a discussion about psychiatry, mental illness, emotional problems, and things that help
Wednesday, February 1, 2017
Compassion vs. Empathy: Reflections on Paul Bloom's Book
Bloom's definition of Empathy
By "empathy," Bloom is specifically referring to the phenomenon of experiencing and feeling what another person is experiencing and feeling. Many of us define empathy more broadly, so as to imply kind consideration for others' distress, a willingness to help, and an intellectual understanding of another person's problems. Even some of the researchers who study empathy are imprecise in their definition, leading them to include items about kindness or willingness to help on a symptom scale supposedly intended to measure empathy.
Bloom clearly is not talking about "understanding." He affirms that it is clearly and obviously important to strive towards understanding of another person's problems or situation, in order to be able to best act morally and helpfully. A variant of empathy, which we could call "cognitive empathy," refers to understanding, but not feeling, another person's emotional state. Bloom affirms that this cognitive empathy is important and positive as a social skill, but is not necessarily a guarantee of moral behaviour. With Bloom's specific, narrower definition of empathy (to feel what another person is feeling), he shows us the following:
Problems with Empathy
1) Empathy does not correlate with kindness. Many people who behave cruelly have a lot of empathy for their victims. In fact, sometimes the empathy for the victim causes a sadistic person to magnify their cruelty. A good fictional example is the character of O'Brien (the "Big Brother" agent) from Orwell's 1984, whose emotional and cognitive empathy guided him to personalize and maximize his torment of the main character.
Conversely, some people who behave with the most astounding kindness and altruism are not guided or motivated by empathy at all. People who perform daring rescues often do not empathize before they act. Having an empathic reaction in an emergency could delay a life-saving action.
One example is described of a person who chose to give his kidney to a stranger for a transplant, guided by a cooly mathematical observation of the needlessness of having two kidneys for health, while many people would face death without a single kidney. People, including young children, are usually motivated to do kind things not because of empathy, but because of a wish to be kind or helpful!
Empathy can actually deter people from behaving kindly, or from even being around suffering people, because the experience of feeling another's suffering is painful and aversive. A caregiver who is highly, reflexively empathic is at greater risk of burnout. Whole groups of people, such as those who identify as having autistic symptoms, may have much less "empathy" than average, but they are not at higher risk of causing anyone harm. Violent offenders do not necessarily have "low empathy"-- the psychological factors associated with violent behaviour have much more to do with low self-control than low empathy.
2) Empathy as a moral guide can cause us to behave in a biased or unfair manner. If we use only empathy to guide us to help a particular suffering person, it can guide us to help that person before helping someone else who needs the help more urgently. Furthermore, we empathize more easily with people who are more similar to ourselves, and who live closer. This may cause us to preferentially help others based on unjust factors (including age, race, ethnicity, etc.). It is easier to empathize with a suffering animal we find "cute" compared to a suffering animal (who may be in even greater need) who is less photogenic.
Bloom rightly critiques the tendency for empathy to be admired as a type of stellar quality, for all of us to emulate in a quest to become better people, better therapists, or better societies. He instead encourages us to strive towards kindness and understanding, with our actions guided by reason rather than the narrow, biased focus of emotional empathy alone. This view is supported by those considered some of the world's greatest altruists, such as the Dalai Lama--in this tradition, it is calm compassion, free of anger, which is felt to be the best guide for moral action, rather than the emotion-swept milieu generated by empathy.
My Thoughts
I see Bloom's thesis as an extension of Kahneman's insights about psychological biases. Our biases and emotional responses are an intrinsic part of being human, but they easily become experiences which fool us, and cause us to behave irrationally.
Empathy, in my opinion, is a quality similar to eyesight or one of the other senses: it does not, in itself, have a moral quality. It can have a narrow focus, which makes it prone to bias, and it can be easily fooled by illusions. Having highly developed empathy does not make you more moral any more than does having sharp eyesight. If you believe strongly that your sharp eyesight allows you to understand things better, you may be very prone to others taking advantage of your belief, and you may be very prone to being fooled by optical illusions. This does not mean we should not cultivate our senses, including eyesight or empathy. They are important talents and skills, and they deserve attention and practice. It is just that we should not rely on them by themselves as moral guides.
Taming Empathy
I do believe that empathy is important, however. It just needs to be "tamed." I can think of many clinical situations in which an empathic moment--even to the point where I might shed a tear--has helped with my patient feeling a sense of connection and trust. A therapist who shows no emotional response to a patient's suffering could be experienced as detached, aloof, and cold. Also, many therapists have a reflexive suppression of their own affect, which is felt to be a part of professionalism, yet which causes an unnecessary and obstructive detachment. A therapist's practice of allowing their own emotions to flow empathically, and to manifest in the session, can be an aspect of fostering connection and demonstrating sensitivity. But if this empathy would lead to the therapist suffering with sadness or panic through the hour, at the same time as the patient, then this clearly would not be helpful! It would probably frighten or disturb the patient, and would also lead to burnout in the therapist. A brief moment of deep empathy can be very therapeutic, but after that point, therapy moves away from pure empathy towards cognitive understanding and gentle problem-solving.
Empathy can also be a joy of life to experience, provided it is not understood to be a moral guide. Empathy can and should be practiced and savoured, just as you would cultivate your other senses--but it should not be granted power as an arbiter of moral decisions.
Empathy for the Therapist!
Bloom makes a nice point that in a good therapeutic environment, sometimes empathy is most beneficial in the opposite direction: if the therapist is gently attuned and understanding, but calm and at peace, then the patient's empathy for the therapist may help the patient to attain calm and peacefulness in the midst of painful emotions.
Empathy could work this way in therapy as an example of social learning therapy combined with CBT: if the patient would see the therapist briefly having a deep empathic moment of "co-suffering," but would then see the therapist gently step back, in a thoughtful, compassionate calm state, this could be an in-the-moment example for the patient to follow...in this way the therapist would truly be an emotional guide. I think this effect should not be overstated, as the therapist's helping role may usually be much more modest and subtle.
The Importance of Listening and Showing Understanding
I believe it is very important to emphasize that we have been talking about Bloom's very focused definition of empathy. I usually use the term empathy in a broader sense. When people are meeting with a therapist or a friend, they often greatly desire to simply be with someone who will listen. Many people do not desire to have advice or reassurance in response to what they are sharing, at least not right away. And they may be frustrated if the other person starts to discuss their own similar problems. It is often very appreciated if the listener at times reflects back what has been said, to convey respectful understanding, of both the situation and the emotions involved. This reflection and demonstrated understanding is what I mean by empathy, most of the time. A typical example could be saying something like, "you had an exhausting day..." When giving this reflection, I would not normally feel exhausted myself! Sometimes a more elaborate or detailed reflection could be good, but sometimes prolonging these responses for more than a brief sentence can interrupt the person's experience of being gently listened to.
Thursday, February 26, 2026
The Psychology of Religion, Chapter 18: Prayer
For many people, prayer is simply reflective or meditative: a grounding moment, a way to name fears and hopes, a way to feel less alone. But many people also pray for things—for an outcome to change, for an illness to heal, for a surgery to go well, for a war to end, for a relationship to mend. That kind of prayer is different. If it is literally effective, it would mean that events in the physical world are being altered—something in the normal chain of causation is being nudged off course. And if this were happening in a consistent, repeatable way, you would expect to see clear clusters of unusually good outcomes in places where people pray the most, or where the “right” kind of prayer is supposedly most common. You would expect the world to look, especially in more religious areas, as though the ordinary rules of physics are being bent on request. I am not aware of any such pattern.
When researchers have tried to test this carefully—especially with “praying for someone else” (intercessory prayer)—the results have not produced a solid, repeatable signal. A well-known example is the STEP trial in cardiac bypass patients: people were randomized to receive or not receive intercessory prayer, and another group was told with certainty that they were being prayed for. Overall, prayer did not reduce medical complications. Interestingly, the group who knew they were being prayed for actually did a bit worse: complications were reported in 59% of those certain they were receiving prayer versus 52% in a comparison group. One plausible explanation is psychological: once a person is told “people are praying for you,” it can quietly raise the pressure. What if I don’t get better? What does that mean about me? About God? About my faith? For someone already frightened and vulnerable, that extra layer—expectation, scrutiny, the sense that a spiritual “test” is underway—can add stress rather than comfort.
It is not hard to consider other thought experiments: if prayer were an instrumental force capable of altering physical reality, we would expect to see distinct epidemiological advantages in highly religious regions. We would expect higher rates of spontaneous remission from illness, fewer natural disasters, and lower mortality rates in areas where people pray more often or hold the supposedly correct beliefs. Yet, when comparing regions with similar socioeconomic and demographic baselines, this supernatural dividend is entirely absent; in fact, highly secular democracies consistently boast the best objective markers of societal health. While religion undeniably provides robust psychological comfort, social cohesion, and subjective well-being to its practitioners, the data reveals a strictly secular mechanism at play. This resilience is not derived from the literal truth of dogmatic claims or divine intervention. Rather, it emerges from the profound social capital of a supportive community and the stabilizing architecture of a shared belief system—even a fundamentally fictional one. Such overarching frameworks equip individuals with a coherent narrative, allowing them to intellectually and emotionally process adversity, uncertainty, and loss more efficiently. But as a mechanism for changing the external, physical world, prayer demonstrates no measurable effect.
Spatial Language
One small point about human religious behaviour, deriving from ancient practice, is the spatial language: “God above.” People sometimes literally look upward when praying. But “up” points in different directions depending on where you are on Earth; and it changes minute by minute as the Earth rotates, orbits the sun, and as the solar system moves through the galaxy. A person in Australia looking up towards Heaven is looking in the same direction as someone in North America looking downwards into the ground. It is a pre-Copernican spatial metaphor, entangled with the older intuition that “up is good, down is bad.”
Of course, “looking upward” is often figurative—but many people do take it quite literally. If one were going to take the gesture literally, it would be just as “valid” to look downward, or inward into one’s own body. If God is omnipresent, shouldn’t God be as present in the depths of the planet—or in our own bodies—as in the sky? The gesture tells us less about the geography of a deity than about the structure of the human imagination.
A related embodied metaphor shows up in some fundamentalist worship styles: people in an entranced state reach forward with their hands during songs or prayer—eyes half-closed, rocking, repeating sacred phrases, emotional intensity magnified by the synchrony of peers. This can be understood as a normal human ecstatic gesture, an ability present in all cultures with or without religion. But the gesture still implies a spatial location of God—reaching out to take God’s warmth with one’s hands, as though God were physically located just ahead, perhaps in the front of the building. Again, the scene tells us much about embodied human longing, and very little about the actual location of a deity.
Prayer & Empathy
The moral structure of prayer often mirrors the moral structure of empathy. Many people’s prayers are genuinely compassionate: they think of struggling friends or family members, or of terrible world events, and they ask for comfort, protection, and healing. But if prayer is believed to cause divine comfort to arrive, this raises an uncomfortable counterfactual: if the prayer had not occurred, would comfort have been withheld? Shouldn’t a loving deity comfort suffering people regardless of whether someone happens to pray for them—especially since some of the worst suffering on earth occurs in isolation, unnoticed, with no one else even aware enough to pray? It suggests a troubling arrangement where God’s help isn’t based on who is suffering the most, but on who is lucky enough to be noticed.
This is also where it helps to remember Paul Bloom’s critique of empathy (see my review of his book, Against Empathy). Empathy is often biased and therefore unjust: it is pulled toward people who resemble us, toward vivid stories, toward those whose suffering is emotionally dramatic, while neglecting the quiet, the distant, the stigmatized, and the statistically larger tragedies that do not come with a single tear-streaked face. Prayer often inherits this same distortion. We pray intensely for the salient and familiar, and far less for abstract fairness, or for the invisible victims who never make it into our attention.
Many prayers are not about others at all; they are about wishing something for oneself. There are battlefield prayers. Prayers before a medical procedure. Prayers for money, for a job, for the return of an ex-partner, for relief from chronic pain, for the outcome of a baseball pitch or a hockey game. As a meditative act, this is deeply understandable. But psychologically it can set up a reinforcement loop: if the prayer is followed by a good outcome, the person will naturally feel it “worked,” and will be bolstered to pray again. If the outcome is bad, the person may conclude they didn’t pray sincerely enough, or long enough, or correctly enough—or that God was busy, or displeased, or testing them. Either way, the practice becomes insulated from disconfirmation.
This helps explain why prayer works psychologically, even if the supernatural claims aren't true. As a form of meditation or reflection, it can be calming and help organize our thoughts. But as a way to change the laws of physics or alter the course of events, it has no effect but still functions as a self-reinforcing loop. When a prayer is followed by a desired outcome, it is taken as proof of God’s power. When it isn't, the failure is easily explained away—either God said 'no,' or we didn't pray with enough faith. This dynamic validates the belief system regardless of the result, but it places a burden on the believer—creating the illusion that their personal spiritual effort is the decisive factor in changing reality.
Next Chapter
Wednesday, August 20, 2014
The Better Angels of Our Nature: Why Violence Has Declined, by Steven Pinker: A Book Review, Part 2
Clearly, rates of violence were much, much higher in all previous periods of history. Today the risk of suffering a violent non-suicidal death (from war or other crimes) is in the order of 1% or less (this is the total risk over an entire lifespan). In most prosperous areas of the world it is much less than 1%. Of the 245 000 deaths in Canada in 2012, 543 were due to homicide (0.2 % of the total).link link2
But in all previous eras of human and pre-human history, these risks were orders of magnitude higher, according to a variety of streams of evidence which Pinker amasses. Instead of 0.2%, the rates were 10% or more. If anything, much of this data may actually underestimate these past rates, since violence was so much a norm in previous periods of history that many violent deaths or even massacres were barely mentioned in historical texts. Risks of non-homicidal violence were much higher still, such that most everyone in the population would have been traumatized in some way, or would have had a close friend or family member who was severely traumatized.
Pinker outlines various of the forces which have driven violent behaviour over the ages; here are some of them:
1) predation
2) dominance
3) revenge
4) communalism/tribalism/nationalism
5) sadism
6) isolation
7) authoritarianism
8) ideology
9) lack of intelligence
1)
Predation is described as a simple goal-oriented motive, such as robbery or looting. Yet this strategy is "zero sum" or "negative sum" in that there is no net gain during a robbery, only a transfer of property, and most likely a destruction of the means to efficiently produce more property (e.g. jewelry may be stolen in an attack, but the infrastructure or morale needed to produce more or better jewelry gets damaged in the process).
With societal evolution, free trade becomes a non-violent alternative to predation, which allows the process to be "positive sum." In this case, goods could be traded for jewelry, leading to a prospering group of jewelers who can then produce more or better jewelry in the future. Both parties gain. In order for free trade to occur, and the ensuing reduction in predatory violence, there must be improved communication, a fairly governed commercial system, and penalties for predation which are agreed upon by both parties.
In a psychotherapeutic milieu, this principle could lead to the idea of improving communication and stable transactional rules between potentially conflicted individuals. In general, the idea of trading with your enemy instead of fighting your enemy may not naturally occur to people.
Pinker does not adequately discuss some of the problems with trading relationships, and of free-market economics in general. Such relationships can be imbalanced, exploitative on some level (either directly towards the individuals or nations involved, or towards the environment), or favouring a relatively small elite while having little benefit for the majority. I think there needs to be more emphasis on "fair" trade, including a strong focus on environmental issues. This is consistent with Pinker's observations about the need to expand a "circle of empathy." This circle should expand to include not just trading partners, but the larger communities affected by trade, and the benefits or consequences to the natural environment. Trade may often benefit the environment, through a simple economic efficiency argument: the lowest-cost economic solution to a problem is favoured by free trade, which in turn can maximize the available eonomic resources to protect the environment. But in order for this efficiency to be protective, there needs to be structured safeguards in place to prevent social or environmental exploitation. Another big issue I have found with conventional economic theory is that costs are underestimated (such as long-term environmental damage), and the cross-sectional cost appears to be very low; often those involved are not held responsible for the ultimate long-term costs. In any case, this inaccuracy in measuring costs distorts the system, and causes it to be short-sighted.
2)
Dominance contests can be seen in many species, often as part of a competition for mates. Most often, of course, these are behaviours seen in males. In humans, this can give rises to meaningless displays of strength or machismo, with an associated culture of "honour" in which small perceived slights can result in excessive aggressive reactions. Associated psychological phenomena include overconfidence, underestimation of the losses associated with the conflict, and of course lack of empathy for the opponent. In celebrating a culture of "glory and honour" there can be an utter disregard for the individuals and families affected by the ensuing violent losses.
If this type of behaviour is selected for in the population, it gives rise to large, aggressive, arrogant, reckless males who are easily provoked. In other species it can give rise to males having harems with multiple mates, while driving away or killing other male challengers (we see literal examples of this in human groups throughout history).
In humans, this type of dynamic can occur in "honour-based" cultures; previous periods of history often featured distinguished gentlemen absurdly fighting to the death in duels, often over trivial conflicts. But entire nations can behave in this fashion as well.
Improvement in this type of problem comes with greater education, strong emphasis on women's rights and gender equality, and selection pressure: reckless, aggressive males with poor impulse control are much less likely to be found attractive as mates in the modern era! Instead, most elements of modern culture favour self-control and a culture of "dignity." It is no longer cool or attractive to be a bully or a hothead.
3)
Revenge is an understandable reflexive process, and it is pointed out that some degree of revenge can be a deterrent to subsequent violence (to show no revenge can invite subsequent exploitation). The problem with revenge, as Pinker shows, is twofold: first, wronged individuals or states tend to want to deliver more punitive harm than a neutral mediator would prescribe. The individuals doing the wrong likewise tend to underestimate their culpability or guilt (e.g. a great many convicted felons may have a smaller estimation of the magnitude of their guilt or responsibility for harm than a neutral observer or their victims would conclude). This leads to a cycle of revenge, in which each group retaliates vindictively against each other, with force that is often out of proportion to the offense, and each wrongdoer underestimates their culpability. The retaliation is itself therefore felt as an assault by the recipient, rather than as a fair punishment. The violence therefore continues in an escalating fashion, with each group feeling justified in their actions, egregiously wronged by the other, and with each group inducing future acts of vengeance from their enemies.
The solutions to this predicament include having neutral arbiters--a fair system of policing and justice, empowered by a neutral and fair government which has a motive of minimizing overall harm in its citizens.
On a psychological level, a solution is to recognize the cognitive biases which lead to excessive retaliations and excessive justifications for one's own excesses. Another solution is to recognize the need for neutral mediation to help resolve ongoing conflicts.
4)
Communalism, tribalism, or nationalism are understandable, common human experiences. Early human culture required a cohesive sense of protecting one's fellow villagers from attacks from neighbours. Yet, tribalism fosters patterns of revenge, predation, and dominance-based aggression on a group level. Having separate tribal cultures, often with language and geographic barriers, is a barrier to empathy for outsiders, particularly if a cycle of warfare has already begun. We see this type of aggression on a large and small scale, all around us. In some cases it is playful, as in sports teams from different communities. Gang behaviour in large cities has a tribal quality, with battles over control, protection, predation of resources, and "honour." But entire nations behave this way. We subjectively have an urge to enjoy national identity, but we have to be wary of the violent associations of this mindset.
An approach to this issue is to expand our "circle of empathy," and to view those from other groups as partners rather than enemies. I suspect the healthiest vestige of nationalism that we can safely keep is to have sports teams. I think this is also a reason to support free, fair international trade. Protectionist policies must be based on a notion that there is an "us" and a "them". But it is fair to view everyone in the world as part of "us" at this point.
Nationalist conflict is one of the most devastating factors causing worldwide violent death and suffering through the ages.
It is for this reason that I support the idea of having international sports events -- I believe that this is a symbolic peaceful sublimation of nationalistic conflict, transforming this type of tension into a playful harmless talent show. The economic indulgence of such events, such as the Olympics, is an understandable complaint, but I think the pursuit of such playful, peaceful activities is very important.
5)
Sadism may seem like a rarity, relevant only to extreme cases. But smaller forms of this issue can occur in communities or in one's inner life. The driving force in sadism is addictive: repeated behaviours, even if extremely harmful, can lose their aversive or "taboo" character through repetition, and even lead to addictive pleasure, associated with excitement, relief of tension, etc. This phenomenon can occur in personalities which had previously been quite "normal." Pinker does point out the likelihood that psychopathic personality--a pathological lack of sympathy for others-- is a risk factor for sadistic behaviour, and that those with this type of personality are more likely to be attracted to occupations in which they could indulge their violent predilections. In the book, he does not address the environmental or social causes of psychopathy, though alludes to this problem being at least to some degree a neurobiological variant with heritable aspects, and not entirely due to environmental adversity. In any case, not all psychopaths end up becoming violent sadists, and not all sadists are psychopaths.
In depressive states, various forms of physical and figurative self-injury can become sources of relief, and lead to an escalating pattern of violence against self. This is not "sadism" but it could be considered as arising similarly, as an addictive habit to which the person becomes tolerant and desensitized, leading to a craving for more and more highly destructive behaviour.
A solution to this issue is to focus on prevention, and to recognize and avoid risk factors. In a police or military setting, for example, it needs to be recognized that maltreatment of hostile prisoners can occur and escalate through this process. Abuses of this kind are not some kind of bizarre perversion, but stem from failure to include judicial safeguards adequately to prevent the police or prison guards from getting involved in an addictive habit of maltreating others. This can be challenging, because many of the prisoners may have behaved in a terrible way themselves (e.g. violent criminals) and so the initial aggressive responses to them may be approved by everyone involved.
In a personal setting, prevention is also important. Self-injury often begins secretively, without the addictive risks being appreciated, and by the time the problem surfaces to others, it has become an entrenched habit. At this stage, approaching it as a potentially lifelong addictive risk becomes necessary, with a variety of psychotherapeutic strategies employed. For those who engage in sadistic behaviour towards others, I think society should be equipped to approach them as permanent risks to others' safety. This does not necessarily mean longer prison terms, etc. (though this may be necessary in some instances) but I think it does at least mean longer-term societal scrutiny for protection of others.
6)
Isolation is a risk factor for violence due to a tendency to form a stronger ingroup, view outsiders as a threat, lack the communication or language to resolve disputes peacefully with outsiders, and to lack the advanced education that could bolster diplomacy, empathy, or self-control.
During early human history, groups existed in relative isolation from each other. Today, groups which are more geographically isolated (e.g. in remote mountainous areas) tend to have much higher rates of violence, as well as less education. With the advent of modern communication and transportation technology, isolation on this level does not ever have to be as absolute as it has been in the past. Yet, some groups may deliberately foster isolation, even when they live in large cities. I think it is important to foster widespread community interactions between isolated groups.
On a personal level, isolation is likely to magnify suspicion towards strangers, leading to exaggerated negative reactions to others' behaviour.
Psychologically, problems with isolation may be due to social anxiety, depression, or psychotic paraoia, but the isolation itself becomes part of the vicious cycle of symptom exacerbation.
Every person or community may have a certain "set point" for healthy engagement with others, e.g. some people are more comfortably gregarious than others, but I think some type of social practice and engagement is necessary for the health of individuals and communities.
On a practical level, learning to speak other languages and customs lessens the isolative boundaries between people. As a strategy of personal development, it could therefore be healthy to learn other languages, to travel to different countries, and to experience and learn respectfully about other cultures. Treatment of underlying symptoms, such as paranoia or social phobia, can of course be important.
7)
Authoritarianism evolves naturally from the most ancient origins: stronger members of a group will dominate and assume leadership powers. This factor fits closely with the ideological dynamics of aggression. Those who challenge the authoritarian leadership can be subject to severe aggression. One of the perpetuating factors for this dynamic includes the cognitive illusion that everyone supports the authoritarian leader or the authoritarian principles. Even those who quietly dissent may be so fearful of reprisal that they will act to support the leader, and even punish other dissenters to prove it. An analogous cognitive distortion is the belief among college students that the majority of their peers enjoy binge drinking--this belief normalizes such behaviour, and causes more people to engage in it because they erroneously thought it was an accepted norm.
A protection against this dynamic is fostering a politically open democracy with freedom of speech. On a personal level, I think it is healthy and protective to question authority as an intellectual norm. This includes not only teachers and professors, but also religious teachings. Authoritarianism that is couched in religious dogma can seem so "sacred" that challenging it would seem disrespectful or like a taboo, thus leading to terrible unchecked excesses and distortions justifying violence or other harms and suppressing intellectual growth.
I had assumed that there would be a universal affirmation of the desirability of multi-party democracy throughout the world. Yet, I have recently been looking at the PewResearch Global Attitudes Project surveys, including a poll done in 2009 (well before the recent conflicts in Russia and Ukraine). (link)
This survey shows that people in Russia and several former Eastern-Bloc countries such as Hungary, have had a huge reduction in their enchantment with the idea of democratic government, beginning long before the recent conflicts. Ukrainians gave some of the lowest ratings of all, regarding attitudes towards democracy, freedom of speech, etc. I suspect that a major reason for this has been that the democratic changes in these countries have been laden with a lot of corruption, instability, and economic problems.
This is reminiscent of what Pinker described in post-colonial African states, which experienced a large surge in violence rates after declaring independence. This does not at all mean that colonialism was "good," but rather that the benefits of democracy and societal freedom can only come after a state has become stable in terms of economy and political organization. The period after major political upheavals can be relatively anarchic, and economically harsh, leading to a steep decline in morale for the population.
8)
Ideology can lead to extreme violence, through offering a cohesive set of beliefs which bind an ingroup harmoniously, often with a utopian goal, leading to a rationalization to destroy outgroups. Utopian goals can sound attractive, but often the enactment of these goals involve suspension of the other elements of societal growth and non-violence, such as fairness, justice, empathy for outgroup memebers, etc. Those who commit catastrophic acts of violence within an ideological framework may understand their actions to be normal or just, and may easily dismiss complaints that their actions are wrong. Our recent history is full of examples of this type, including Nazi Germany.
Unfortunately, there are many examples in history of religious ideologies leading to extreme violence in this way, continuing with examples in today's news.
A prevention for this type of problem includes education, including in the arts and humanities, a commitment to ecumenical approaches in theology (regardless of one's religious orientation), and a commitment to have diplomatic relationships with those having different ideological viewpoints.
I think these preventions apply on a large scale in societies, but also on a personal, individual level.
9)
Intelligence, the greatest talent of humankind, has the power to defuse conflict through negotiation, wise strategizing, and improved empathic understanding of one's opponents. Cognitive biases are not eliminated by intelligence alone (as Kahneman has shown), but the capacity to employ reason rather than rage to solve problems is enhanced by intellectual training. Such intelligence has grown over the generations, as Pinker has shown. This is likely due to better education, and exposure to a more stimulating global cultural milieu. Unfortunately, many in the world lack access to the basic resources or freedoms to develop their intellect in this way. Part of global peacemaking must therefore include a strong emphasis on universal access to education.
Intelligence, of course, also permits a higher chance for employment, prosperity, and diverse leisure activities, all of which reduce risks for violence and other harms.
On a more immediate, personal level, intellectual development could be framed as a component of psychotherapy. This could work not only as a way to focus the brain on activities apart from depressive rumination, but also could strengthen faculties of the mind which could act as skilled "negotiators" to calm the self-injurious impulses which can occur in depression or anxiety. Some of the CBT literature shows that this type of therapy works better in those who are more highly educated. Conversely, I suspect that better education and intellectual training can make psychotherapy work better.
Sunday, June 9, 2019
Review: "The Righteous Mind" by Jonathan Haidt
In The Righteous Mind, Jonathan Haidt shows that different people have different foundations which underlie their moral judgments or beliefs.
On the "left," the foundations of fairness and charity are more prominent. On the "right," the foundations of loyalty and "purity" are more prominent.
These styles or foundations may be propagated in culture or family upbringing, but also are partly influenced by heredity (genes). In the middle part of the book, Haidt argues that each of these moral foundations can convey improved survival or natural selective advantage to whole groups. For example, a group which values loyalty very strongly as a moral foundation is more like to be cohesive, and therefore more resilient to various stresses, including warfare or internal discord.
Haidt concludes his book with a strong message that we should empathize with people or groups which have different moral foundations, rather than simply fight with them or view them as enemies. He espouses the goal of befriending opponents, including those who have different political or religious beliefs or moral foundations. Such friendship would then reduce extremes of polarization and conflict, and allow groups to move forward more peacefully.
I respect his thesis very much, of cultivating understanding and empathy for people or groups which have different moral, religious, or political beliefs than one's own. In a psychotherapy environment, such empathy is required in order for progress to occur, even when the therapist may object strongly to aspects of the patient's behaviour.
But I have some criticisms of Haidt's thesis:
Haidt seems to disparage the importance of reason or rationality. In a type of "straw man" argument, he suggests that "reason" without other moral foundations such as loyalty, is insufficient or even pathological. He uses a metaphor of a person or a mind being like an elephant, a powerful creature guided by instincts and passions, with the "rider" of the elephant being our "reason" or logical faculties. The "rider" is described as a recent evolutionary development, intended to serve the elephant, rather than rule over it.
He anticipates in the book that some people will disagree with him on this. I certainly do. I do not disagree that the development of sophisticated reason or rationality is a recent development in evolutionary history, that it indeed did develop in service to the "elephant," and that there are strong selective advantages for "non-rational" qualities, which remain prevalent in nature. But the evolutionary presence of traits is not evidence of their high moral value.
Modern rationality is the foundation of the justice system. Imagine a court system, a scientific lab, a factory producing safety equipment, or a spacecraft agency such as NASA, which would not hold reason as the highest foundation in its decision-making, but instead would consider "loyalty" or "purity" as most important. Such foundations would, and often have, led to disaster.
I realize that some applications of reason may in retrospect prove not so "reasonable" after all. Reason is always fallible, and can be the foundation of huge mistakes--not just technical failures due to mistaken ideas that were apparently well-supported at the time (e.g. the belief in medical remedies such as bloodletting), but also moral catastrophes. But the process of reason requires it to be flexible, to monitor itself for mistakes, to be willing to make corrections when new information arises. This differs from "loyalty" which is by definition resistant to change despite the arrival of new information.
"Loyalty" could be considered a component of "reason" which requires a waiting period before acting on new ideas. It could be like electing a senator for a 6 year term, with other representatives elected for 2 year terms. The senators would be more resistant to rapid or erratic whims of a capricious populace, while the representatives would be poised to act more quickly; the two chambers would ideally lead to an effective equilibrium, sensitive to change, but not impulsively so.
I am not saying that "loyalty" or "purity" are unimportant, but they cannot be viewed as morally equivalent to reason, on some kind of equal footing, such that differences between people can be understood simply as cultural variation.
I was bothered in Haidt's book by his passing disparaging reference to "new atheists" such as Richard Dawkins, more or less dismissing the value of their ideas without acknowledging their wisdom or contribution. There are major problems with these thinkers which warrant fair criticism, but they do deserve respect and attention. This is ironically contrary to Haidt's best conclusion, which is to have some empathy and respect for viewpoints different from one's own.
I am more allied to scholars such as Steven Pinker or Paul Bloom, who are "rationalists" in their approach to psychology and morality. But I have to admit that Jonathan Haidt is an important thinker as well, and deserves respect and attention.
Any author of a book has a tendency to have some inflexibility in their position afterwards, due to several psychological biases. If you have publicly asserted a position, and have become famous for it, you are more likely to maintain it in order to appear consistent, even if there are good arguments against it. There can be some degree of ego involved as well--people don't like to admit that they are wrong. I wish there was a little bit more humility when scholars or experts assert positions on these issues.
I am not an author (except for this modest blog), but I know that I have an ego as well, and I would have a tendency to defend positions that I have asserted, even when they may need to be changed or adapted. I need to watch this tendency in myself, as we all do in ourselves.
In some cases, it may not be possible to have a friendly, empathic dialogue in a setting of conflict, oppression, or injustice. Haidt does not explore this type of scenario adequately. Friendship and empathy are neglected in the management of conflict and polarization, but it is important to acknowledge as well that some of the necessary forces of positive change and justice can be rather more difficult and conflict-ridden.
Thursday, July 31, 2025
Reflections on Religion: Reference List
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Greene, B. (2004). The fabric of the cosmos: Space, time, and the texture of reality. Alfred A. Knopf.
Haidt, J. (2001). The emotional dog and its rational tail: A social intuitionist approach to moral judgment. Psychological Review, 108(4), 814–834. https://doi.org/10.1037/0033-295X.108.4.814
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Ineichen, B. (2022). Faith healing and psychosomatic illness: A critical review. Journal of Religion and Health, 61(1), 200–213.
Kahneman, D. (2011). Thinking, fast and slow. Farrar, Straus and Giroux.
Koenig, L. B., McGue, M., Krueger, R. F., & Bouchard, T. J., Jr. (2005). Genetic and environmental influences on religiousness: Findings for retrospective and current religiousness ratings. Journal of Personality, 73(2), 471–488. https://doi.org/10.1111/j.1467-6494.2005.00338.x
Konnikova, M. (2016). The confidence game: Why we fall for it... every time. Viking.
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MacArthur, J. (2013). Strange fire: The danger of offending the Holy Spirit with counterfeit worship. Thomas Nelson.
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Friday, December 10, 2021
Recommended Reading 2021: an updated book list
Updated list of interesting books that I encourage checking out:
Steven Pinker: Better Angels of Our Nature: Why Violence has Declined (2012)
Steven Pinker: Enlightenment Now (2019)
Hans Rosling: Factfulness (2018)
These three books, aside from being enjoyable and informative to read, also give a message of hope, that there are things actually getting better in the world, thanks to science, reason, and progress in justice, despite the world's many ongoing gravely serious problems. They do not discount the gravity of ongoing problems, but are a nice antidote for the resignation or despair that can set in when faced with an onslaught of depressing daily news about politics, environment, disease, war, etc.
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Thomas Picketty: Capital in the Twenty-First Century (2017)
This is a masterpiece, a historical analysis of wealth disparity and taxation, making an extremely compelling moral and economic case for introducing a better progressive system of wealth, income, and estate taxation. This is not "socialist" as Picketty does not advocate state control of the market, but does advocate for fair regulation and progressive taxation in order to prevent regression to a pre-20th century societal style of wealthy aristocrats idly owning an increasing majority of national wealth, while most others work hard to hover near the poverty line, with little chance to progress beyond that level. I find this issue of great importance as a psychiatrist, because it touches on the issue of managing poverty and fairness, permitting access to personal and community growth, in a way that is grounded in freedom and justice.
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Richard Prum: The Evolution of Beauty (2018)
Almost every book or documentary I've seen dealing with evolutionary biology has emphasized natural selection as the main force of evolutionary change, while often only mentioning sexual selection in passing. This book deals with sexual selection, a phenomenon first described by Darwin but relatively neglected in the next century. This is of interest because Prum argues that sexual selection leads to a type of "co-evolution" in which esthetic choices lead to changes in culture which often improve autonomy, especially for females. As a psychiatrist I think it is interesting as another emphasis of the cultural and biological foundations of esthetic choice-making in humans. At the very least, interesting ideas to think about.
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Daniel Kahneman: Thinking: Fast and Slow (2013)
Daniel Kahneman: Noise: A Flaw in Human Judgment (2021)
Kahneman's books are must-reads for any person. His 2013 book is a masterpiece, an introduction to the subject of biases which influence human judgment. I can't emphasize enough how important this subject is in the modern world, where our judgments are constantly influenced by factors within ourselves, and from external sources, which we are not aware of. It is of relevance in psychiatry or mental health because of the importance for wellness to make healthy, well-informed, unbiased judgments, and because of the exaggeration of biases caused by depressive or anxious states.
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Jonathan Haidt: The Righteous Mind: Why Good People are Divided by Politics and Religion (2013)
This is an incredibly important book, of the greatest relevance for the problems we face in the world in the past few years. It is a compassionate look at the psychology underlying political, ideological, and religious difference, with recommendations of ways we can mend these differences and reduce polarization.
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Paul Bloom: Against Empathy: The Case for Rational Compassion (2016)
This is a nice application of the psychology of bias, as described by Kahneman and others, to the practice of altruism and of caring for other people. Bloom is a brilliant Yale psychologist, initially from Montreal, who has shown that typical reflexive emotional biases can cause our altruistic behaviour to be surprisingly misdirected, or unfair to those who need it most. I don’t agree with all of his points, but I think this book is essential reading for a person interested in fairness, compassion, altruism, and justice.
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Nicholas Christakis, Blueprint: The Evolutionary Origin of a Good Society (2019)
Nicholas Christakis, Apollo's Arrow: The Profound and Enduring Impact of Coronavirus on the Way we Live (2020)
I'm pleased to have discovered Christakis. Blueprint is a great sociological study of group dynamics-- interesting descriptions of groups surviving on their own in remote locations or after shipwrecks; or groups separating themselves from the rest of society, including small religious enclaves, and an interesting introduction to the mathematical structure of group dynamics in communities.
Apollo's Arrow is a nice review of the sociology of pandemics, including those from long ago as well as Covid since 2020. The only critique is that it was published in late 2020, which is only about halfway through the Covid story as we know it today.
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Robert Sapolsky, Behave: The Biology of Humans at our Best and Worst (2017)
Of course, on a psychiatrist's reading list, pretty important to include a title on neuroscience! This is a great, detailed but readable introduction to how the brain works, with a particular focus on neuroanatomy and neuroendocrinology. There are a few shortcomings, but overall highly recommended. Everyone should be introduced to this subject matter.
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Maria Konnikova, The Confidence Game: Why We Fall for it, Every Time (2017)
Konnikova is a psychologist who has studied con artists. This book is an entertaining story of spectacular con artistry over the past century, with some commentary on the psychology of con artists and their victims. This subject is incredibly important today, because we are not only prone to being conned by financial scams, online fraud, etc. but also in choice of political leaders, as we have seen beginning in 2016. We see that con artists can often be so persuasive that even after they are exposed and prosecuted, victims sometimes still support them, because of how effective the con was, and how humiliating it could be for a victim to admit or understand what happened. Once again, we see this in particular political leaders since 2016.
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Ellen Peters, Innumeracy in the Wild: Misunderstanding and Misusing Numbers (2020)
Ellen Peters show us the extent to which the majority of people have poor understanding of mathematics, even at a basic level of interpreting simple data. This is of great importance because so many of the decisions we have to make in the world today, both on a personal and a political level, require clarity of understanding of issues that are best described in a quantified way, and an ability to understand and question data intelligently.
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Judea Pearl, The Book of Why (2018)
This is a book about the science of causality, which could be considered a branch of statistics. This subject is important in order to understand information in such a way as to guide decision making rationally, and to overcome biases. The first half of the book is most interesting, with a survey of the history of statistics, stories of particular important theorists whose ego unfortunately slowed down progress in the field (a common theme in history!), and with an introduction to thinking of problems through a lens of causality. There is some discussion of the theory underling AI (artificial intelligence) which is going to be an extremely important area in all of our personal and cultural lives, from this point forward in history. The second half of the book gets more technical, and in my opinion this material would be better presented in a textbook with worked examples, rather than in an ordinary text.
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John Kelly, The Great Mortality: An Intimate History of the Black Death, the Most Devastating Plague of All Time (2006)
This is an exploration of a very important historical event, arguably the worst thing ever to have happened in human history. The Black Death, starting in 1347, killed, quite suddenly, up to 50% of the population. The scale of this pandemic was hellish beyond anything we can imagine. It is obviously relevant in the context of our current pandemic. Even though the Black Death occurred over 650 years ago, we still see the same extremities of human behaviour showing itself during our present pandemic, despite all the wisdom we've accumulated over the centuries. This includes fanatical groups with bizarre theories of causation about the problem; racist extremists who blamed minority groups for the disease, leading to mass killings; and some heroic figures who tried to help, at tremendous risk to themselves.
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Robert Cialdini, Influence: The Psychology of Persuasion (2006)
Cialdini is a psychologist who specialized in persuasion, initially by studying the tactics used by successful salesmen. He identifies six major factors increasing the effectiveness of persuasive communication. This subject matter is relevant for scientists, community leaders, and health care professionals, in order to convey health information in a way which is more likely to lead to positive change. Obviously, this is incredibly relevant during the pandemic. The other reason to be acquainted with this area is to be empowered to identify unwelcome persuasive techniques being used by marketers, politicians, or pundits, to avoid being conned or manipulated. Unfortunately, I see that Cialdini's subsequent work has been of similar material directed mostly towards businesses and marketers, without further major contribution as a psychologist. But this initial book remains as a must-read.
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Richard Dawkins: The Selfish Gene (1987)
Richard Dawkins: The Ancestor's Tale (2004)
Richard Dawkins: The God Delusion (2006)
Dawkins is one of the greatest science writers. The subject of evolutionary biology should, in my opinion, be familiar to everyone. This is not a dry subject--Dawkins' stories of animal life cycles are often fascinating and beautiful, akin to watching an Attenborough nature documentary. And the scientific thinking is often spectacularly incisive. In my opinion, Dawkins' often scathing critiques of religion are really critiques of fundamentalism in all its forms, and in my opinion are really just challenges to people of faith to be able to accommodate scientific understanding of the world into a belief system which is not rigid or unjust. This is relevant for psychiatry and mental health, both because evolutionary factors obviously contribute to the existence of all human traits and problems, but also because the subject matter itself, and the way in which it has been received by society in the past two centuries, has been impacted by psychological factors including ingroup biases.
I specifically mention The Ancestor's Tale because at the time I read it, it struck me as my favourite Dawkins book.
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Steven Pinker: Rationality: What it is, why it seems scarce, why it matters (2021)
This book is nice review of other material that would be familiar if you've read some of the other books suggested here, such as by Haidt, Kahneman, and others. The genre is extremely important because our country and the whole world has been afflicted by waves of what Pinker calls "my-side-ism" or "motivated reasoning," driven by ingroup biases, tribalism, polarization, magnified by partisan news sources and misinformation. Pinker is always carefully rational, a pleasure to read, with measured optimism and suggestions of ways we can improve the dire problems we are facing.
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Steven Hawking; A Brief History of Time (1998)
I include these books here, because I just think everyone should know something about astronomy and cosmology. It's a foundation of understanding the universe and its history, it's wonderfully interesting, and as a psychiatrist I find that it helps us to cultivate a sense of awe and wonder about nature, the world, and reality, in a way which is deeply enlivened by the science, and which does not require superstitions or mystical thinking. In my opinion, it is an example of how scientific understanding rather than pseudoscience deepens our experience of the world, of nature, and of our humble role as humans in the universe around us. I think it's pretty important to know what the sun is made of, how far away it is, how old it is, what will happen to it in a few billion years, how far away the stars are, where they came from, etc. For me it is an intersection of the existential with the scientific, something of great importance to psychological well-being.
I would like to add similar titles relating to science subjects such as quantum mechanics, relativity, chemistry, paleogeology, and pure mathematics, as I think these are also sublimely interesting, in the same way that astronomy is, with similar existential impacts on mental health and well-being.
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Video Documentaries
All of David Attenborough’s nature documentaries are, in my opinion, essential as part of enjoying nature and understanding the world. Starting with Planet Earth, in 2006, the photography is spectacular. A great way to learn, to be inspired, to enjoy nature, and hopefully to be motivated to do more to protect our world’s environment. I consider an appreciation and personal experience with nature to be an important component of maintaining good mental health. Another reason to watch Attenborough is because he is one of the great people, one of the great souls, of the past hundred years, in terms of character, integrity, values, and intellect.
Neil deGrasse Tyson’s 2014 remake of Carl Sagan’s Cosmos series is another great documentary looking at the history of science, with a particular personal look at interesting people, many of whom you might never have heard of, who made great contributions to understanding and improving the world.
The Mind, Explained is a good series of short documentary episodes (20 minutes each) looking at particular aspects of how the mind works (including subjects such as anxiety, focus, attention, etc.). I’m impressed how much information they are able to pack into such brief episodes. They might not always give a full picture of each issue, but are a great introduction.
Tuesday, February 24, 2026
The Psychology of Religion, Chapter 7: Dogma
Some dogmatic beliefs may contain wise reflections about morality or justice. At best they can be treated as mythic narratives—not history or physics, but poetic story, figurative teaching, or a prompt for moral reflection. But once people treat dogma as literal fact—or as rigid moral law—it often produces a narrow and flattened morality. Furthermore. some religious stories are so brutal, or so sharply at odds with other parts of the same tradition, that even a charitable metaphorical reading can feel strained.
One can often find, in the same religious text, stories or teachings that contradict each other—sometimes directly, sometimes in subtler ways. Because of this, many individuals end up “picking and choosing” passages to bolster a pre-existing stance on almost any subject. There is a name for this in religious studies—proof-texting—and it is one of the main ways dogma becomes both rigid in tone and flexible in application.
One of the clearest signs of the problem is that the same sacred text can be used to defend opposite moral conclusions. Christians have quoted the Bible to defend hierarchy, exclusion, and harsh punishment; others have quoted it to argue for equality, mercy, and liberation. That alone should make us cautious about treating scripture as a self-interpreting moral manual.
Many people feel that their guidance regarding right and wrong—their foundation of morality—comes from religion or religious texts. People may consider the Ten Commandments to be an obvious moral guide. Yet thinking about morality this way reminds me of the moral development of children. At an early stage, a child may feel morality is dictated by a rigid external rule: “don’t take that cookie,” or “you’ll be punished if you take that cookie.” In this stage, the reason not to take the cookie is not understanding, empathy, or principle, but obedience and fear of punishment. That may keep order, but it is a precarious foundation for morality.
Real moral development requires more than rule-following. It requires thinking about why an action is right or wrong, taking other minds seriously, weighing short-term impulse against long-term consequence, and recognizing that rules sometimes conflict or require exceptions. A person may have to resist an authority figure rather than obey one. That is not moral failure; sometimes it is moral maturity.
Rule-following is not the same thing as conscience. If the main reason a person is not stealing from you or assaulting you is fear of divine punishment or obedience to an external rule, that is not especially reassuring! Most people want something deeper in themselves and in those closest to them: judgment, empathy, guilt, restraint, and the ability to reason through difficult cases. Rare exceptions do exist. Stealing food to save a starving child is not the same thing as theft or greed. Humans are capable of this kind of moral reasoning whether they are religious or not, and there are good reasons why it emerges naturally in social species and cooperative cultures.
I do have to acknowledge that some religious texts contain inspired statements about moral reasoning—for example, the Sermon on the Mount, with its emphasis on kindness, love, and humility. But many of these ideas are not unique to Christianity. Variations of the Golden Rule—the ethic of reciprocity—appear across many traditions: Confucian, Jewish, Buddhist, Hindu, Islamic, and others. This is not evidence of divinity; it is what we would expect in human societies grappling with the same recurring problems of cooperation, conflict, and conscience.
The treatment of religious texts as perfect moral instruction manuals is problematic on many levels. Even within traditions that claim “inspiration,” it is hard to maintain that every specific word—let alone every translation choice or manuscript tradition—is a flawless, literal directive. Most people therefore focus on a higher level of organization: a verse (a numbered unit), which is the most common unit studied in sermons or religious meetings.
Many churches have a kind of “book club” format in which small groups meet in someone’s home—refreshments served—to discuss a particular passage, often guided by published interpretations consistent with the group’s existing style of thinking. Sometimes the analysis stops at the verse level, partly out of practicality. It is complicated to integrate a theme across an entire text like the Bible, with its many books, authors, genres, and historical layers. For each theme or figure of speech present in one verse, there may be dozens of resonant passages elsewhere, sometimes in widely disparate parts of the text, and contradictions—either direct or qualitative—are not difficult to find.
But, as with studying literature, it is a narrow way to understand a text to focus only on its most granular fragments. Much meaning in literature comes from a more holistic analysis: genre, context, narrative arc, tension, voice, contrast. Likewise, if you look at a photograph, it would not make sense to divide it into tiny sections and analyze each separately as though the whole image were nothing but a pile of fragments. It is often inconvenient to do holistic analysis in most sermons or study sessions, so many communities stop at the verse level—or at best, a short passage. And it matters that these verse divisions were decided upon by editors, rather than being features of the earliest manuscripts.
This preference for the fragment over the whole reflects one characteristic failure of dogmatic thinking. By turning complex ancient literature into a storage box of isolated rules, people can avoid the harder work of empathy, judgment, context, and reason. Dogma is attractive partly because certainty feels safe, and shared certainty binds a group together. But the cost is high. When we trade nuance for rigidity, we do not just limit our own moral growth; we also make collective intolerance and cruelty easier to justify.
Tuesday, May 26, 2009
MDMA (ecstasy): risks and benefits
MDMA has been shown in many studies to be neurotoxic, particularly causing harm to the cells in the brain which produce serotonin. There is evidence that MDMA can cause permanent harm or cell death. These studies have been done using rodents, monkeys, and using laboratory cell cultures. The neurotoxicity seems to be associated with, or magnified by, the increase in body temperature caused by ecstasy ingestion. Here are a few of the many references about this:
http://www.ncbi.nlm.nih.gov/pubmed/1379014
http://www.ncbi.nlm.nih.gov/pubmed/18991870
http://www.ncbi.nlm.nih.gov/pubmed/16884865
http://www.ncbi.nlm.nih.gov/pubmed/12464456
But here is a paper describing long-term MDMA exposure in monkeys, which did not lead to chemical evidence of neurotoxicity:
http://www.ncbi.nlm.nih.gov/pubmed/15039771
An important body of research is the Netherlands XTC Toxicity (NeXT) study. This 2008 paper from the NeXT study describes a prospective follow-up of new low-dose ecstasy users, and found evidence through functional brain imaging of neurotoxicity in the ecstasy-using group:
http://www.ncbi.nlm.nih.gov/pubmed/18842607
Here is another similar 2007 paper published in Archives of General Psychiatry describing a slight reduction in verbal memory performance in individuals who had used even just a few doses of ecstasy, compared to individuals who had not used any:
http://www.ncbi.nlm.nih.gov/pubmed/17548754
However, this paper gave rise to a good debate in subsequent issues of this journal. Basically, neither group in the study declined in memory performance, it's just that the non-ecstasy group improved more than the ecstasy group on re-testing. The ecstasy group included some people who had used much more than others. Also, the ecstasy-using group may have been more anxious about negative memory effects, since they had been warned about this possibility in advance. Such anxiety can impare test performance. The ecstasy-using group may have taken drugs tainted with impurities. A very important point I would add is that most people who use ecstasy recreationally do so in a chaotic, loud environment such as a rave--the drug may act as an emotional or interpersonal "amplifier", which in the case of a rave, could give rise to an amplification of social chaos. Also such an environment might lead to a higher degree of hyperthermia, which is associated with worse neurotoxicity. Use of ecstasy in a controlled, gentle, intimate environment might be much safer.
Here's a reference to a 2009 British Journal of Psychiatry study showing no difference in serotonin transporter binding between groups of former MDMA users, other drug users, and controls with no history of street drug use:
http://www.ncbi.nlm.nih.gov/pubmed/19336788?ordinalpos=1&itool=EntrezSystem2.PEntrez.Pubmed.Pubmed_ResultsPanel.Pubmed_DefaultReportPanel.Pubmed_RVDocSum
This is a randomized, double-blind study looking at physical and emotional effects of acute MDMA ingestion, at low (1 mg/kg) and high (1.6 mg/kg) doses. It did not demonstrate hyperthermia as an effect of the drug, rather it implies that hyperthermia is caused by the environmental situation in conjunction with the drug (e.g. vigorous activity dancing indoors in a crowd).
http://www.ncbi.nlm.nih.gov/pubmed/18626271
There may be therapeutic applications for MDMA. The subjective effects of the drug can be to dramatically increase a feeling of openness, empathy or connectedness with other people, both on an emotional level and also sensually or physically.
Here are some references about this:
http://www.ncbi.nlm.nih.gov/pubmed/19273493
{this is a brief 2009 review of the subject of possible psychotherapeutic uses of MDMA, such as in anxiety disorders and PTSD}
http://www.ncbi.nlm.nih.gov/pubmed/19004414
{this 2008 study from Madrid showed that 50-75 mg doses of MDMA used in conjunction with psychotherapy for PTSD appeared to be physiologically and emotionally safe for 6 subjects. The study apparently had to be ended due to political pressures, before more subjects could be treated. Clearly, this is a controversial issue}
A psychiatrist by the name of Michael Mithoefer is trying to do research about using MDMA for treating PTSD. Here are some related sites:
http://scienceblogs.com/neurophilosophy/2007/11/mdma_for_ptsd.php
http://www.maps.org/mdma/protocol/
http://www.maps.org/mdma/
I think it is important to be open-minded about things outside the mainstream, and to recognize that mainstream research may sometimes dismiss ideas considered too controversial. Yet I recognize that the above sites have a biased agenda of their own which may undervalue important risk analyses published in the mainstream literature.
Answering questions relating to controversial issues, such as the potential use of MDMA as a therapeutic agent, requires a very neutral, unbiased research environment.
Aside from therapeutic possibilities in PTSD, it seems to me that MDMA might be worth investigating as an adjunct for couples' therapy, particularly for couples who feel inhibited or disconnected with each other. MDMA can foster a sense of connectedness, sensuality, and empathy. These three domains are often major weaknesses in troubled relationships. Apparently MDMA has been used in relationship therapy in the past, but the results have been poorly documented.
I have seen patients for whom MDMA use appears to have been part of a destructive long-term drug abuse pattern, which has most likely exacerbated mood, anxiety, and interpersonal problems. I have also seen a few patients for whom isolated experiences with MDMA have led to strong, memorable experiences of openness and intimacy with friends or partners.
In conclusion, I emphasize that MDMA is clearly a dangerous drug. It is most definitely neurotoxic. The risk of neurotoxicity is most likely higher with frequent, regular, or long-term use. Most "ecstasy" obtained on the street is tainted with numerous impurities--both deliberately, to reduce production costs, and as by-products of crude synthetic techniques; the impurities are likely to add to potential toxicity. I think that the setting in which MDMA is used most frequently (e.g. as a "dance drug") is likely to magnify its toxicity, in that hyperthermia is more likely, and any intimate emotional benefit is less likely. Many MDMA users are taking this drug frequently, over a period of years--I think this pattern has a very high risk of causing permanent neuropsychiatric harm.
We do not know yet if MDMA could have a positive therapeutic role for some people, but if it did, it would most likely have to be used only a very small number of times, in a carefully controlled, socially supported, comfortable, quiet, cool setting, by individuals who are already in a state of relative emotional calm. I suspect that a history of psychotic or bipolar illness, or a history of other street drug use or dependence, would greatly magnify the psychiatric risks of MDMA use. In the meantime, the existing research shows that any possible benefits would have to be weighed against very substantial risks. It remains an illegal drug in most jurisdictions.