmann 2009). At the same time the monumental, unfounded trust in capitalism and in the free market system has collapsed.
Powerful BRIC15 Countries Point towards a Multipolar World Even Though They Also Feel the Pains of the Crises
Brazil, Russia, India and China, until recently totally excluded from power centers, have united to become valid interlocutors in the global scene.16 They have emerged as the countries able to continue growing (except for Brazil and Russia), hold the largest financial reserves and become the bankers of a world in crisis. This is why the G-8 has included them in the G-20. There are additional reasons for their integration: Brazil can be counted on to split emerging emancipatory integration in Latin America and holds the key to the largest world natural resources in the Amazon. Europe’s future energy supply depends upon Russia. India holds nuclear power and needs allies to tackle the constant threat coming from the USA/Pakistan alliance. And the US economy and China’s have become totally interdependent.
At the G-20, China has emerged as a threat to the dollar hegemony while developing a proposal to replace it with a new global currency that can remain stable in the long run and that is not linked to the interests of a single country (Zhou 2009). China would remain the main creditor to the USA but would lower its risks from dollar devaluation.
Russia has supported the initiative as long as the ruble is also included in a mix of currencies to be adapted to that purpose. It is conceivable that Washington could have no option but to accept China’s dollar replacement proposal even though it would desperately try to avoid it since losing such a privilege could drive it to bankruptcy. This would explain why Obama, an anti-war campaigner during the electoral process, turned immediately into a warrior as soon as he took office.
The other issue on which BRIC agrees is not to contribute to the IMF until they are given expanded voting power. However, they do support IMF bond emissions denominated in Special Drawing Rights (SDRs) so as to eliminate the risks posed by the dollar, and are ready to invest in them. They are well aware they must stop investing in US Treasury bonds, lest they continue to fund their own source of military threat. The explicit goal is to establish a new world order ending US military and economic hegemony (Hudson 2009a, 2009b).
Regarding domestic crises, Brazil reactivates its huge internal market and officially announces it expects the financial crisis to be short-lived. Nevertheless, its vocation as a primary exporter and its dependence on foreign capital make it especially vulnerable to demand contraction (ECLAC 2009). Impacts on employment are being partially counteracted by conditioned cash transfers, by increasing the minimum salary, by fiscal incentives for employers to fire fewer workers, and by protecting social expenditure from budget cuts. Additionally the productive sector is being supported in areas corresponding to popular priorities (Dowbor 2009). Brazil is expanding cooperation and trade with BRIC members in their own currencies.
Russia rescues the powerful and braces up to repress social protest. With recent experience in undergoing crises17 within BRIC it is Russia that is expected to suffer the worst recession. The main reaction has been a massive public resource transfer into rich private hands, combining the worse traits of market capitalism with the most inefficient forms of governmental regulation, all with a huge dose of ‘blaming the victim’ (Kagarlitsky 2009).
The Kremlin has left impoverished workers defenseless and wounded by social budget cuts (Volkov 2009). Banks that were awarded rescue packages continue speculating in currency markets while the ruble devaluates and the public budget shrinks due to falling oil prices. The public deficit increases as reserves dwindle. On the positive side, the Kremlin has presented a law proposal to increase Central Bank authority on bank control and to ensure no future public assistance is provided to banks that engage in speculation (Global Research 2009). The scene is ripe for social protest and the Kremlin and the Duma know it because they are revamping repressive authority (Volkov 2009).
The economy of India continues growing – though less than usual, while the crisis targets the rural poor. The banking system continues to be healthily free of toxic assets, due to an existing policy decision to strictly regulate it, as well as foreign capital transactions. No rescue plan or capital injections have been necessary, even though foreign capital sources have been lost and the international demand for Indian goods has been considerably diminished. The reactions to the financial crisis have mainly been geared to increase liquidity, make low interest credits available, and to lower big corporation taxes (Panagariya 2009).
The short-lived boom as a consequence of India’s global insertion as a cheap labor supplier has only benefited the more privileged sectors of society (Kranti and Deepal 2009). Even with China, its main market, Indian trade is asymmetrical in that it continues to increase its trade deficit by exporting primary products with hardly any added value. At the same time it imports finished products from China with high added value (Aiyar 2009). The endemic poverty and exclusion crises in the rural area where transnationals like Monsanto have destroyed poor farmers has been intensifying and is reaping a harvest of suicides among them (Shiva 2005). The World Food Programme (WFP) has warned that the return of the urban unemployed to the countryside will only intensify this crisis.
China has been the country to take most advantage of globalization with the least risks in regard to trade and direct foreign investment. This has been due to its strong control over finances and its currency, as well as its ability to direct financial flows towards its own economic development plan. It has thus achieved the highest growth rates in the history of humanity and it is expected to continue growing at quite respectable rates. China has mainly concentrated its investments in US Treasury bonds and has been labeled ‘the USA’s banker’ for its role in funding the Obama administration, rescue package and military endeavors alike. The reality points towards a symbiotic relation with the USA in which China aims to protect the main market for its products as well as its investments, avoiding further dollar devaluations that would come with increased US currency emissions, should a last resort lender such as China not exist (Pellegrino 2009).
Nevertheless, China has started to diversify its investments and commercial partners, and to trade in yuan and other currencies, rather than in dollars with BRIC and East Asian partners. In order to ensure its strategic basic resource reserves, it offers credits without conditionalities and funds development projects all over the world (Hiro 2009).
In order to further reduce the risks posed by the devaluation of its dollar based reserves, it has requested the IMF to emit yuan based bonds hoping to offload excess dollars to credit demanding countries, and especially to the US Treasury (Stoupe 2009).
China reactivates its internal demand with a sizeable economic stimulus package, and in so doing, reactivates the economy of East Asia which produces inputs for Chinese industry. In addition, China’s global insertion as a source of cheap labor and the decline of the demand for its manufactured goods will mean negative domestic labor impacts throughout East Asia and in China’s urban areas. Due to government control over economic and monetary policies, the impacts in China will be less severe than those in Japan and South Korea, which have followed neoliberal policies and are therefore less able to manage their own economic futures.
China is now strengthening its semi-abandoned welfare systems and establishing minimum wage, training, health and pension programs that will go a long way toward reducing disparities, compensating for declining remittances to the rural areas, and reducing social unrest. The fact that unemployed urban migrants maintain their rural bases and the property of their land, and that the government is placing more land into agricultural production, will soften the risk of hunger and will provide a basis for small scale entrepreneurship (Selden 2009). Whether rural reactivation will threaten carbon sink forests, which contribute to improve carbon balance in this country that by 2006 became the world’s largest CO2 emitter, remains to be seen (Velazquez 2009). Increased innovation capabilities and less environmentally aggressive production could increase China’s growing world leadership.
[The full version of this article can be found at http://crs.sagepub.com/content/36/5/635 ]
Speranţă
Plumbul e leneş,
glonţu-i încă pe drum.
Mai avem timp .
anunţ la mica publicitate
caut câine
cu 2 boturi
care să nu fie obligat să tacă
atunci când muşcă
(din volumul Ich steh auf den Treppen des Winds (Ausgewahlte Gedichte 1972-1985) / Stau pe treptele vântului (Poeme alese 1972-1985), Editura ICR , 2008, în traducerea Norei Iuga)
NEW YORK — The big white pill was brought to her in an earthenware chalice. She’d already held hands with her two therapists and expressed her wishes for what it would help her do.
She swallowed it, lay on the couch with her eyes covered, and waited. And then it came.
“The world was made up of jewels and I was in a dome,” she recalled. Surrounded by brilliant, kaleidoscopic colors, she saw the dome open up to admit “this most incredible luminescence that made everything even more beautiful.”
Tears trickled down her face as she saw “how beautiful the world could actually be.”
That’s how Nicky Edlich, 67, began her first-ever trip on a psychedelic drug last year.
She says it has greatly helped her psychotherapeutic treatment for anxiety from her advanced ovarian cancer.
And for researchers, it was another small step toward showing that hallucinogenic drugs, famous but condemned in the 1960s, can one day help doctors treat conditions like cancer anxiety and post-traumatic stress disorder.
The New York University study Edlich participated in is among a handful now going on in the United States and elsewhere with drugs like LSD, MDMA (Ecstasy) and psilocybin, the main ingredient of “magic mushrooms.” The work follows lines of research choked off four decades ago by the war on drugs. The research is still preliminary. But at least it’s there.
“There is now more psychedelic research taking place in the world than at any time in the last 40 years,” said Rick Doblin, executive director of the Multidisciplinary Association for Psychedelic Studies, which funds some of the work. “We’re at the end of the beginning of the renaissance .”
He said that more than 1,200 people attended a conference in California last weekend on psychedelic science.
But doing the research is not easy, Doblin and others say, with government funders still leery and drug companies not interested in the compounds they can’t patent. That pretty much leaves private donors.
“There’s still a lot of resistance to it,” said David Nichols , a Purdue University professor of medicinal chemistry and president of the Heffter Institute, which is supporting the NYU study. “The whole hippie thing in the 60s” and media coverage at the time “has kind of left a bad taste in the mouth of the public at large.
“When you tell people you’re treating people with psychedelics, the first thing that comes to mind is Day-Glo art and tie-dyed shirts.”
Nothing like that was in evidence the other day when Edlich revisited the room at NYU where she’d taken psilocybin. Landscape photos and abstract art hung on the walls, flowers and a bowl of fruit adorned a table near the window. At the foot of the couch lay an Oriental rug.
“The whole idea was to create a living room-like setting” that would be relaxing, said study leader Dr. Stephen Ross.
Edlich, whose cancer forced her to retire from teaching French at a private school, had plenty of reason to seek help through the NYU project. Several recurrences of her ovarian cancer had provoked fears about suffering and dying and how her death would affect her family. She felt “profound sadness that my life was going to be cut short.” And she faced existential questions: Why live? What does it all mean? How can I go on?
“These things were in my head and I wanted them to take a back seat to living in the moment,” she said. So when she heard NYU researchers speak about the project at her cancer support group, she was interested.
Psilocybin has been shown to invoke powerful spiritual experiences during the four to six hours it affects the brain. A study published in 2008, in fact, found that even 14 months after healthy volunteers had taken a single dose, most said they were still feeling and behaving better because of the experience. They also said the drug had produced one of the five most spiritually significant experiences they’d ever had.
Experts emphasize people shouldn’t try psilocybin on their own because it can be harmful, sometimes causing bouts of anxiety and paranoia.
The NYU study is testing whether that drug experience can help with the nine months of psychotherapy each participant also gets.
The therapy seeks to help patients live fuller, richer lives with the time they have left.
Each study participant gets two drug-dose experiences, but only one of those involves psilocybin; the other is a placebo dose of niacin, which makes the face flush.
The homey NYU room where Edlich had been getting psychotherapy was the setting for her drug experiences. She had brought along photos of her son, grandchildren and partner. She met with two therapists she’d come to trust, knowing they would stay with her through her hours under the influence.
Taking the drug followed a ritual, including the chalice and the hand-holding, because ritual has been part of psilocybin’s successful use for centuries by traditional cultures, said Ross, the lead researcher.
After swallowing the white pill, Edlich perused an art book for about a half-hour while waiting for the psilocybin to take effect. Then she lay on the couch with headphones and listened to music with eyeshades over her eyes.
After her vision of the brilliantly colored dome, Edlich went on to two more experiences involving parts of her life. She won’t describe those much, even to friends. They “brought me profound sadness and profound grief” but also transformed her understanding of what was important to her in the areas of relationships and trusting, she says.
She sat up and talked with her psychotherapists about what had gone on. And after nine hours in that room, she went home and wrote 30 pages in a diary about what had happened. And she thought about it for weeks afterward.
Did the drug experience help?
It let her view the issues she was working on through a different lens, she said.
“I think it made me more aware of what was so important and what was making me either sad or depressed. I think it was revelatory.”
All three people in the study so far felt better, with less general anxiety and fear of death, and greater acceptance of the dying process, Ross said. No major side effects have appeared. The project plans to enroll a total of 32 people.
Ross’ work follows up on a small study at the University of California, Los Angeles; results haven’t been published yet, but they too are encouraging, according to experts familiar with it.
Yet another study of psilocybin for cancer anxiety, at Johns Hopkins University, has treated 11 out of a planned 44 participants so far. Chief investigator Roland Griffiths said he suspected the results would fall in line with the UCLA work.
In interviews, some psychiatrists who work with cancer patients reacted coolly to the prospects of using psilocybin.
“I’m kind of curious about it,” said Dr. Susan Block of the Dana-Farber Cancer Institute in Boston. She said it’s an open question how helpful the drug experiences could be, and “I don’t think it’s ever going to be a widely used treatment.”
Ross, meanwhile, thinks patients might benefit from more than one dose of the drug during the psychotherapy. The study permits only one dose, but all three participants asked for a second, he said.
Edlich said her single dose “brought me to a deeper place in my mind, that I would never have gone to … I feel a second session would even take me to more important places.
“I would do it a second time in a New York minute .”
http://www.google.com/hostednews/ap/article/ALeqM5iyYvBJd6C_Kjgm68JUwMk8gRJ5nwD9F8HNAO3
By John Horgan , Apr 16, 2010
You know that psychedelics are making a comeback when the New York Times says so on page 1. In “Hallucinogens Have Doctors Tuning In,” John Tierney reports on how doctors at schools like Harvard, Johns Hopkins, UCLA and NYU are testing the potential of psilocybin and other hallucinogens for treating depression, obsessive-compulsive disorder, post-traumatic stress disorder, alcoholism—and for inducing spiritual experiences.
Tierney’s brisk overview neglects to mention the most mind-bending of all psychedelics: dimethyltryptamine, or DMT. It was first synthesized by a British chemist in the 1930s, and its psychotropic properties were discovered some 20 years later by the Hungarian-born chemist Stephen Szara, who later became a researcher for the National Institute on Drug Abuse.
Why is DMT so fascinating? For starters, DMT is the only psychedelic known to occur naturally in the human body. In 1972, the Nobel laureate Julius Axelrod of the National Institutes of Health discovered DMT in human brain tissue, leading to speculation that the compound plays a role in psychosis. Research into that possibility—and into psychedelics in general–was abandoned because of the growing backlash against these compounds.
In 1990, however, Rick Strassman, a psychiatrist at the University of New Mexico, obtained permission from federal authorities to inject DMT into human volunteers. Strassman, a Buddhist, suspected that endogenous DMT might contribute to mystical experiences. From 1990 to 1995, he supervised more than 400 DMT sessions involving 60 subjects at the University of New Mexico. Many subjects reported that they dissolved blissfully into a radiant light or sensed the presence of a powerful, god-like being.
On the other hand, 25 subjects underwent what Strassman called “adverse effects,” including terrifying hallucinations of “aliens” that took the shape of robots, insects or reptiles. Some subjects remained convinced that these aliens were real in spite of Strassman’s efforts to convince them otherwise. In part out of concern about these adverse effects, Strassman discontinued his research, which he describes in his 2000 book DMT: The Spirit Molecule.
DMT is also the primary active ingredient of ayahuasca, a tea that Amazonian tribes brew from two plants and drink as a sacred medicine. After hearing about ayahuasca from the legendary Harvard botanist Richard Shultes, the beat writer William Burroughs traveled to South America and swilled the stuff in 1953. In a letter to the poet Allen Ginsberg, Burroughs said that during his first ayahuasca trip he thought he had been poisoned, and he felt himself turning into half-man-half-woman. Burroughs nonetheless drank the tea again and praised its ability to facilitate “space time travel.”
By the mid-20th century, ayahuasca had also been adopted as a sacrament by several urban sects in Brazil. The largest of these is the Uniao Do Vegetal, which combines elements of Christianity with indigenous Indian beliefs. Researchers led by the UCLA psychiatrist Charles Grob (who is mentioned in Tierney’s story) have reported that Brazilian UDV members are on average healthier physiologically and psychologically than a control group. UDV members also claimed that ayahuasca had helped them overcome alcoholism, drug addiction and other self-destructive behaviors. A decade ago, a branch of the UDV based in New Mexico sued for the right to consume ayahuasca legally in the U.S. In 2006 the U.S. Supreme Court ruled in favor of the group.
In Antipodes of the Mind, the Israeli psychologist Benny Shanon, who has consumed ayahuasca more than 100 times, provides a gripping account of his own and others’ visions. Shanon says the tea transformed him from a “devout atheist” into a spiritual believer awestruck by the mysteries of nature and the human mind. Yet Shanon, like Strassman, acknowledges that these hallucinogenic experiences pose risks. Quoting one ayahuasca shaman, Shanon warns that ayahuasca can also be “the worst of liars,” leaving some users gripped by delusions.
I drank ayahuasca a decade ago while researching my book Rational Mysticism . It tastes like stale beer dregs flavored with cigarette butts. After I threw up, I had a cosmic panic attack, in which I was menaced by malevolent, dayglo-hued polyhedra. I have no desire to repeat this experience.
I applaud the psychedelic renaissance, with this caveat: Spiritual texts often emphasize the dangers of mystical experiences, whether generated by drugs, fasting, meditation or other means. That is the theme of an old Talmudic tale in which four rabbis are brought into the presence of God. One becomes a heretic, one goes crazy, one drops dead and one returns home with his faith affirmed.
ABOUT THE AUTHOR
John Horgan, a former Scientific American staff writer, directs the Center for Science Writings at Stevens Institute of Technology. (Photo courtesy of Skye Horgan.)
http://www.scientificamerican.com/blog/post.cfm?id=dmt-is-in-your-head-but-it-may-too-2010-04-16
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Once again, scientists are studying psychedelics—this time for clues on how they might help cure mental illness
By Jessica Fromm
THE first ceremony begins at dark. The participants come into the octagon spiritual room in the middle of the Amazon rainforest. They sit in a circle and state their intentions about what they want out of the ceremony. The more specific the question they want answered, the better.
The doses of ayahuasca are handed out in small cups. Everyone drinks it together, most wincing at the acrid taste that has been likened to “the entire jungle ground up and mixed with bile.” As soft tribal music plays in the background, everyone lies down. They focus their attention and wait.
Ayahuasca is not the kind of psychedelic that one takes to go dancing at a party. A tea derived from two vines that grow in the Amazon jungle, this powerful psychoactive causes intense nausea in most people. It also catapults its users into an intense, introspective psychedelic experience that many feel is capable of curing addiction, anxiety and depression—or just healing past trauma.
Lakshmi Narayan, a Santa Cruz businesswoman who was introduced to ayahuasca years ago in Peru, describes it as a “powerful but gentle” experience that helped her recover from the pain of her father’s death. “It was a wound I had no way of healing, it was so big and powerful,” she says. After a hallucinogenic experience of several hours during which she was visited by the image of her father, she says, “I had nothing left to heal.”
Over the last decade, ayahuasca has become a favorite among the psychedelic community. Also called yage, it is the very same plant that the beat writer William S. Burroughs sought out while corresponding with poet Allen Ginsberg in The Yage Letters.
Since the 1990s, there has been an upswing in the establishment of neoshamanic retreats in Brazil, Peru and Ecuador. More and more Westerners are traveling to South America with the intent of undergoing these psychedelic experiences for personal growth and healing.
Long used by natives in the Amazon basin for healing and divination, ayahuasca—the active ingredient of which is dimethyltryptamine (DMT)—can currently only be used in the United States by members of the União do Vegetal (UDV) and Santo Daime churches, both of which have won Supreme Court battles in the last three years.
But a growing body of research is examining the use of ayahuasca and other psychedelic drugs for healing purposes. After decades of social marginalization and governmental suppression, a renaissance is going on in the world of psychedelic research. In 2010, there are as many research projects on mind-altering drugs going on as there were in the late 1960s, before the U.S. government started cracking down on them.
Last week Deborah Quevedo, who has attended more than 50 ceremonies in South America, presented her own graduate-school research on ayahuasca at a conference hosted by the Santa Cruz–based Multidisciplinary Association for Psychedelic Studies (MAPS), a nonprofit committed to mainstreaming the medical use of psychedelic drugs. Called “Psychedelic Science in the 21st Century,” the San Jose conference was the biggest international psychedelic science gathering in almost two decades.
Quevedo, who with her husband has worked for decades in the fields of holistic and alternative healing at O’Connor Hospital in San Jose, Stanford University Medical Center and UCSF Medical Center, says she’d heard reports about ayahuasca being effective in the treatment of addictions.
The Quevedos made their first trip to a Brazilian ayahuasca retreat in 2001 to experience the drug themselves. “It was really life-changing for me,” she says. “I had never had any experience with any mind-altering substances before, so it was all new and very expansive.
“I came home from that retreat when I was starting a Ph.D. I basically spent the next six years of my graduate school trying to figure out what had happened to me.”
“I’m really glad people are recognizing what a tool it is for our own evolution,” says Narayan. “There’s something very feminine about ayahuasca. And that’s kind of what the world needs, is more feminine energy.”
The alternative medicine guru Dr. Andrew Weil, who began his career in the 1960s as a psychedelic researcher and wrote several popular books on the subject, says people have always used certain drugs “to allow them to transcend their human and ego boundaries, to feel greater contact with the supernatural , or with the spiritual, or with the divine, however they phrase it.
“Drugs don’t have spiritual potential,” he says, “human beings have spiritual potential. And it may be that we need techniques to move us in that direction, and the use of psychoactive drugs clearly is one path that has helped many people.”
Weil was a colleague of Timothy Leary and Richard Alpert at Harvard, where the three men rocked academia with their studies. At that time, LSD was legal, but that changed quickly. After a brief public debate about its potential merits, LSD was outlawed in 1966.
Leary, who had by then become “the Psychedelic Messiah,” was not surprised by the development.
“The effect of consciousness-expanding drugs will be to transform our concepts of human nature , of human potentialities, of existence,” Leary said. “These possibilities naturally threaten every branch of the establishment. The dangers of external change appear to frighten us less than the peril of internal change. LSD is more frightening than the Bomb!”
Leary continued crusading for psychedelics, organizing events like the 1977 psychedelics conference at UC–Santa Cruz, the first to be held at a university. Allen Ginsberg, Ken Kesey and LSD pioneer Albert Hofmann attended.
Having learned from the mistakes of the acidheads of that era, today’s psychedelic community might be better prepared to deal with some of the most powerful substances on earth, even as they discover further evidence of that power and try to harness it to cure persistent ills.
There are promising studies under way around the world into the use of psilocybin for cancer patients, MDMA (ecstasy) for autism and Asperger’s syndrome, ibogaine for addiction and LSD-assisted psychotherapy for the treatment of anxiety associated with terminal illness. Still, MAPS and the broader psychedelic community aren’t out of the woods yet. It took the researchers at MAPS five years of fighting and navigating the bureaucracy of the Drug Enforcement Agency and Food and Drug Administration to get their most recent, and influential, study under way.
Michael Mithoefer’s 7-1/2-year, $2.2 million trial study into the use of MDMA in the treatment of post-traumatic stress disorder (PTSD) was the first legal pilot study of its kind in the United States in decades and has been widely hailed by the medical community as a breakthrough in psychedelic research.
Despite the DEA putting up roadblocks at every turn, Mithoefer’s MAPS-funded research will be expanding this summer into the MDMA treatment of Iraq war veterans’ PTSD.
Meanwhile, the power of psychedelics to combat addiction is gaining attention. Brian Anderson, a Stanford University medical student, says he has seen evidence that ayahuasca “really works” in the treatment of addiction.
“I think a lot of other medical professionals are starting to reach into this literature,” he says. “They say this is a good reason we should investigate these substances in controlled trials, in a more medical setting here in North America.”
Randolph Hencken, MAPS’ director of communication, says it wasn’t a Brazilian vine but an African shrub that cured his addictions. In his early 20s, Hencken says, he was a heroin addict.
“I’d been a junkie for four years,” he says. “I’d pissed off my family, I’d pissed off my friends. I didn’t like myself anymore, but it was easier to keep using heroin.”
After he tried 12-step programs and methadone clinics, Hencken heard about ibogaine. While it has a long history of use in African spiritual rituals, there is also a large international underground movement of people using the drug to treat addiction. Desperate, Hencken made the trip down to Mexico City in 2001 to take capsules of the drug with a doctor (ibogaine is currently illegal in the United States).
“It wasn’t a fun trip,” Hencken says. For more than 24 hours he experienced ataxia, rendering him unable to move as the substance’s psychoactive effects took hold, bringing with it visions from throughout his life. “I don’t think I had any epiphanies that day,” he says, “but it did stir up all these things I was suppressing about my childhood that were interrelated as to why I was a drug addict.”
Hencken says he has been clean for nine years. Since then he has earned degrees from San Diego State University and is dedicated to spreading the word about alternative drugs.
“Getting through something that is so mentally tough, I think gave me some strength,” he says. “It made me confident that if I could get through that, then I can stay away from using heroin.”
If human beings are set apart by their ability to design and use tools, then, in a way, psychedelic drugs are a form of technology. Whether they be synthetically synthesized substances like MDMA or LSD or naturally occurring drugs like psilocybin and mescaline, psychedelics can be viewed as a tool for the brain to be able to tune into diverse states of consciousness.
Considering the extraordinary power of psychedelic drugs, it’s not shocking that when LSD and other mind-altering substances first appeared in the mainstream in the 1960s, some people were terrified. A mere 50 micrograms of acid, an amount that could fit onto the head of a pin, can launch a person into a full-blown psychedelic experience.
“What we often hear from the media is that psychedelics will bring out your demons and make you go crazy,” Hencken says. “Or they’ll give you schizophrenia or you’ll jump off the roof—things that have only really happened to a very few people. I think the bulk of people, if they have these experiences and do them in the right setting, they’ll find them to be very beneficial to their lives.”
As an organization, MAPS would like to see psychedelics accepted to the point that they can be administered safely.
“I first did psychedelics when I was in high school, and I remember friends taking friends to go tripping in a graveyard,” Hencken says. “That’s a terrible place to go tripping. You’re opening yourself up to a situation where you’re going to see dead people, and you’re going to freak out. A lot of people choose terrible places to do these drugs for the first time.”
Hencken says that the bulk of the “bad trips” that people experience on psychedelics could be prevented if the drugs were regulated and the users were properly informed about how to conduct a safe trip.
“Ideally, MAPS would like to see a situation in the near future where people who are interested in these drugs can get honest information. Where they can get unadulterated, clean, safe drugs, and they can do them with a guide that understands the power of these things.”
IT’S a poetic coincidence that last week’s MAPS conference took place in the heart of Silicon Valley . Many of the engineers and entrepreneurs who created the digital revolution were inspired by the use of psychedelics in their formative years.
Apple Inc. CEO Steve Jobs is probably the most candid of the Silicon Valley pioneers on the subject of his drug use. He has called taking LSD and traveling in India in the early 1970s “one of the two or three most important things I have ever done in my life.”
Jobs’ former partner Steve Wozniak has also discussed his experimentation with psychedelics, as have Microsoft CEO Bill Gates and Lotus founder Mitch Kapor. Bob Wallace, the early Microsoft employee who went on to found Quicksoft and coined the term “shareware,” is known as an “online drug guru” and donated generously to MAPS and other psychedelics research before his death in 2002.
Programmer Mark Pesce, one of the early developers of the Virtual Reality Modeling Language, says he was inspired by an LSD experience, as was Douglas Engelbart, inventor of the first mouse prototype at the Stanford Research Institute in 1963.
Internet pioneer John Gilmore, one of Sun Microsystems’ first employees and co-founder of the free-software firm Cygnus Software, says psychedelic drugs have been an essential tool in his life’s work. “It sort of taught me that our relationship to reality is a little bit fuzzy,” he says. “It’s mediated through our senses and through our expectations. That knowledge has helped me puzzle my way through a bunch of situations in both programming and business, sort of not taking the obvious at face value but looking around the corner to see, well, how does it look from that angle?”
Gilmore is responsible for a well-known saying about the nature of the Internet: “The Net interprets censorship as damage and routes around it.” He says he has taken drugs when confronting big life decisions—moving to a new town, taking a new job, breaking up a relationship—because they help him see things in a different light. “Having had the experience, I could then use the knowledge I’d learned in everyday life,” he says.
http://www.metrosantacruz.com/metro-santa-cruz/04.21.10/feature-1016.html
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Not Feeling Well? Perhaps You’re ‘Marijuana Deficient’
For several years I have postulated that marijuana is not, in the strict sense of the word, an intoxicant.
As I wrote in the book Marijuana Is Safer: So Why Are We Driving People to Drink? (Chelsea Green, 2009), the word ‘intoxicant’ is derived from the Latin noun toxicum (poison). It’s an appropriate term for alcohol, as ethanol (the psychoactive ingredient in booze) in moderate to high doses is toxic (read: poisonous) to healthy cells and organs.
Of course, booze is hardly the only commonly ingested intoxicant. Take the over-the-counter painkiller acetaminophen (Tylenol). According to the Merck online medical library, acetaminophen poisoning and overdose is “common,” and can result in gastroenteritis (inflammation of the gastrointestinal tract) “within hours” and hepatotoxicity (liver damage) “within one to three days after ingestion.” In fact, less than one year ago the U.S. Food and Drug Administration called for tougher standards and warnings governing the drug’s use because “recent studies indicate that unintentional and intentional overdoses leading to severe hepatotoxicity continue to occur.”
By contrast, the therapeutically active components in marijuana — the cannabinoids — appear to be remarkably non-toxic to healthy cells and organs. Further, they mimic compounds our bodies naturally produce — so-called endocannabinoids — that are pivotal for maintaining proper health and homeostasis.
In fact, in recent years scientists have discovered that the production of endocannabinoids (and their interaction with the cannabinoid receptors located throughout the body) play a key role in the regulation of proper appetite, anxiety control, blood pressure, bone mass, reproduction, and motor coordination, among other biological functions.
Just how important is this system in maintaining our health? Here’s a clue: In studies of mice genetically bred to lack a proper endocannabinoid system the most common result is premature death.
Armed with these findings, a handful of scientists have speculated that the root cause of certain disease conditions — including migraine, fibromyalgia, irritable bowel syndrome, and other functional conditions alleviated by clinical cannabis — may be an underlying endocannabinoid deficiency.
Now, much to my pleasant surprise, Fox News Health columnist Chris Kilham has weighed in on this important theory.
Are You Cannabis Deficient?
via Fox News
If the idea of having a marijuana deficiency sounds laughable to you, a growing body of science points at exactly such a possibility.
… [Endocannabinoids] also play a role in proper appetite, feelings of pleasure and well-being, and memory. Interestingly, cannabis also affects these same functions. Cannabis has been used successfully to treat migraine, fibromyalgia, irritable bowel syndrome and glaucoma. So here is the seventy-four thousand dollar question. Does cannabis simply relieve these diseases to varying degrees, or is cannabis actually a medical replacement in cases of deficient [endocannabinoids]?
… The idea of clinical cannabinoid deficiency opens the door to cannabis consumption as an effective medical approach to relief of various types of pain, restoration of appetite in cases in which appetite is compromised, improved visual health in cases of glaucoma, and improved sense of well being among patients suffering from a broad variety of mood disorders. As state and local laws mutate and change in favor of greater tolerance, perhaps cannabis will find it’s proper place in the home medicine chest.
Perhaps. Or maybe at the very least society will cease classifying cannabis as a ‘toxic’ substance when its more appropriate role would appear to more like that of a supplement.
Paul Armentano is the Deputy Director of NORML and the NORML Foundation. He has spoken at numerous national conferences and legal seminars, testified before state legislatures and federal agencies, and assisted as a consultant and expert witness in dozens of criminal drug cases. He is a frequent guest on radio and television, and is a faculty member at Oaksterdam University in Oakland, where he lectures on the medicinal properties of cannabinoids. Mr. Armentano is a prolific writer on the subject of marijuana and marijuana policy. His work has appeared in over 500 publications, including the New York Times, Washington Post, and The Christian Science Monitor. His writing has been featured in more than a dozen textbooks and anthologies, and he is a frequent contributor to AlterNet, The Huffington Post, and the Washington, D.C. newspaper The Hill. Mr. Armentano is a 2008 recipient of the ‘Project Censored Real News Award for Outstanding Investigative Journalism.’ In 2009, Mr. Armentano co-authored the book Marijuana is Safer: So Why Are We Driving People to Drink? (2009, Chelsea Green), which rose to #14 on Amazon.com’s best-sellers list and was recently selected by Publishers Weekly as one of “20 titles from independent presses that show big promise.”
http://blogs.alternet.org/speakeasy/2010/03/23/not-feeling-well-perhaps-youre-marijuana-deficient/
Poate o parte din dvs. vor fi interesati de acest site:
http://www.academia.edu/signup
Puteti sa va faceti cont daca sunteti afiliati unei universitati (studenti,
cercetatori , etc.) sau daca sunteti doar pasionati de anumite subiecte academice / ati terminat o facultate si doriti sa continuati studiile in strainatate.
Siteul este o buna modalitate de a gasi persoane interesate de aceleasi subiecte academice ca dvs. Deseori puteti gasi pe paginile diversilor cercetatori si cateva din articolele pe care le-au scris (altfel ar fi trebuit sa platiti pt a avea acces la ele prin intermediul bazelor de date academice internationale).
Din pacate, putini romani sunt prezenti pe aceasta platforma desi este o buna modalitate de networking academic. Ar fi fost normal ca universitatile din Romania sa fie semnificativ reprezentate pe site dar se pare ca nu s-au deranjat nici macar in scopuri de “imagine” (spre deosebire de Cambridge si Oxford de ex.).
Pentru a nu irosi timp in completarea profilului, un inceput bun ar fi sa
identificati un cercetator din domeniul dorit (adaugati-l la “follow”). Apoi accesati profilul lui si selectati acele “research interests” relevante (astfel le veti prelua pe propriul profil).
Link catre profilul unui jurnal academic:
http://transpersonalstudies.academia.edu/transpersonalstudies
Un jurnal interesant din Romania:
The Journal of Comparative Research in Anthropology and Sociology is an open access, peer-reviewed publication edited by the Department of Sociology and Social Work, University of Bucharest.
Don Lattin recalls the creation of the harvard Psilocybin Project (Harvard Psychedelic Club) in 1960-1961 by a group of four students interested in studying the effects of psychedelic drugs. The students, Timothy Leary, Andrew Weil, Huston Smith, and Richard Alpert (Ram Dass) would later introduce Americans to mind expanding drugs, alternative healing and medicine, and world religions. Don Lattin discussed his book at the Harvard Book Store in Cambridge , Massachusetts.
http://www.c-spanvideo.org/program/id/218596
NOTA: Voi mai posta probabil pe acest blog diverse articole referitoare la studiul substantelor psihedelice. Nu este un domeniu care sa ma intereseze academic insa ar fi poate util sa aflam ce fel de cercetari se fac in SUA (primesc pe email de la cercetatori link-urile postate). Exista speranta ca o mai buna intelegere a acestor substante va ajuta la tratarea in mediu controlat a alcoolismului cronic, a migrenelor, a traumelor (soldatilor si refugiatilor) cauzate de razboi sau violenta extrema , a durerilor si depresiei cauzate de cancerul in stadiu terminal, etc. Stim inca mult prea putin pentru a putea afirma cu certitudine ca substantele psihedelice sunt utile /inutile ca parte a unor terapii atent realizate si validate...
The center is financed by the Danish National Research Foundation, with supplementary funding from the University of Copenhagen (Faculty of Humanities, Faculty of Theology, Faculty of Health Sciences).
The status and nature of the self is increasingly being discussed in a variety of fields, not only in the humanities, but also in cognitive neuroscience, developmental psychology, and psychiatry. Some scientists have recently questioned the legitimacy of the concept. Some have argued that the self is nothing but a neurologically induced illusion, others that it is a mere social convention. In contrast, the guiding hypothesis of center’s research program is that the notion of self is crucial for a proper understanding of cognition, action, sociality, and experience, and consequently indispensable for a variety of different disciplines including social philosophy, psychiatry, philosophy of mind, developmental psychology, cultural studies and cognitive neuroscience.
It has recently been argued that if self-consciousness is understood simply as consciousness with a sense of self, then every conscious mind is self-conscious. We will look closer at the relation between experience, self-awareness and selfhood in order to evaluate this proposal.
We will seek to clarify the relationship between two currently quite popular notions of self: the core (or minimal) self and the extended (narrative or autobiographical) self. Whereas some have argued that the self is an integral and fundamental part of conscious life, others have argued that the constitution of the self is a social process and that self-experience is necessarily intersubjectively mediated. These two different notions of self are not necessarily at odds. They might be seen as complementary notions.
In order to investigate this possibility further, we will seek to clarify the issue by means of resources found in developmental psychology. When and how does selfhood emerge in the infant’s development?
We will investigate the affective and cognitive dimension of self-experience. We will focus on emotions and understanding as inseparable ways of orienting oneself in relation to others, and to a world more or less shared with others.
We will consider pathology , since the study of anomalous experiences and behaviors associated with mental or neurological diseases can enrich our insight into the nature and functioning of selfhood. We will study distorted forms of self-experience in patients with schizophrenia, in patients with various memory disorders, and in patients suffering from autism.
Finally, we will return to the issue concerning the social dimension of the self, by focusing explicitly on the relation between selfhood and normativity.
Although the clinical and cognitive sciences have started to contribute with important insights to the field, the neuroscientific study of the self is still in its infancy not only in terms of conceptual models but even with respect to the vocabulary. In contrast, the topic is by no means a terra incognita for those familiar with the philosophical tradition. Today the time is ripe for a unified endeavor. Empirical science can offer new tools to investigate problems that philosophers have been debating for centuries. Empirical data can serve to challenge or validate the philosophical distinctions between different concepts of self. Inversely, philosophy can provide directions and conceptual tools to the empirical scientists and might help in the design and development of experimental paradigms. It is a simple fact that the concept of self connotes different things in different disciplines – sometimes radically different things. Given the complexity of the topic, a plurality of perspectives is necessary if the investigation is to be truly successful.
Although the center’s research is mainly focused on conceptual and theoretical issues, it is not a narrowly conceived philosophical investigation, but one that is enriched and informed by empirical research, and which involves active collaboration with psychologists, psychiatrists and neuroscientists.
The Center for Subjectivity Research, which is supported by a generous grant from the Danish National Research Foundation during the period of March 1, 2002 – February 28, 2012, has just been subjected to a detailed and comprehensive external review. The conclusion of the evaluation is very positive. The Danish National Research Foundation writes that “in a highly original manner, the Center has combined philosophy, psychiatry and theology in excellent and innovative studies of a complex subject.”
The Research Foundation notes further that “during the period of funding, the Center has had a strong international impact at the highest levels of the involved disciplines”, and furthermore that “the organization and very strong identity of the Center has been crucial in facilitating a very active research environment. “Finally, the Research Foundation considers the Center to be “an excellent role model for how research fields in the humanities can establish internationally recognized Centers of Excellence”.
Cand vom avea in Romania astfel de Centre de excelenta?
Sub-types of depression and self-treatment
A model for self-treatment of four sub-types of symptomatic ‘depression’ using non-prescription agents: Neuroticism (anxiety and emotional instability); malaise (fatigue and painful symptoms); demotivation (anhedonia) and seasonal affective disorder ‘SAD’
Bruce G. Charlton Medical Hypotheses. 2009; 72: 1-7
Summary
This article will present a model for how ‘depression’ (i.e. depressive symptoms) can be divided into four self-diagnosed sub-types or causes which might then be self-treated using agents available without prescription. (Another, much rarer, cause of depressed symptoms is the classical illness of ‘ melancholia ’, which when severe cannot be self-treated and typically requires hospitalization.) A self-management option and alternative is now needed due to the an inappropriate emphasis of modern psychiatry on treatment of imprecise syndromal ‘disorders’ which may entail treating ‘depression’ at the cost of making the patient feel and function worse. By contrast, the basic theoretical stance of self-management is that depressed mood should be seen as a result of unpleasant symptoms – and it is the symptoms that require treatment, not the mood itself. Furthermore, drugs (or other interventions) need to be classified in terms of their potential therapeutic effects on these symptoms that may cause depressed mood. The four common causes of depressed mood considered here are the personality trait of Neuroticism; the state of malaise (fatigue, aching etc) which accompanies an illness with an activated immune system; demotivation due to lack of positive emotions (anhedonia); and the syndrome of seasonal affective disorder (SAD). Each of the four sub-types is then ‘matched’ with a first–line non-prescription agent. The ‘stabilizing’ agents such as St John’s Wort and the antihistamines chlorpheniramine and diphenhydramine are used for treatment of Neuroticism; analgesics/pain killers such as aspirin, ibuprofen, paracetamol/acetaminophen and the opiates are used to treat malaise; energizing agents such as caffeine and nicotine are used for the treatment of demotivation; and bright light used in the early morning to treat SAD. Self-treatments are intended to be used after research and experimentally, on a trial-and-error basis; with self-monitoring of beneficial and harmful effects, and a willingness to stop and switch treatments. The model of S-DTM (self-diagnosis, self-treatment and self–monitoring) is suggested as potentially applicable more widely within psychiatry and medicine.
Introduction
‘Depressive disorder’ and ‘anti-depressant’ are categories that should be discarded
Imprecise diagnosis and treatment of depression
Self-diagnosis by introspection – the ‘phenomenological’ approach
The self-diagnosis, -treatment and- monitoring (S-DTM) model [4] treating depressed mood pharmacologically
Introduction
‘Depressive disorder’ and ‘anti-depressant’ are categories that should be discarded
The gross imprecision of the diagnosis of ‘depression’ has become farcical in recent decades, when the supposed prevalence of ‘depression’ has risen from a fraction of a percent by about a hundred-fold to anything from ten to twenty-five percent [1] and [2]. Nowadays, any person suffering a persistent unpleasant emotional state may be officially diagnosable as depressed, and treated with drugs termed ‘anti-depressants’.
I have previously argued that the disease category of mood (affective) disorder called depression is neither coherent nor useful; and instead it would be preferable to regard ‘depressed mood’ as secondary to a variety of unpleasant emotional states [3]. In other words, depressed mood should be seen as caused by symptoms and emotions – for example anxiety, fatigue or lack of positive emotions (anhedonia) can all lead to depressed mood. Diagnosis and treatment of ‘depression’ should therefore be focused on the emotional states which cause depressed mood, and not upon treating a vaguely-defined – hence over-inclusive – syndrome termed ‘depressive disorder’. In principle there might be an unbounded number of causes of negative, depressed states of unhappiness – in practice, I will focus upon four which are apparently amenable to improvement by therapeutic intervention .
I have also argued that the term ‘anti-depressant’ should not be used, since there are no drugs which have a general action to alleviate depressed mood: what the effective drugs are really doing is to alleviate the causes of depressed mood [3]. There are a variety of different drugs types which can alleviate some symptoms that may lead to depressive symptoms in some people. For example, when anxiety is causing depressed mood then any drug which reduces anxiety (including alcohol, neuroleptics/antipsychotics, benzodiazepines or selective serotonin-reuptake inhibitors – SSRIs) may all (for a while) alleviate ’depression’. But when a person’s depressed mood is not caused by anxiety then these same drugs could be ineffective or may actually worsen the depressed mood.
I believe that a self-management option and alternative [4] is now urgently needed (at least in the UK and USA) due to the incorrect and counter-productive theoretical stance of modern psychiatry [3], the corruption of modern psychiatry by industrial and political influences [2], and the inappropriate emphasis of modern psychiatry on treatment of syndromal ‘disorders’ [3] and [4]. This focus on syndromes may lead modern psychiatrists to treat ‘depression’ at the cost of making the patient feel and function worse [5]
This is the rationale and justification for the following article, which represents a personal view – speculative and tentative – of a possible future for psychopharmacology in psychiatry, specifically in relation to negative symptoms of ‘depression’ such as sadness unhappiness, lack of motivation, long-term miserable anxiety, unpleasant mood swings and the inability to feel happiness. My hope is that these ideas are sufficiently accurate and valid to be useful and applicable – but also that they will stimulate discussion and serve as a basis for a process of evolution and improvement.
By extension, this general model of self-diagnosis, self-treatment and self-monitoring (S-DTM) could potentially be extended to other areas of psychiatry and medicine in which symptoms are the focus and where effective treatments are available without prescription. Indeed, as well as being used to alleviate negative states, the model is also applicable to lifestyle /quality of life enhancement [3] and [5].
Imprecise diagnosis and treatment of depression
I believe that, one the one hand, the treatment of depression can be more specific and effective than at present; but on the other hand it is also correct that the psychoactive drugs are all imprecise in their effects, and in particular tend to affect different people differently. This means that psychiatric treatment (whether self-treatment or treatment by professionals) is almost inevitably a trial-and-error matter, and should be embarked-upon in an experimental spirit.
Psychiatric drugs (and also some other psychiatric interventions such as electroconvulsive therapy and perhaps bright light) tend to be non-specific in relation to traditional diagnostic syndromes [3]. Different categories of drugs such as ‘antidepressants’ and the neuroleptics/antipsychotics often have over-lapping therapeutic effects, side effects and indications – mainly because many of the most-used drugs were chemically-developed from a relatively small number of coloured dyes which were initially made into antihistamines during the 1940s then further modified over the following decades to make the neuroleptic/antipsychotics, tricyclic and SSRI antidepressants [1], [6] and [7].
So, drug recommendations for symptomatic treatment in psychiatry are mainly about suggesting which drug to try first. There needs to be an attitude of trial-and-error; with self-monitoring of the effects of treatment, willingness to change to stop treatment or change to another treatment if the first choice has undesirable side effects or is apparently ineffective.
With these cautions in place, I see no compelling reason why people should not self-treat for psychiatric symptoms using drugs which are available ‘over the counter’ and without prescription. After all, in a country such as the UK or the USA people in their tens of millions already self-treat for headaches and back pains, constipation and diarrhoea, runny noses and blocked noses, hay fever and eczema, high cholesterol, skin infections and duodenal ulcers. And in a world where it is common to assert that anything up to half the population have significant psychiatric symptoms of some sort (e.g. depression, anxiety states, various phobias and compulsions, insomnia) then self-treatment become a practical necessity.
Furthermore, I suggest that symptomatic self-treatment for ‘depression’, when done by careful and informed people, might well be superior to the average treatment on offer from psychiatric professionals. The main constraint is the limited range of drugs available without prescription (especially, see below, in the case of demotivated depression); but this restrictive public policy may change over time or be circumvented by the increased ease of purchasing pharmacological agents without prescription.
Self-diagnosis by introspection – the ‘phenomenological’ approach
The process by which self-diagnosis may be accomplished requires some elucidation. I have previously termed the sequence S-DTM – meaning Self-Diagnosis, self-Treatment and self–Monitoring. The aim is to introduce to self-management a helpful degree of thoroughness and formalization to make the process both safer and more effective than unstructured self-management.
The first step involves developing self-awareness of symptoms. The word ‘phenomenology’ refers to the process of introspection or inward-looking by which a person can become aware of their inner, subjective states – psychiatric symptoms are one of the body states which may be accessible to such introspection [3], [8] and [9]. To self-diagnose by introspection requires a skill which may be unfamiliar. For example, it is possible to be anxious but unaware of the anxiety [10] and [11]. To become aware of anxiety as a feeling, a person needs to be able to identify their own state of mental angst, muscular tension, rapidly beating heart, sweatiness, ‘butterflies in the stomach’ and so on.
Furthermore, inner states must be identified in terms of a system of classification – because body sensations tend to be experienced as formless and undividedly ’holistic’ unless there is a systematic classification which can describe them. Without some such analytic scheme, it may not be possible for someone to be aware of, and to express even to themselves, much more than a simple dichotomy of feeling either ‘good’ or ‘bad’. Self-treatment, however, requires that different types of ‘feeling bad’ can be distinguished and identified.
In terms of ‘depression’ – the process begins with recognition of a depressed mood, in other words a negative or unpleasant mood state which could be characterized by some kind of unhappiness. Then there is a further introspective process by which the sufferer tries to identify some inner physical, bodily state which may be the main cause of this unhappiness. The assumption is that if this causal symptom can be alleviated or eliminated then the person may become happier.
Happiness is not necessarily entailed by removing the cause of unhappiness, but it is easier and more probable that a currently-unhappy person will become happy if they are relieved of unpleasant symptoms. For example, it is hard to be happy when suffering a headache and relief of the headache may therefore cause a person to become happy who would otherwise have remained miserable.
More exactly, there is an attempt to match-up inner states against a pre-determined classification. Four body states which may cause unhappiness include emotional instability with anxiety (Neuroticism); fatigue and bodily aches and pains (malaise); lack of emotion – especially loss of the ability to anticipate future pleasures (demotivated depression); and sleepy, hungry, irritable mood specifically during the winter season (SAD).
Having identified a particular aversive body state as a probable cause of depressed mood, this symptom is then made the focus for self-treatment; and the symptom is monitored for its response to treatment. A treatment agent or mode is selected as being both safe and potentially able to alleviate the specific symptom, and a trial of this treatment is made. So, if the symptom underlying depressed mood is identified as anxiety and unstable emotions then stabilizing drug is chosen (such as St John’s Wort or chlorpheniramine – see below); and the symptom is monitored to see whether it responds to this treatment.
The self-diagnosis, -treatment and- monitoring (S-DTM) model [4] treating depressed mood pharmacologically
Self-diagnosis
1. Recognition of a depressed, unhappy, low mood.
2. Introspective self–diagnosis of the sub-type of symptomatic and emotional cause of depressed mood.
3. Matching the symptoms and emotions to one of the four sub-types of ‘depression’.
4. Matching the sub-type of depression to the drug class which is most likely to alleviate those symptoms and emotions.
5. Researching the scientific literature on the effects, side effects and possible interactions of the drug class – and choose a (probably) safe first-line agent.
Self-treatment
6. Begin trial of treatment.
Self-monitoring
7. Very careful monitoring for effects and side effects for the first 4 hours after taking the agent, and continued vigilance for several days. Keep a record. (e.g. Consider self-monitoring blood pressure when using psychostimulant type drugs.)
8. If immediate problems of side effects or feeling worse after taking a drug, consider stopping immediately – or continue with vigilant self-monitoring.
9. If no benefit at all after a few days consider increasing dose or stopping and trying another agent.
10. If side effects are bad, or there is concern over dependence, or if unsure about whether or not the drug is having benefit, or if wanting to stop taking the drug; consider stopping the drug and self-monitoring the result of stopping – then consider restarting and monitor the results of restarting.
11. Go through the process for each new drug tried. Avoid interactions between the drug stopped and a new one started, and between multiple agents.
Four sub-types of self-treatable depression
I will consider four sub-type causes of depressed mood (’depressive disorder’) which may be suitable for self-treatment: these are Neuroticism, Malaise, Demotivation and Seasonal Affective Disorder-SAD. I will also refer to a fifth type of depressive disorder – Melancholia – which was the original type of depression recognized for centuries, and is often too severe and debilitating to be self-treated and for which the best treatment (electroconvulsive therapy) cannot be self-administered.
This list of five sub-types is not exhaustive, and there almost certainly are other well-defined syndromes that are causes of depressed mood (or these four sub-types may fruitfully further be subdivided), and these might require different treatment, or treatments that are not available without prescription, but probably those sub-types described here are the commonest.
So, my suggestion is that sustained depressed mood (i.e. so – called depressive disorder) is ‘caused’ by least five more – specific sub-types. Naturally, each of these sub-types must have its own cause. Typically this cause is unknown or uncertain – and I will not consider the matter further here; because – whatever their cause may be – each sub-type has somewhat different symptoms and there are relatively specific treatments which have the potential to alleviate these symptoms.
I further suggest that there is no general purpose ’antidepressant’ action of a drug. Instead of there being ‘anti-depressants’, in actuality there are several types of intervention which alleviate different unpleasant symptoms and emotions, and which may as a result make people feel less depressed. A drug which alleviates depression in one person may actually cause depression in another person because the effect on depression is secondary to the effect on the symptoms or emotions. In what follows, drugs are classified according to their effect on symptoms; drug types considered here include stabilizing drugs; analgesics/pain killers and energizing drugs.
Melancholia – not self-treatable
Probably it is best to note and set-aside the ‘melancholia’ type of depression at this point. Melancholia is probably best described in textbooks from at least thirty years ago, before the diagnosis of depression became over-inclusive [12]. This is the classic, severe, debilitating form of ‘endogenous’ depression which may have psychotic features such as hallucinations, delusions, thought disorder, catatonia and psychomotor retardation.
Melancholia typically renders the sufferer incapable of work with severely-diminished or absent self-care and often suicidal tendencies. Subjectively, the mood state may be one of profound sadness, despair, emptiness, guilt, nothingness – speech and movement are slowed to near inertia, appetite may be absent, and death by starvation is a possibility.
Patients usually require admission to a hospital or similar institution for the treatment of melancholia – and they may require close supervision to prevent suicide. The episode of illness usually lasts for several months and the most effective treatment to improve symptoms is electroconvulsive therapy/electroshock therapy (ECT/ECS) [13] and [14].
Neuroticism
Anxiety is a normal, evolved human emotion which functions to increase alertness and avoid harm. However, anxiety is almost certainly the most frequently-experienced psychiatric symptom, and anxiety and depression are major feature of the ‘neurotic’ personality type characterized by emotional instability.
Neuroticism is one of the ‘Big 5’ personality traits, and was derived from the work of Hans Eysenck [15] and [16]. Neuroticism is an underlying disposition which is substantially hereditary and tends to endure throughout life. The personality type extends from high Neuroticism with extreme unpleasant mood swings at one extreme, to emotional stability at the opposite extreme. Other aspects of high Neuroticism include guilt feelings, low-self esteem, irrationality, shyness, moodiness and emotionality. Low Neuroticism personalities are described as emotionally stable, and display the opposite traits: calmness, cheerfulness, confidence.
I regard Neuroticism as more-or-less the same entity as Nutt’s category of ‘depression with anxiety’ [17]; very similar to Neurotic Depression on the Newcastle Diagnostic Scale [12] and essentially the same entity as DSM IV dysthymic disorder [18]. Watson calls it ‘negative emotionality’ – the tendency to experience strong negative emotions [19].
Neuroticism is a kind of hypersensitivity to the environment, akin to feeling the hyper-vigilant state of being alone in an unfamiliar and threatening environment. The average level of Neuroticism is higher in women, and high Neuroticism may be commoner in modern mass societies [3].
Since it is a type of personality and not a disease, Neuroticism probably cannot be ‘cured’. But severity of symptoms related to Neuroticism tend to wax and wane, probably in response to life stresses and also factors such as age, illness, drug usage etc. Given the ineffectiveness of psychotherapy and counseling, the psychiatric treatment of Neuroticism is essentially a matter of using drugs either to blunt exacerbations or else to promote long-term stabilization of emotions.
Because Neuroticism is a dispositional trait, emotion blunting drugs – when they work – are perceived to have caused a change in personality – and such change in personality may be perceived either positively or negatively [20] and [21].
Stabilizing drugs for Neuroticism
The anxiety component of a personality high in Neuroticism can be treated using a variety of anti-anxiety agents (e.g. neuroleptics/antipsychotics, benzodiazepines, propranolol – and people may self-medicate with alcohol) but since the core problem is emotional instability then the more relevant classes of drugs seem to be those that stabilize by buffering or blunting emotions. I shall term these the class of ‘stabilizing’ drugs.
The most powerful emotion stabilizing drugs are the neuroleptics/antipsychotics; but these tend to blunt emotions to the point of blank inertia [7]. Indeed, the neuroleptic core effect is to induce Parkinsonism as a method of non-sedating behavior control – as implied by the name which means ’nervous system-seizing’ (i.e. seizing and holding the nervous system, so it does not react) [22] and [23].
So assuming that people do not wish to suffer from self-inflicted Parkinson’s disease, neuroleptic/antipsychotics should be avoided and instead the most appropriate class of drugs for treating emotional instability are probably those which have serotonin-reuptake-inhibiting properties of which the class of selective serotonin-reuptake inhibitors (SSRIs) are the best-known and most widely-prescribed examples. These can buffer or blunt the strength of emotions [3] (Healy has termed them ‘serenic’ in their effect [2]) but without necessarily demotivating the individual. Indeed, the emotional stability induced by SSRIs might provide previously-Neurotic people with better focus and direction.
‘Over the counter’ versions of the SSRIs that are available without prescription include at least two of the drugs sold as ‘antihistamines’ [4]. These antihistamines were used as the basic molecules from which SSRIs drugs were manufactured [6], [7], [24], [25] and [26]. (They were also the base molecules for the tricyclic antidepressants such as imipramine, and the earliest neuroleptics/antipsychotics such as chlorpromazine – consequently there are overlapping therapeutic effects and side effects among these drug classes [7].)
Diphenhydramine was the base molecule for synthesizing fluoxetine (‘Prozac’) which was the first SSRI to reach market [6]. Diphenhydramine is marketed as a sedative cough suppressant; and is probably an SSRI in terms of blocking reuptake of serotonin more potently than noradrenaline [24] (this is the pharmacological definition of an SSRI).
Chlorpheniramine was the base molecule for the synthesis of zimelidine; which was the first SSRI to be made but which never reached market due to its side effects [25] and [26]. Chlorpheniramine is sold as an anti allergy/anti-hay fever medication and is regarded as very safe; even being used in pregnancy for the treatment of nausea [27]. Chlorpheniramine blocks the reuptake of serotonin and also of noradrenaline [24], so is probably best regarded as a Serotonin and Noradrenalin Re-uptake Inhibitor (SNRI) resembling venlafaxine [26].
To support the use of these antihistamines in treating depressive symptom exacerbations due to Neuroticism there is the above strong theoretical argument plus a small literature of the beneficial effects of chlorpheniramine as an anti-anxiety drug and probably stabilizing agent (e.g. [28], [29] and [30]) – evidence for the benefits of diphehydramine is at present more theoretical and anecdotal. However, with a self-treatment approach using safe and non-prescription drugs, the evidence of effectiveness comes from personal experience – it is relatively easy to discover whether the drug ‘works for you’ since typically the benefits (and side effects) on the core symptom of emotional instability can be felt (or not felt) as soon as the drug is absorbed – i.e. within an hour or two. However, drug effects on mood are much more indirect and more variable, and mood improvement may take days or weeks to emerge [3].
However, probably the best drug for producing emotional stabilization is the herb St John’s Wort/Hypericum. The evidence concerning the usage and value of this drug is conveniently gathered in an excellent Wikipedia survey [31]. According to the preponderance of randomized trials, St John’s Wort (SJW) seems to be the equal or superior of the SSRIs; in terms of equal or better therapeutic effectiveness, fewer unwanted side effects and greater drug safety. St John’s Wort has mainly been evaluated as an anxiolytic and/or ‘anti-depressant’; but my inference is that SJW is essentially an emotion stabilizing drug akin to SSRIs. SJW is available in measured doses without prescription from pharmacists and supermarkets, usually being sold as a food supplement alongside vitamins, minerals and other herbs.
In conclusion, an exacerbation of ‘depression’ due to Neuroticism may imply a first-line self-treatment with St John’s Wort, chlorpheniramine or diphenhydramine. Since Neuroticism is a personality trait, when stabilizing drugs are effective they produce a change in personality, and potentially may make the neurotic individual feel more positive than ever before – they may seem to themselves and others as if they are ‘better than well’ [20]. Alternatively, stabilizing drugs such as SSRIs in another individual, or too high a dose, might cause a ‘hardening’ of personality (making the person more indifferent to things which ought to be of concern) and this may cause a reduction in motivation and a reduced inability to enjoy life (anhedonia) [21].
Very rarely SSRIs (and other psychoactive drugs, such a neuroleptics) can provoke extreme unpleasant states of inner turmoil or suicidal feelings in predisposed individuals [2] – and this may be a feature of the chemical structure of stabilizing drugs [7].
Malaise
Malaise is a term I suggested in 2000 for a sub-type of depression which is underpinned by that state of exhaustion which is familiar as the effect (and persisting after – effect) of infectious disorders such as influenza or glandular fever [3] and [32]. Since this description, some of the main features of the Malaise theory of depression have been confirmed by further studies (e.g. [33], [34], [35], [36], [37] and [38]).
The main symptoms of malaise are fatigue, feeling physically ‘TAT’ (tired all the time – and by ‘tired’ is meant physically-exhausted rather than sleepy), a washed-out or drained sensation in the body and limbs, heaviness in the head or limbs, aching, headaches and low-grade pain or tenderness in trunk and limbs. Malaise corresponds to Kurt Schneider’s ‘vital’ symptoms of depression, which he regarded as being of primary diagnostic significance [39].
Depressed mood is the response to this state of malaise, so that malaise depression is primarily a problem of the body, and not necessarily the brain. The idea of malaise comes from a general recognition of ‘sickness behavior’ as the general behavior which is characteristic of a sick mammal (summarized in [32]). Sickness behavior is regarded as an evolved adaptation to acute infectious disease – a behavioral state that is energy-conserving, risk-minimizing and immune-enhancing to allow an all-out (but temporary) attack on invading micro-organism.
So, malaise is caused by activation of the immune system, and is associated with increased blood levels of immune chemicals called cytokines – eg interferons, interleukins, Tumor Necrosis Factors (TNFs) and dozens more types. There is considerable evidence of raised levels of cytokines in depression (e.g. [32], [36] and [39]). But blood cytokines are typically also increased in autoimmune diseases (such as rheumatoid arthritis) and disseminated cancer – and these types of disease are also associated with ‘sickness behavior’ and malaise which can lead to depressed mood [3].
From anecdotal observation and general reading, I believe that sleep disruption is probably a common cause of malaise. Potentially there can be neurotransmitter and/or hormone changes triggered by sleep deprivation or sleep disruption. For example, malaise often follows sleepless nights, shift working or as an aspect of ’jet lag’ due to crossing several time zones; or post-operative states with catabolism triggered by tissue destruction and sleep disruption; or following childbirth (with a combination of major hormonal and phychological changes, tissue damage and sleep disruption).
Since malaise is characterized by unpleasant, pain-like physical states, it follows that an appropriate treatment for malaise is with analgesic or pain killer drugs [32]. For example, painkillers often alleviate (to some extent) the aching and exhausted physical state associated with influenza or its aftermath.
Analgesics/pain killers for malaise
There is considerable anecdotal and indirect evidence to suggest that analgesics are effective in treating some types of depression. I am aware of one formal trial designed partially to test this hypothesis – which confirmed it [38].
However, the effectiveness of the traditional ‘tricyclic’ antidepressants (TCAs) in ’major depressive disorder’ (which includes malaise symptoms in its definition) may be interpreted as being due the drugs’ analgesic properties [40]. Especially this applies to the effectiveness of amitriptyline, which has been the most widely-prescribed TCA for depression [1]; and which is also currently used in the treatment of cancer pain in terminal/palliative care, migraine etc. Furthermore, opiates (which are analgesics) have, at various times throughout history – most recently during the 1980s – been apparently successfully used in the treatment of depressive symptoms [3], [32] and [41]. (By contrast, SSRIs probably do not have significant analgesic properties [3] and [40].)
When depressed mood is associated with a malaise state, there could be a trial of the various simple analgesics available without prescriptions: aspirin, ibuprofen, paracetamol/acetaminophen and the mild opiates such as codeine or dihydrocodeine. Either aspirin or ibuprofen can also be combined with paracetamol and/or an opiate. Individual responsiveness to these analgesics is variable, and so are the experienced side effects – so there may need to be a period of trial-and-error before concluding that analgesics are ineffective.
As when treating Neuroticism with stabilizing drugs; the analgesics/pain killers would be expected to have a rapid effect in alleviating malaise symptoms as soon as the drug has been absorbed – i.e. in just a few hours [3]. But because mood is not directly related to malaise symptoms, it may take days or weeks before a reduction in malaise symptoms leads to an improvement in mood. So even when malaise is alleviated with treatment, the mood may remain depressed for other reasons – perhaps due to other unpleasant emotions, or to circumstances or habit [3], [9] and [32].
Demotivated depression
Demotivated depression is characterized by reduced positive emotions; and it is this inability or impaired ability to experience pleasure (i.e. anhedonia) that is the cause of demotivation.
Motivation is at root a product of the ability to feel current pleasure in anticipation of future situations – it is this pleasurable anticipation of future positive states of emotion which provides the immediate motivation needed for present action [3] and [10]. If one cannot experience pleasure, and if nothing seems likely to induce pleasure, then there will be a generalized loss of interest in life and its opportunities, and this will be experienced as a lack of vitality and drive (including reduced sexual drive).
Life usually involves a trade off between present and future pleasure and pains – normal people will often do something which is worse in the here-and-now, if this leads to the prospect of something better in the future. Something as simple as making the effort to visit a friend is done in the expectation that the here-and-now inconvenience of walking or catching a bus will be compensated by the future pleasure of conversation. But if the thought of having a conversation with a friend does not lead to a here-and-now sense of pleasure (pleasurable anticipation), then the deterrent effect of the unpleasant aspects of walking or catching a bus will weaken the motivation to visit the friend.
Demotivated depression is therefore a concept derived from and almost identical with Nutt’s ‘Depression with loss of interest and energy’ [17] and Watson’s state of low positive emotionality [19]. Causally, demotivated depression may be an exacerbation of the personality trait of introversion (asocial, quiet, submissive, timid, avoidant) [15] and [16] or a sub-clinical state of early Parkinsonism [42]. Demotivation may be a consequence of taking certain types of drug – especially drugs that lead to a reduction in dopaminergic – or noradrenergic/norepinephric – activity in brain; agents such as the neuroleptic/antipsychotic drugs which block dopaminergic receptors [7] and [23]. The motivational system seems to involve mainly the dopaminergic neurotransmitter system, and this seems to interact with noradrenergic, serotonergic and cholinergic systems – among others [43].
It is important to recognize that demotivated depression would probably be made worse by stabilizing drugs which tend to blunt emotions – since stabilizers would blunt the positive emotions which are already deficient in demotivated depression.
Energizing drugs for demotivated depression
The suggested treatment of demotivated depression is with energizing drugs which enhance dopamine or norepinephrine actions – either directly or indirectly [44]. The classic examples of such drugs include the psychostimulants such as dexamphetamine or methylphenidate (‘Ritalin’). Other energizing drugs include bupropion, monoamine-oxidase inhibitors such as phenelzine or moclobemide, amineptine, reboxetine, and the tricyclic desimipramine [17] and [44]. However, these drugs are only available with a prescription.
There are few energizing drugs which are available without prescription (probably due to fears of inducing addiction or dependence). The best-known and by far the most widely used energizers are caffeine and nicotine.
Caffeine [45] is found in coffee and tea and available in tablet form without prescription. It is a weak psychostimulant which increases alertness. Caffeine probably has properties as an analgesic or painkiller; and probably also has beneficial effects in preventing and perhaps treating Parkinson’s disease (suggesting that caffeine acts like a dopamine agonist) [46] and [47].
Nicotine [48] is found in tobacco but is also available as a non-prescription drug (for example as lozenges, chewing gum, or skin patches). While nicotine works directly upon the cholinergic neurotransmitter system, it appears to have indirect effects as a ‘dopaminergic’ psychostimulant – it often increases energy and alertness and like caffeine (but with stronger evidence) seems to have both a preventive and therapeutic effect on Parkinson’s disease [47], [48], [49] and [50].
In conclusion, the range of possibilities for self-treatment of demotivated depression with non-prescription drugs are at present both limited and somewhat speculative.
Seasonal Affective Disorder – SAD
Seasonal Affective Disorder (SAD) is winter depression or winter blues: low mood that occurs with greater frequency at more extreme latitudes (north or south) almost certainly due to the short daylight hours during winter months [51]. It is treated, not with drugs, but with bright artificial light, usually administered in the early morning [52] and [53].
The typical symptoms of SAD include excessive sleeping (hypersomnia) i.e. still tired when waking in the morning and sleepy throughout the day; increased appetite with carbohydrate craving and weight gain; irritability; fatigue; reduced motivation and sociability. In other words, while sleepiness and carbohydrate craving with weight gain are somewhat distinctive to SAD; many of the symptoms of SAD overlap with the three other sub-types of depression (i.e. irritability overlaps with Neuroticism, fatigue overlaps with malaise, and reduced motivation and sociability overlap with demotivated depression).
It is therefore the seasonal pattern of depressed mood and the characteristic behaviors which are crucial for the diagnosis rather than the specific subjective symptoms being experienced. Another diagnostic factor is the rapid and profound improvement of these symptoms in response to exposure to bright early morning light – which makes the response to light treatment something of a ‘diagnostic test’ for SAD.
SAD needs to be distinguished from the increased seasonal incidence of malaise symptoms which would be expected during winter months due to the increased prevalence of infectious diseases in many parts of the world (especially upper respiratory tract infections such as colds and influenza). Indeed, discriminating SAD from malaise could be tricky, since in the first place the main symptom of malaise is physical tiredness or ‘fatigue’ while the main symptom of SAD is mental tiredness or ‘sleepiness’. In the second place there is no reason why a person should not simultaneously suffer from both malaise and SAD, therefore from ‘tiredness’ due to both fatigue and sleepiness.
Indeed, it is plausible that the circadian hormone disruptions which are plausibly associated with SAD might themselves lead to immune activation as a secondary consequence – so that SAD might precipitate malaise.
Bright light therapy for the treatment of SAD
Bright artificial light usually administered early in the early morning seems a very effective treatment for SAD [51], [52] and [53] – this requires no prescription but only the purchase of a device delivering suitably bright light.
Especially-bright artificial light is needed to treat or prevent SAD because the aim is to simulate the kind of brightness that is provided by natural outdoor light. Normal indoor house lighting in a kitchen is only about 400 lux (there is even less light in bedrooms), while outdoors, even on a cloudy day, there is about 10 times greater intensity of light – 4000 lux.
Specialized ‘light boxes’ generate about 10000 lux of suitable-wavelength light at close range. This should be sufficient to cure SAD if administered for 30 minutes – however the subject must usually be sedentary and near to the light. A ‘light visor’ shines the light from much closer to the eye for about the same length of time, while allowing the subject to be mobile. ’Dawn simulators’ are like an alarm clock that brightens up to about 400 lux over a period of about an hour – apparently these also seem to work for some people.
If a person has SAD, then bright early morning light will probably produce a marked improvement in their symptoms within just a few days and continued use of bright light therapy would probably prevent a return of SAD symptoms.
SAD is a syndrome
SAD therefore is an example of diagnosing and treating a syndrome; rather than the symptom based-management model as recommended for Neuroticism, malaise and demotivation.
The delineation of SAD is actually a tremendous success story of psychiatry within the past few decades. And interestingly, (although perhaps not surprisingly) this process of definition and development of treatments happened largely outside of the professional structures of modern psychiatry, presumably because bright light treatment is non-pharmacological and not patentable.
It is a significant paradox (and one which supports the need for self-management in psychiatry) that probably the most valid and most effectively-treatable of recently-defined psychiatric syndromes arose mostly outwith the ‘official’ field of heavily-funded psychiatric research.
Conclusion
The main benefits of the S-DTM approach to self-management of psychiatric symptoms using non-prescription drugs (Table 1) is that it allows people to avoid contact with modern psychiatry and to maintain control of their own therapy and tailor treatment to their own needs. The main limitations are those of limited (or inaccurate) knowledge, difficulties of introspection and self-monitoring, and the restricted range of treatments available without prescription.
Table 1.
Four sub-types of ‘depression’ and first-line agents for their treatment
Sub-type Emotions Treatment
Neuroticism Anxiety, unstable emotions Stabilizing drugs
Malaise Fatigue, pains Analgesics/pain killers
Demotivated Anhedonia – lack positive emotions Energizing drugs
SAD Winter seasonal symptoms Bright morning light
One major advantage of a more specific approach to diagnosing and treating sub-types of ‘depression’ in a symptomatic fashion is that of avoid the damaging consequences of treating demotivated depression with stabilizing drugs. Under the currently prevailing standard model of depressive disorder, it is quite likely that any person with a depressed mood would first be tried-out with the stabilizing and emotion blunting SSRIs; and any observed worsening of mood would probably be blamed on the ‘disease’ of depression instead of the drug. But since demotivated people lack strong positive emotions, SSRIs would probably make them feel worse by blunting their emotions still further. (i.e. if your problem is insufficient pleasurable experience, the last thing you need is to be made even less responsive to pleasurable stimuli.)
The five sub-types of ‘depression’ (including melancholia) are not mutually exclusive. An individual might suffer from two or more of these syndromes simultaneously. Various combinations are possible. For example, a person with depressed mood due to a neurotic and unstable personality might well in addition suffer from seasonal affective disorder during the winters, or from malaise following influenza. Or a person with lack of drive due to a chronic demotivated depression might in addition experience malaise secondary to a chronic infection or autoimmune disease, or SAD. Such subjects might perhaps, rarely, go on to develop severe melancholia.
In such situations of several simultaneous diagnoses, alleviation of one type of symptom could fail to improve mood due the persistence of other types of symptom. More than one type of treatment may be required simultaneously, as in any situation characterized by multiple causal pathologies.
In terms of the treatments available without prescription, the biggest problem is that there is only a limited number of energizing drug treatments available without prescription; and the premier energizing drugs all require prescription at present. On the other hand, St Johns Wort is quite possibly the best all-round stabilizing drug (better than SSRIs), bright light therapy is certainly the best treatment for SAD (short of moving to live in a latitude nearer the equator and with sunnier weather); and there is a reasonable range of effective analgesics available ’over the counter’ for treating malaise – stronger opiates and stronger NSAIDs being the main categories of pain killers currently requiring a prescription.
In sum, the ability of individuals to self-manage ’depression’ is already powerful, and the future looks promising. I hope the above ideas will be useful and will also stimulate debate. And, looking beyond depression, it is possible that the general S-DTM model might be more widely-applicable within psychiatry and medicine, and for enhancement of the quality of life.
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januar 11, 2010
INVITATION!
The Network for Research in Faith and Health in Denmark invites all interested researchers to participate in the coming international conference on Research in Faith and Health in Secular Society.
The conference takes place from the 17th-19th of May 2010 in the Congress Center of The University of Southern Denmark on Campusvej 55, 5230 Odense, the City of Hans Christian Andersen.
Abstract: Research in faith and health and religious coping has made important strides over the past decades. However, most of this research has been conducted in North America in quite a different cultural and religious setting than that of secular Northern Europe. In these countries, the research traditions of existential philosophy and psychology have been more predominant when investigating existential needs and orientations of patients rather than the North American tradition of religious coping. The conference seeks to bring together insights of both traditions in an attempt to strengthen research competences in meaning and health in secular society.World leading researchers in the field will address issues of high importance to the field during keynote sessions. Ongoing research projects will be presented during parallel paper sessions. Researchers involved in such projects are encouraged to submit papers or posters that will be presented at the conference.
Registration: Please click here for online conference registration, abstract submission and accomodation options. NB: Deadline for abstract submission for paper and poster: 1st of March 2010
Because of a research grant from The Danish Council for Independent Research | Humanities (Forskningsrådet for Kultur og Kommunikation, FKK) the conference is offered at a low cost.
The conference takes place just after the European Conference on Religion, Spirituality and Health, Bern, Schweiz (13.-15. May). The two conferences are complementary. Whereas the conference in Bern deals broadly with the topic of religious coping in a European context, the conference in Denmark supplements with perspectives on research in faith and health in secular society with the particular challenges this provides for the field. Thus, it will be a significant advantage to take part at both venues, which is why there is a reduction of conference costs when participants register for both venues. Researchers that submit papers that are selected for paper sessions will have free admission to the conference.
The regular conference fee is 2000 DKK. / 270 Euro. A reduced fee applies for: 1. students, 2. members of the Network in Research in Faith and Health and 3. participants at the European Conference on Religion, Spirituality and Health, Bern, Switzerland (13.-15. May).
Conference fee reduction will be reimbursed when papers are selected for paper sessions.
Questions concerning the scientific programme can be sent to : Ass. Prof., theol.dr. Niels Christian Hvidt: nchvidt@health.sdu.dk
Preliminary PROGRAM
The conference opens with three world-leading experts in the field: Prof. Dr., Kenneth I. Pargament, Department of Psychology, Bowling Green University, Ohio, MD., MHSc, Prof. Dr., Harold G. Koenig, Duke University & Duke Medical School, North Carolina, Prof. Dr., David M Wulff, Department of Psychology, Wheaton College, Massachusetts.
On the second conference day, three more experts in the field will discuss adequate methods in research in faith and health in secular society with examples of their own research : Prof., Dr.med., Arndt Büssing, Zentrum für Integrative Medizin, Universität Witten/Herdecke, Germany, Prof. Dr., Fereshteh Ahmadi, Department of Caring Sciences and Sociology, University of Gävle, Sweden and Prof. Dr., Kevin Ladd, Department of Psychology, Indiana University, South Bend, Indiana.
In between these presentations there will be paper sessions presenting ongoing research projects conducted in secular society in the broad field of faith and health. Concluding the conference Prof. Dr. Tor Johan Grevbo, Diakonova University College, Oslo, Norway, will be talking about pastoral care perspectives on the research of faith and health in secular society.
Monday 17 May 2010:
10:00 Welcome and Introduction: By Ass. Prof., theol.dr. Niels Christian Hvidt, Institue of Public Health, University of Southern Denmark and Ph.d. clinical health psychologist Peter La Cour, Pain Clinic, Rigshospitalet, Copenhagen.
Plenary Opening Session: Status on Research in Religion, Health and Meaning Making in secular society:
10:30 State of the Art in Research in Faith and Health: By MD., MHSc., Prof. Dr., Harold G. Koenig, Duke University & Duke Medical School, North Carolina
11:15 State of the Art in Research in Religion and Coping: By Prof. Dr., Kenneth I. Pargament, Department of Psychology, Bowling Green State University, Ohio
12:00 Positive Illusions: Reflections on the Reported Benefits of Being Religious: By Prof. Dr., David M. Wulff, Department of Psychology, Wheaton College, MA
14:30 Paper sessions – paper sessions with response from the three keynote speakers mentioned above
Tuesday 18th May:
10:00 Plenary on quantitative, qualitative and mixed methods in research in Religion, Health and Meaning making:
10:00 Quantitative methods: Prof. Dr., med., Arndt Büssing, Zentrum für Integrative Medizin, Universität Witten/Herdecke, Germany
10:45 Qualitative methods: Prof. Dr., Fereshteh Ahmadi, Department of Caring Sciences and Sociology, University of Gävle, Sweden
11:30 Mixed and Integrative Methods: Prof. Dr., Kevin Ladd, Department of psychology, Indiana University, South Bend, Indiana
17:00 Social event in Odense: Boat Trip on Odense River. Visit to Odense Zoo and apperitif with the penguins.
15:30 Faith and Health in Secular Society in the Perspective from Theory and Practice of Pastoral Care: Prof. Dr. Tor Johan Grevbo, Diakonova University College, Oslo.
16:30 Concluding summary on Conceptual Issues in Religion, Health and Meaning Making, by Ph.d., Peter La Cour and Theol. Dr., Niels Christian Hvidt
