An Interview With Research Psychologist Vaughan Bell

An expert on abnormal brain function talks about drugs, hallucinations, and addiction.

Vaughan Bell gets around. The multifaceted clinical and research psychologist, currently a Senior Research Fellow at the Institute of Psychiatry, King’s College, London, is, in fact, down in Colombia right now. He arrived in the country to teach clinical psychiatry at Hospital Universitario San Vicente de Paúl and the Universidad de Antioquia in Medellín, Colombia, where he remains an honorary professor, but right now he works for Médecins sans Frontières (Doctors Without Borders) as mental health coordinator for Colombia, which means he is quite frequently off in the jungle, doing good work under very bad conditions. Bell has written for numerous scientific journals, including Cognitive Neuropsychiatry, Psychiatry Research, and Cortex. He has also written for Slate, The Guardian, Scientific American, and is a contributing editor at Wired. The New York Times ran a fascinating profile of Bell’s work on debunking theories about the Internet as a cause of addiction and psychosis. He is well known online for his contributions to the Mind Hacks blog, which covers unusual and intriguing findings in neuroscience and psychology. He is also working on The Enchanted Window: How Hallucinations Reveal the Hidden Workings of the Mind and Brain, a book for Penguin UK.


Q. You’ve been looking into abnormal brain states of late: delusions, hallucinations, and dissociative disorders.  Do drugs, madness, brain injuries, and religious experiences have anything in common? Is there an underlying cause for seeing or experiencing things that aren’t there?

Vaughan Bell: Apart from involving the brain, often not. Unusual perceptions occur because the normal processes that allow us to generate sensory impressions of the world become distorted. For example, the idea that we see the world as it is, is a bit of a myth, because we experience things that aren’t there all the time. The eye allows light to fall on the retina, two flat areas of photoreceptor cells which provide only patchy and poor resolution coverage of the visual field, and yet we have a very rich visual experience. The brain is filling in the rest. In your blind spots, you receive no visual information and yet we don’t have two black spots in our vision because we ‘hallucinate’ the best guess visual experience.

These are not usually considered hallucinations because the experience remains stable and predictable but these same processes, with just slight instabilities, can lead to spectacular hallucinatory states – such as Charles Bonnet syndrome –where damage to the retina leads to visions of monkeys, rabbits and little men. In other words, there are as many causes for hallucinations as there are causes for our perception of reality. If the same processes are affected through drugs, brain damage, trance states, stress or simply expectation, we can say that a particular experience has a similar basis but we have to think of the interaction to understand them fully. Trying to explain experiences solely by the brain, mind or environment makes little sense.

Q: You’ve experimented with “the vine”—ayahuasca, a powerful South American hallucinogenic plant that contains DMT. You obviously lived to tell about it. Did you see any transdimensional machine elves?

Bell: There were no transdimensional machine elves, although the whole experience was quite striking. I was kindly invited to take part in the ceremony by a chap called Romualdo, a Uitito taita (shaman), who I happened to meet in a conference about indigenous culture and I was very grateful for the opportunity.

I suspect the experience of meeting what McKenna called the "machine elves" is more prominent when pure DMT is smoked which gives a more concentrated acute dose. The traditional process of taking ayahuasca, known as yagé in Colombia, involves drinking a potion made from the vine until you start puking. To get a fair dose you need to repeat this process several times, so the absorption is much slower. I managed three or four drink – puke cycles and the psychedelic effects were prominent although I never lost track of reality. I was, however, very struck by the appearance of classic Kluver form constants, geometric patterns that are probably caused by the drug affecting the visual neurons that deal with basic perceptual process (e.g. line detection).

Q. As a research psychologist, you have been critical of the disease model of addiction for being both too simplistic about mind and behavior, and too all-encompassing to be credible. In an article for Slate, you wrote: "Despite the scientific implausibility of the same disease—addiction—underlying both damaging heroin use and overenthusiasm for World of Warcraft, the concept has run wild in the popular imagination. Our enthusiasm for labeling new forms of addictions seems to have arisen from a perfect storm of pop medicine, pseudo-neuroscience, and misplaced sympathy for the miserable." How should we view addiction, and how should we be dealing with it?

Bell: I think we should view addiction as an over-applied label that is distracting us from the fact that not everyone’s difficulties with unhelpful repetitive behavior can be understood and treated in the same way. Often compulsive behaviors do have shared factors. Obsessive-compulsive disorder, impulse control disorders (like pathological gambling or compulsive stealing) and drug addictions are all known to have shared similar behavioral, neurological and genetic features but that does not mean that each disorder is essentially the same.

The idea that playing too many computer games or compulsive use of the Internet is an addiction like any other is really obscuring the fact that different compulsive behaviors also have many different components. It would be like saying that all "mood disorders" are essentially the same—it would neither be scientifically nor clinically helpful and would cause more confusion than insight. This is the situation we have with addiction at the moment.

Q. You’ve been living and working in South America for some time now. How has the drug trade and the drug war changed that part of the world, in your own experience?

Bell: If you don’t mind, I’m going to skip this question. The drug trade is interwoven with the conflict in Colombia and myself and my colleagues in Médecins sans Frontières (Doctors Without Borders) work in areas where the fighting is live and ongoing. One of the things that allows us to do our work in areas controlled by armed groups is that we are a neutral organization solely concerned with providing medical care without getting involved in the politics behind the conflict. Of course, like everyone else, I have a view, but in case it affects either our access to the people we’re trying to treat or the security of our teams in the field, I’ll keep it to myself when I’m mentioned alongside the organization.

Graphics Credit:  http://news.softpedia.com/

The Rehab Scandal: Relapse Rates

If 8 out of 10 addicts fail, is it really treatment?

The British drug treatment and recovery community has been squabbling recently over annual figures published by the National Treatment Agency (NTA) showing a marked increase in the number of people in drug treatment programs in Britain.

BBC home editor Mark Easton dug into the data and found that, of 202,000 people in treatment, a total of 7,324 “left the treatment programme drug free last year.” Ergo, “Just 3.6 % of those in treatment were discharged free of illegal drugs. “

Andrew Brown, a writer who covers addiction and substance abuse, cited studies showing relapse rates of 80 % or more, and wrote in the UK Telegraph that residential treatment advocates “can be fervent, and persuasive, in their enthusiasm, especially those individuals for whom rehab represents the turning point in their battle with addiction. But the fact is that the expected outcome from most people who enter a treatment centre remains—relapse.”

In the current issue of Newsweek, science writer Sharon Begley gives us some inadvertent clues. Since most residential treatment therapy revolves around individual and group counseling by psychologists, not M.D.s or prescribing psychiatrists, it is unnerving to discover, in a study highlighted by Begley, that clinical psychologists in general practice do not necessarily use “the interventions for which there is the strongest evidence of efficacy.” In other words, where’s the science?

This is an argument that severely rankles psychologists, naturally enough. But Begley writes that because of rigorous clinical trials, we know, for example, that cognitive behavioral therapy can be effective against depression, OCD, bulimia, and other strongly serotonin-mediated disorders. “Neuroscience,” writes Begley, “has identified the brain mechanisms by which these interventions work, giving them added credibility.”

What, then, do we find being used as therapeutic tools in such situations by psychotherapists in the trenches, including those in addiction treatment facilities? The answer, according to Begley, is likely to be “chaotic meditation therapy, facilitated communication, dolphin-assisted therapy, eye-movement desensitization....”

Begley could have added sacral cranial therapy, electric acupuncture, and a host of other questionable practices now subsumed under the broad rubric of clinical psychology. The point is obvious: With more than a thousand brands of psychotherapy currently being practiced, it is safe to say that the field is rife with conflicting opinions about what works.

The problem is that the addicted person has no way of knowing whether the clinical therapy on offer during treatment is backed up by enough sound scientific evidence to warrant participation.

As long as clinics are showing relapse rates not unlike those shown by alcoholics and other addicts going it alone, patients and those involved in their recovery have every reason to view addiction therapy programs with a critical eye.

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Fearing Medicine

By Dirk Hanson

Have Americans become afraid of their doctors?

Once upon a time, Americans went to their doctors to get pills. Doctors complained that patients believed competent medical care consisted of being handed a prescription. In the absence of that piece of paper with the unintelligible signature, a patient was apt to claim that the doctor’s visit had been a waste of time. What was the point of seeing a doctor if the doctor didn’t give you anything that would cure what ailed you?

That was then. Patients now demand that doctors and pill makers come clean about the safety of the products they offer (long overdue), and that the pills themselves be absolutely benign in their effects (utterly impossible). In ever-greater numbers, Americans are coming to fear prescription drugs. This condition, in extremis, is a phobia with a recognized set of diagnostic criteria: pharmacophobia—an abnormal fear of medicine.

Today, Americans go to their doctors to be healthy and “drug-free.” If they are taking prescription medications, their goal is to get off them. Yesterday, patients demanded pills for conditions they didn’t have, or for which pills were ineffective. Today, patients are routinely filing lawsuits, demanding to know why their doctor gave them pills. Ironically, one of the major hindrances to health care, from a doctor’s point of view, is “patient non-compliance”—sick people often don’t take their pills properly. (This may be a good place to note that I do not work for, or with, or against Big Pharma, as the drug companies are now called. I don’t work for anybody.)

The drug industry, one of the most tightly regulated industries in America, is the kind of corporate villain Americans understand. What particularly rankles many critics is that the drug companies advertise.

“Presumably,” Joseph Davis concedes in his jeremiad against drug advertising in the journal Hedgehog Review, “some percentage of those who identify their face and their feelings with those signified in the ads actually suffer from a debilitating condition. So much to the good.”

But of little significance, it seems. The central issue for Davis is: What if people who don’t need those pills are exposed to those ads? Normal people might think they need those pills—and they don’t! And very soon, as you can easily see, you’ve got trouble in River City. In the same issue of Hedgehog Review, biomedical ethics professor Leigh Turner professes similar shock, recounting with indignation “a world where a host of marketing strategies are used to package tidy, authoritative, and often profoundly misleading claims” about the safety and effectiveness of products. You can imagine how I felt when I learned that commercial advertisers were capable of doing that.

For lack of a better term, we will have to settle for calling it the real world, where soap, life insurance, housing, cars, psychiatric care, and legal advice are all marketed in misleading ways, to people who don’t always need them. And so it is with pills. However, where once patients desired this, they now resent the offer. Writing in the May 2007 issue of Harper’s, Gary Greenberg declares that “Under the agreement we’ve made—that they are doctors, that I am sick, that I must turn myself over to them so they can cure me—the medicine must be treated with the reverence due a communion wafer.”

Previously, patients wanted their communion wafers, and doctors were often accused of withholding them. Now, as Greenberg makes clear, patients fear doctors will drag them to the altar and force the holy wafers down their throats. One cannot help wondering what manner of pact Greenberg would like to arrive at with his treating physicians. His approach does not seem like a particularly promising step forward in doctor-patient relations.

Interestingly, Americans have shown little interest in a thorough examination of the adverse side effects of non-pharmaceutical approaches to health. Talk therapists and holistic practitioners of every stripe operate in a virtually regulation-free environment. Where, for example, can one find a list of common side effects associated with the practice of various forms of psychotherapy, from post-Freudian talk therapy to, say, the increasingly popular varieties of cognitive therapy? Where, I would like to know, is the list of unwanted side effects that can occur as the result of an on-air encounter with that manipulative bruiser, Dr. Phil?

Science writer Sharon Begley, in a June 18 Time column entitled “Get Shrunk at Your Own Risk,” declares: “What few patients seeking psychotherapy know is that talking can be dangerous, too—and therapists have not exactly rushed to tell them so.”

Among many other examples, Begley reminds us of the “recovered memory” therapies that tore families apart and sent innocent people to prison for the alleged sexual abuse of children. And “stress debriefing,” a method of re-experiencing traumatic events in an effort to eliminate Post Traumatic Stress Disorder, sometimes leads to increased stress and higher levels of anxiety, compared to PTSD victims who do not undergo such therapy. I’ll privilege an upset stomach and occasional loose stools from pills over that kind of deep-seated trauma any day.

Begley also cites a 2000 study of professional grief counseling which concluded that four out of ten people grieving for the death of a loved one through formal therapy would have been better off with no therapy at all. Compared to a control group, 40 per cent of mourners in professional therapy experienced increased depression and grief. (In some cases, the most benign contraindication is when the treatment doesn’t do anything at all.)

The side effects associated with talk therapies remain shrouded in mystery. “The number of people undergoing potentially risky therapies reaches into the tens of thousands,” Begley concludes. “Vioxx was yanked from the market for less.”

Does AA Work?

Bill W., co-founder of AA








Adapted from The Chemical Carousel: What Science Tells Us About Beating Addiction © Dirk Hanson 2008, 2009.


Despite recent progress in the medical understanding of addictive disease, the amateur self-help group known as Alcoholics Anonymous, and its affiliate, Narcotics Anonymous, are still regarded by many as the most effective mode of treatment for the ex-addict who is serious about keeping his or her disease in remission. A.A. and N.A. now accept anyone who is chemically dependent on any addictive drug—those battles are history. In today’s A.A. and N.A., an addict is an addict. A pragmatic recognition of pan-addiction makes a hash of strict categories, anyway.

Nonetheless, under the biochemical paradigm of addiction, we have to ask whether the common A.A.-style of group rehabilitation, and its broader expression in the institutionalized form of the Minnesota Model, are nothing more than brainwashing combined with a covert pitch for some of that old-time religion. As Dr. Arnold Ludwig has phrased it, “Why should alcoholism, unlike any other ‘disease,’ be regarded as relatively immune to medical or psychiatric intervention and require, as AA principles insist, a personal relationship with a Higher Power as an essential element for recovery?”

The notion is reminiscent of earlier moralistic approaches to the problem, often couched in strictly religious terms. It conjures up the approach sometimes taken by fundamentalist Christians, in which a conversion experience in the name of Jesus is considered the only possible route to rehabilitation. But if all this is so, why do so many of the hardest of hard scientists in the field continue to recommend A.A. meetings as part of treatment? Desperation? Even researchers and therapists who don’t particularly like anything about the A.A. program often reluctantly recommend it, in the absence of any cheap alternatives.

In 1939, Bill Wilson and the fellowship of non-drinkers that had coalesced around him published the basic textbook of the movement, Alcoholics Anonymous. The book retailed for $3.50, a bit steep for the times, so Bill W. compensated by having it printed on the thickest paper available—hence its nickname, the “Big Book.” The foreword to the first printing stated: “We are not an organization in the conventional sense of the word. There are no fees or dues whatsoever. The only requirement for membership is an honest desire to stop drinking. We are not allied with any particular faith, sect or denomination, nor do we oppose anyone. We simply wish to be helpful to those who are afflicted.”

In short, it sounded like a recipe for complete disaster: naive, hopeful, objective, beyond politics, burdened with an anarchical structure, no official record
keeping, and a membership composed of anonymous, first-name-only alcoholics.
......................
Amid dozens of case histories of alcoholics, the Big Book contained the original Twelve Steps toward physical and spiritual recovery. There are also Twelve Traditions, the fourth one being, “Each group should be autonomous except in matters affecting other groups or A.A. as a whole.” As elaborated upon in Twelve Steps and Twelve Traditions, “There would be real danger should we commence to call some groups ‘wet’ or ‘dry,’ still others ‘Republican’ or ‘Communist’…. Sobriety had to be its sole objective. In all other respects there was perfect freedom of will and action. Every group had the right to be wrong. The unofficial Rule #62 was: “Don’t take yourself too damn seriously!”

As a well-known celebrity in A.A. put it: “In Bill W.’s last talk, he was asked what the most important aspect of the program was, and he said it was the principle of anonymity. It’s the spiritual foundation.” Co-founder Dr. Bob, for his part, believed the essence of the Twelve Steps could be distilled into two words—“love” and “service.” This clearly links the central thrust of A.A. to religious and mystical practices, although it is easily viewed in strictly secular terms, too.

Alcoholics Anonymous recounts a conversation “our friend” had with Dr. C.G. Jung. Once in a while, Jung wrote, “…alcoholics have had what are called vital spiritual experiences…. They appear to be in the nature of huge emotional displacements and rearrangements.” As stated in Twelve Steps and Twelve Traditions, “Nearly every serious emotional problem can be seen as a case of misdirected instinct. When that happens, our great natural assets, the instincts, have turned into physical and mental liabilities.”

Alcoholics Anonymous asserts that there are times when the addict “has no effective mental defense” against that first drink.

Bill Wilson wrote:
"Some strongly object to the A.A. position that alcoholism is an illness. This concept, they feel, removes moral responsibility from alcoholics. As any A.A. knows, this is far from true. We do not use the concept of sickness to absolve our members from responsibility. On the contrary, we use the fact of fatal illness to clamp the heaviest kind of moral obligation onto the sufferer, the obligation to use A.A.’s Twelve Steps to get well."

This excruciating state of moral and physical sickness—this “incomprehensible demoralization”—is known in A.A. as hitting bottom. “Why is it,” asks Dr. Arnold Ludwig, “that reasonably intelligent men and women remain relatively immune to reason and good advice and only choose to quit drinking when they absolutely must, after so much damage has been wrought? What is there about alcoholism, unlike any other ‘disease’ in medicine except certain drug addictions, that makes being in extremis represent a potentially favorable sign for cure?”

Hitting bottom may come in the form of a wrecked car, a wrecked marriage, a jail term, or simple the inexorable buildup of the solo burden of drug-seeking behavior. While the intrinsically spiritual component of the A.A. program would seem to be inconsistent with the emerging biochemical models of addiction, recall that A.A.’s basic premise has always been that alcoholism and drug addiction are diseases of the body and obsessions of the mind.

When the shocking moment arrives, and the addict hits bottom, he or she enters a “sweetly reasonable” and “softened up” state of mind, as A.A. founder Bill Wilson expressed it. Arnold Ludwig calls this the state of “therapeutic surrender.” It is crucial to everything that follows. It is the stage in their lives when addicts are prepared to consider, if only as a highly disturbing hypothesis, that they have become powerless over their use of addictive drugs. In that sense, their lives have become unmanageable. They have lost control.

A.A.’s contention that there is a power greater than the self can be seen in cybernetic terms—that is to stay, in strictly secular terms. The higher power referred to in A.A. may simply turn out to be the complex dynamics of directed group interaction, i.e., the group as a whole. It is a recognition of holistic processes beyond a single individual—the power of the many over and against the power of one.

“The unit of survival—either in ethics or in evolution—is not the organism or the species,” wrote anthropologist Gregory Bateson, “but the largest system or ‘power’ within which the creature lives.” In behavioral terms, A.A. enshrines this sophisticated understanding as a first principle.

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