July 24, 2012
July 24, 2012
Living With Voices: A new way to deal with disturbing voices offers hope for those with other forms of psychosis
July 24, 2012
Hans used to be overwhelmed by the voices. He heard them for hours, yelling at him, cursing him, telling him he should be dragged off into the forest and tortured and left to die. The most difficult things to grasp about the voices people with psychotic illness hear are how loud and insistent they are, and how hard it is to function in a world where no one else can hear them. It’s not like wearing an iPod. It’s like being surrounded by a gang of bullies. You feel horrible, crazy, because the voices are real to no one else, yet also strangely special, and they wrap you like a cocoon. Hans found it impossible to concentrate on everyday things. He sat in his room and hid. But then the voices went away for good.
Modern American psychiatry treats auditory hallucinations as the leading symptom of serious psychotic disorder, of which the most severe form is schizophrenia. When the German psychiatrist Emil Kraepelin first distinguisheddementia praecox, as he called it, from manic-depressive disorder in 1893, back when Freud was drafting the Interpretation of Dreams, he argued that schizophrenia could be recognized by its persistent, deteriorating course. These days, schizophrenia is often imagined as the quintessential brain disease, an expression of underlying organic vulnerability perhaps exacerbated by environmental stress, but as real and as obdurate as kidney failure. The new post-psychoanalytic psychiatric science that emerged in this country in the 1980s argued that mental illnesses were physical illnesses. Many Americans and most psychiatrists took away from this science a sense that serious mental illnesses were brain dysfunctions and that the best hope for their treatment lay in the aggressive new drugs that patients often hated but that sometimes held symptoms at bay.
The book that defined the era was called The Broken Brain (1984) by Nancy Andreasen, later editor of the American Journal of Psychiatry, member of the National Academy, and recipient of the National Medal of Science. Her leading example was schizophrenia, recognized by its characteristic combination of hallucinations (usually auditory), delusions, and deterioration in work or social life.
The commonsense understanding that accompanied this wisdom was that nonpharmacological treatments for schizophrenia were useless. But recently a new grassroots movement has emerged. It argues that if patients learn to address their voices directly and appropriately, as if each voice had intention and agency, the voices will become less hostile and eventually go away. From the perspective of modern psychiatry, this assertion is radical, even dangerous. But it is being taken seriously by an increasing number of patients and psychiatrists.
Hans is a Dutch man in his 20s, kind and large and careful in his speech and movement. He has the profile typical of someone with schizophrenia. He had been an excellent student in grade school, but things started to fall apart in his teens. He began to smoke a lot of marijuana and quit school at 17 to work in a factory. One evening, he heard a woman outside his apartment screaming for help. She was shrieking that five men were raping her and that they were going to kill her. Hans was afraid. He called the cops, anonymously, and they came to search, but they couldn’t find the woman in the apartment complex. Hans saw them drive away. He could still hear her screaming, high, loud, spine-chilling screams. Hans began to think that if the men raping her knew he could hear them, they would come to kill him, too, so he ran to his car and drove. He drove for half an hour, hard, until he could no longer hear her screams. She’s dead, he thought, and he didn’t dare go back to his apartment. He slept in his car that night, then went to work the next day. He got a newspaper to find out what had happened, but no one had reported the murder. He concluded that the men who had done it wanted him, too. Then he decided that one of them was his closest friend. He took a knife and went to see his friend, intending to slit his throat. He sat there with his friend, drinking tea, waiting for the right time to kill him—but he didn’t. He left his friend’s apartment and went back to his car, where he lived for two months. He heard voices outside his head, talking about him, commenting on the way he dressed, the way he looked, what they thought he should do. Which was mostly to die.
These external commenting voices are so distinctive that if patients report only that one symptom, and if their life has gone awry, they meet criteria for the diagnosis of schizophrenia. The voices told Hans that truck drivers were in on the conspiracy, too, so he could no longer sleep in highway pullouts. He went home to his mother. Hans is a quiet man, so he didn’t tell her about the voices or the knives he carried with him, and at first she didn’t notice. Then he confessed to her that he had raped a good friend. His mother didn’t believe it. She persuaded him to invite the girl to tea, and indeed the girl said he hadn’t raped her. That relieved Hans, but not his mother.
So Hans found himself in an inpatient psychiatric hospital, where he stayed for more than a year. He was diagnosed with schizophrenia and given Clozaril, one of the new “miracle” drugs for schizophrenia—miracle for a small handful of patients, a desperate stopgap for the rest. Nothing really changed for Hans on Clozaril, neither his voices nor his delusions, but he became calm. He became so calm that he slept all day. His panicked mother argued with the doctors, telling them this was no kind of life. They told her sleeping was normal “at this stage.” Hans’s skin itched. He gained 90 pounds, and now he could not think clearly or move comfortably, a Michelin man with tubby limbs. Over the course of the year, little changed.
Then Hans joined a group of people like him who met once a week. They talked about their voices, and they were encouraged to talk back to them. They were even encouraged to negotiate with their voices. One of Hans’s voices thought he would be better off if he devoted his life to Buddhist prayer. Hans is not a Buddhist—like many Dutch, he grew up as a secular Protestant—and he did not want to follow the voice’s command. The group persuaded him to cut a deal with his voices. He told his voices that he would read a book on Buddhism every day for one hour—but no more. He would say one Buddhist prayer every day—but no more. And if he did this, he told them, they had to leave him alone…
July 24, 2012
On a recent Sunday afternoon, the Syrian port city of Tartus buzzed in the summer heat. Car showrooms displayed lines of new vehicles. Markets full of clothes, furniture, and household knicknacks bustled with customers. Clouds of nargileh smoke wafted from hookah pipes at the see-and-be-seen restaurants lining sandy Mediterranean beaches. Yachts bobbed indifferently in the port.
This Middle Eastern haven, however, lies just 60 miles west of Homs, the battle-broken city that is the center of gravity in the civil war that has shattered Syria, killing more than 16,000 people and displacing a quarter of a million more. Tartus, though, has become a refuge for the country’s minority Alawi Shiite population. “As an Alawi, I don’t really care about Bashar al-Assad,” says 30-year-old Majed, referring to Syria’s president, who is also Alawi. “The only thing that concerns me is security.”
Eight months ago, after losing his job and fearing for his safety, Majed escaped Homs. (Like others interviewed for this article, Majed chose to keep his last name private for security reasons.) In Tartus, he has found work as a telecommunications salesman. “Everyone thinks we defend the regime and the authorities, but the opposition has given us no choice but to flee to the coast,” he says. “It’s like I’m not even in the Middle East here, I feel so secure.”
Similar sentiments are easy to find in Tartus. Fayez, a 35-year-old import-export business owner, also abandoned Homs last year after opposition fighters operating under the banner of the Free Syrian Army kidnapped his cousins and wrote “Get out” on the door of his home. “Revolutionaries,” Fayez describes them sarcastically, holding up his fingers in bitter air quotes. “Tartus is my new home. I don’t ever intend to leave,” he says. “In the end, Bashar al-Assad will go and our children will be left, and we have to defend their future here.”
Eighteen months of fighting have hardened both men’s sectarian resolve. In their view, Alawites are under attack by a Sunni majority, which uses its religious identity as an organizing principle for mobilizing the militias operating under the Free Syrian Army umbrella. In turn, the coastal Sahel region is the only safe haven, and this stretch of land — encompassing the port cities of Latakia, Baniyas, Jableh, and Tartus, and the mountains separating them from the rest of Syria’s plains — must be protected against Sunni encroachment at all costs.
Far removed from the shabiha, Assad’s vigilante militias notorious for carrying out the regime’s crackdown against the uprising, these men in the Sahel are neither fanatic nor armed. But they represent a demographic force creating another de facto divide in the country. As fighting takes place along Syria’s central artery running northward from Homs to Idlib, Alawites are increasingly setting up shop in the Sahel, looking to cordon themselves off from the chaos that they believe will come as Assad’s grip on the country weakens.
In several conversations, Alawites said that thousands of families have relocated to the coast. Others spoke of friends and family members who have not yet moved but have purchased homes there in anticipation of a shift in fortunes. Although the real figure is impossible to determine, visits to Damascus, Homs, and Tartus indicated that such numbers are plausible. Official tallies — from the UN agencies operating inside Syria, for instance — are nonexistent.
Such movement could be an early harbinger of territorial entrenchments of Syria’s sectarian fault lines. “At this point, the regime is not looking at itself as a small state within Syria,” says one Alawi academic who lives in both Damascus and Latakia. “It wants all of Syria, and it will stay that way until the last possible moment.” Alawites talk of a return to the coast is specious, he says, the product of a regime “game” of hyping threats in order to instill fear in minorities. Still, he adds, “Just like the weapons game, the sectarian game is a dangerous one. People are hearing rhetoric like, ‘We want to annihilate Alawis. We want their deaths.’ You never know if it will pass a point at which you can’t stop it, you lose control.”
That fear is rooted in the community’s historical marginalization. Throughout centuries of Mamluk and Ottoman rule, Alawites, a heterodox offshoot of Shia Islam, largely confined themselves to the mountains east of Latakia. Aside from tiny minorities in the villages around Homs and Hama, they emerged from their “wild hills” only occasionally to work as menial laborers. After World War I, French mandate authorities codified these isolationist impulses, creating a sovereign Alawi territory extending from Latakia to Tartus in 1920. Though Alawi leaders initially cheered their region as a bulwark against Sunni domination of the interior, even French protection could not make the state viable. Alawites constituted a majority of the population, but city-based Sunni and Christian communities lagged behind by only a third, possessed far greater wealth and education, and were strongly in favor of union with Damascus. By 1937, the experiment had failed; the state was incorporated into modern-day Syria…
Decadence Destiny: New Orleans’s American tourists often feel that they’ve arrived in a foreign country, and they’re not entirely wrong
July 24, 2012
New Orleans’s American tourists often feel that they’ve arrived in a foreign country, and they’re not entirely wrong. The city’s history dates back to its status of uneasy observer of the nation’s founding. As the 13 colonies were forging a nation, the elite Spanish subjects in New Orleans looked on not with elation, but with unease, Tulane professor Lawrence N. Powell writes in The Accidental City, his chronicle of the Big Easy’s pre-1812 history. Plantation owners and wealthy merchants worried about what kind of message their slaves would absorb from the inconvenient republican rhetoric up north. New Orleans has always been just a bit different, and those differences endure to this day.
The Crescent City’s location is its original sin—but the sinners, like many of their lot, had their reasons. In the early eighteenth century, the French crown, Louisiana’s first royal sponsor, needed money to pay off its massive debts, and it hoped tobacco might wean the populace off British-controlled imports. “New Orleans was founded as a company town,” writes Powell. Impresarios of the royally chartered Company of the West, which would administer the new colony, found an easy mark at Versailles, as French colonial policy under Louis XIV “was largely one of aimlessness and drift.”
France needed water access from the American continent to Europe, and the Mississippi River provided that route. “The site was dreadful,” Powell observes, but the “situation” was “superb.” The river itself was so difficult that explorers had a tough time even finding it, and, once they did, not losing either it or themselves. As for the dry ground alongside the water: Europe has paintings older than this land, which was much more suitable for flooding than for building. Crown and company preferred to defend a much smaller settlement near present-day Biloxi, Mississippi or Mobile, Alabama, rather than a dense city. As one French official put it, “The land is flooded, unhealthy, impracticable.” Another said, in Powell’s paraphrase, that “it must be abandoned, pure and simple.”
But Canadian-born Jean-Baptiste Le Moyne, Sieur de Bienville, who governed early-day New Orleans, thought otherwise, in part because he figured—correctly—that he could better control and profit from land that he built up from scratch. Bienville got his way through other people’s bad luck. The Company of the West struggled for years and then collapsed in the early 1720s, and “while the company was distracted” by its looming failure, Bienville worked “assiduously to get New Orleans populated by every means at his disposal.” Present-day New Orleanians live with Bienville’s choices.
They live also with his visions, architectural and economic. The planners whom Bienville hired laid out a grid built on a sliver of relatively high ground. The cathedral formed the center, Latin-style. Bienville was so intent on making sure that other people’s ideas didn’t ruin his “Enlightenment mania for balance, order, and clarity” that he “even outlawed lawyers.” To create a plantation-based economy and to ensure loyalty, Bienville then parceled out land. Rich people lived closest to the river, with the poor in the “back of town,” though good land was so scarce that everyone lived in close proximity, anyway.
To grow and export crops, Bienville needed people, but not many were interested. Since Enlightenment ideals prohibited neither forced migration nor forced labor, Bienville embraced both. He had a ready supply of forced migrants from France, which had a policy in the early 1700s to deport undesirables. “One fourth of the original male colonists of New Orleans were convicts, smugglers, and deserters,” whom France forcibly deported, Powell reveals. Bienville supplemented them with wholesale imports of West African slaves, dispensed to his loyalists. The slaves, in turn, built not only New Orleans’s agro-economy but also its vital protections against flood.
Bienville created a culture that was to endure long after Spain took over the colony in 1766 as a war prize. One feature was that, “like modern-day Italy,” as Powell puts it, New Orleans had “tons of [laws] that few people cared to obey.” It wasn’t that unwilling laborers and European exiles were somehow morally defective. Economics and geopolitics, and plain old human nature, had more to do with it.
Consider the problem presented by Louisiana’s very reason for existence: mercantilism. The point of the colony, under both French and Spanish rule, was to supply the respective crowns with raw or lightly produced materials and buy finished goods from the mother country in return. Whatever the merits of the theory, the practice didn’t work. Weak crops, bad weather, intercolonial wars, and personal desires forced colonial administrators to turn a blind eye, at best, to “smuggling”—that is, freer trade. Both France and Spain had difficulty producing sufficient quality goods for export, Powell notes, but “even those items that the mother country was able to supply, Louisianans didn’t want.” Whites, blacks, and Indians alike preferred English-finished fabrics to Continental. French-raised colonists wanted French wine, not Spanish. New Orleans, then, traded heavily with the British colonies and later, the United States; it also traded with the West Indies and Spanish-held Cuba…