The New York Review of Books :The Illusions of Psychiatry

JULY 14, 2011
Marcia Angell

The Emperor’s New Drugs: Exploding the Antidepressant Myth
by Irving Kirsch
Basic Books, 226 pp., $15.99 (paper)

Anatomy of an Epidemic: Magic Bullets, Psychiatric Drugs, and the Astonishing Rise of Mental Illness in America
by Robert Whitaker
Crown, 404 pp., $26.00

Unhinged: The Trouble with Psychiatry—A Doctor’s Revelations About a Profession in Crisis
by Daniel Carlat
Free Press, 256 pp., $25.00

Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, Text Revision (DSM-IV-TR)
by American Psychiatric Association
American Psychiatric Publishing, 992 pp., $135.00; $115.00 (paper)

United Artists/Photofest
Lan Fendors, Louise Fletcher, and Jack Nicholson in One Flew Over the Cuckoo’s Nest, 1975

In my article in the last issue, I focused mainly on the recent books by psychologist Irving Kirsch and journalist Robert Whitaker, and what they tell us about the epidemic of mental illness and the drugs used to treat it.1 Here I discuss the American Psychiatric Association’s Diagnostic and Statistical Manual of Mental Disorders (DSM)—often referred to as the bible of psychiatry, and now heading for its fifth edition—and its extraordinary influence within American society. I also examine Unhinged, the recent book by Daniel Carlat, a psychiatrist, who provides a disillusioned insider’s view of the psychiatric profession. And I discuss the widespread use of psychoactive drugs in children, and the baleful influence of the pharmaceutical industry on the practice of psychiatry.

One of the leaders of modern psychiatry, Leon Eisenberg, a professor at Johns Hopkins and then Harvard Medical School, who was among the first to study the effects of stimulants on attention deficit disorder in children, wrote that American psychiatry in the late twentieth century moved from a state of “brainlessness” to one of “mindlessness.”2 By that he meant that before psychoactive drugs (drugs that affect the mental state) were introduced, the profession had little interest in neurotransmitters or any other aspect of the physical brain. Instead, it subscribed to the Freudian view that mental illness had its roots in unconscious conflicts, usually originating in childhood, that affected the mind as though it were separate from the brain.

But with the introduction of psychoactive drugs in the 1950s, and sharply accelerating in the 1980s, the focus shifted to the brain. Psychiatrists began to refer to themselves as psychopharmacologists, and they had less and less interest in exploring the life stories of their patients. Their main concern was to eliminate or reduce symptoms by treating sufferers with drugs that would alter brain function. An early advocate of this biological model of mental illness, Eisenberg in his later years became an outspoken critic of what he saw as the indiscriminate use of psychoactive drugs, driven largely by the machinations of the pharmaceutical industry.

When psychoactive drugs were first introduced, there was a brief period of optimism in the psychiatric profession, but by the 1970s, optimism gave way to a sense of threat. Serious side effects of the drugs were becoming apparent, and an antipsychiatry movement had taken root, as exemplified by the writings of Thomas Szasz and the movie One Flew Over the Cuckoo’s Nest. There was also growing competition for patients from psychologists and social workers. In addition, psychiatrists were plagued by internal divisions: some embraced the new biological model, some still clung to the Freudian model, and a few saw mental illness as an essentially sane response to an insane world. Moreover, within the larger medical profession, psychiatrists were regarded as something like poor relations; even with their new drugs, they were seen as less scientific than other specialists, and their income was generally lower.

In the late 1970s, the psychiatric profession struck back—hard. As Robert Whitaker tells it in Anatomy of an Epidemic, the medical director of the American Psychiatric Association (APA), Melvin Sabshin, declared in 1977 that “a vigorous effort to remedicalize psychiatry should be strongly supported,” and he launched an all-out media and public relations campaign to do exactly that. Psychiatry had a powerful weapon that its competitors lacked. Since psychiatrists must qualify as MDs, they have the legal authority to write prescriptions. By fully embracing the biological model of mental illness and the use of psychoactive drugs to treat it, psychiatry was able to relegate other mental health care providers to ancillary positions and also to identify itself as a scientific discipline along with the rest of the medical profession. Most important, by emphasizing drug treatment, psychiatry became the darling of the pharmaceutical industry, which soon made its gratitude tangible.

These efforts to enhance the status of psychiatry were undertaken deliberately. The APA was then working on the third edition of the DSM, which provides diagnostic criteria for all mental disorders. The president of the APA had appointed Robert Spitzer, a much-admired professor of psychiatry at Columbia University, to head the task force overseeing the project. The first two editions, published in 1952 and 1968, reflected the Freudian view of mental illness and were little known outside the profession. Spitzer set out to make the DSM-III something quite different. He promised that it would be “a defense of the medical model as applied to psychiatric problems,” and the president of the APA in 1977, Jack Weinberg, said it would “clarify to anyone who may be in doubt that we regard psychiatry as a specialty of medicine.”

When Spitzer’s DSM-III was published in 1980, it contained 265 diagnoses (up from 182 in the previous edition), and it came into nearly universal use, not only by psychiatrists, but by insurance companies, hospitals, courts, prisons, schools, researchers, government agencies, and the rest of the medical profession. Its main goal was to bring consistency (usually referred to as “reliability”) to psychiatric diagnosis, that is, to ensure that psychiatrists who saw the same patient would agree on the diagnosis. To do that, each diagnosis was defined by a list of symptoms, with numerical thresholds. For example, having at least five of nine particular symptoms got you a full-fledged diagnosis of a major depressive episode within the broad category of “mood disorders.” But there was another goal—to justify the use of psychoactive drugs. The president of the APA last year, Carol Bernstein, in effect acknowledged that. “It became necessary in the 1970s,” she wrote, “to facilitate diagnostic agreement among clinicians, scientists, and regulatory authorities given the need to match patients with newly emerging pharmacologic treatments.”3

The DSM-III was almost certainly more “reliable” than the earlier versions, but reliability is not the same thing as validity. Reliability, as I have noted, is used to mean consistency; validity refers to correctness or soundness. If nearly all physicians agreed that freckles were a sign of cancer, the diagnosis would be “reliable,” but not valid. The problem with the DSM is that in all of its editions, it has simply reflected the opinions of its writers, and in the case of the DSM-III mainly of Spitzer himself, who has been justly called one of the most influential psychiatrists of the twentieth century.4 In his words, he “picked everybody that [he] was comfortable with” to serve with him on the fifteen-member task force, and there were complaints that he called too few meetings and generally ran the process in a haphazard but high-handed manner. Spitzer said in a 1989 interview, “I could just get my way by sweet talking and whatnot.” In a 1984 article entitled “The Disadvantages of DSM-III Outweigh Its Advantages,” George Vaillant, a professor of psychiatry at Harvard Medical School, wrote that the DSM-III represented “a bold series of choices based on guess, taste, prejudice, and hope,” which seems to be a fair description.

Not only did the DSM become the bible of psychiatry, but like the real Bible, it depended a lot on something akin to revelation. There are no citations of scientific studies to support its decisions. That is an astonishing omission, because in all medical publications, whether journal articles or textbooks, statements of fact are supposed to be supported by citations of published scientific studies. (There are four separate “sourcebooks” for the current edition of the DSM that present the rationale for some decisions, along with references, but that is not the same thing as specific references.) It may be of much interest for a group of experts to get together and offer their opinions, but unless these opinions can be buttressed by evidence, they do not warrant the extraordinary deference shown to the DSM. The DSM-III was supplanted by the DSM-III-R in 1987, the DSM-IV in 1994, and the current version, the DSM-IV-TR (text revised) in 2000, which contains 365 diagnoses. “With each subsequent edition,” writes Daniel Carlat in his absorbing book, “the number of diagnostic categories multiplied, and the books became larger and more expensive. Each became a best seller for the APA, and DSM is now one of the major sources of income for the organization.” The DSM-IV sold over a million copies.

As psychiatry became a drug-intensive specialty, the pharmaceutical industry was quick to see the advantages of forming an alliance with the psychiatric profession. Drug companies began to lavish attention and largesse on psychiatrists, both individually and collectively, directly and indirectly. They showered gifts and free samples on practicing psychiatrists, hired them as consultants and speakers, bought them meals, helped pay for them to attend conferences, and supplied them with “educational” materials. When Minnesota and Vermont implemented “sunshine laws” that require drug companies to report all payments to doctors, psychiatrists were found to receive more money than physicians in any other specialty. The pharmaceutical industry also subsidizes meetings of the APA and other psychiatric conferences. About a fifth of APA funding now comes from drug companies.

Drug companies are particularly eager to win over faculty psychiatrists at prestigious academic medical centers. Called “key opinion leaders” (KOLs) by the industry, these are the people who through their writing and teaching influence how mental illness will be diagnosed and treated. They also publish much of the clinical research on drugs and, most importantly, largely determine the content of the DSM. In a sense, they are the best sales force the industry could have, and are worth every cent spent on them. Of the 170 contributors to the current version of the DSM (the DSM-IV-TR), almost all of whom would be described as KOLs, ninety-five had financial ties to drug companies, including all of the contributors to the sections on mood disorders and schizophrenia.5

The drug industry, of course, supports other specialists and professional societies, too, but Carlat asks, “Why do psychiatrists consistently lead the pack of specialties when it comes to taking money from drug companies?” His answer: “Our diagnoses are subjective and expandable, and we have few rational reasons for choosing one treatment over another.” Unlike the conditions treated in most other branches of medicine, there are no objective signs or tests for mental illness—no lab data or MRI findings—and the boundaries between normal and abnormal are often unclear. That makes it possible to expand diagnostic boundaries or even create new diagnoses, in ways that would be impossible, say, in a field like cardiology. And drug companies have every interest in inducing psychiatrists to do just that.

In addition to the money spent on the psychiatric profession directly, drug companies heavily support many related patient advocacy groups and educational organizations. Whitaker writes that in the first quarter of 2009 alone,

Eli Lilly gave $551,000 to NAMI [National Alliance on Mental Illness] and its local chapters, $465,000 to the National Mental Health Association, $130,000 to CHADD (an ADHD [attention deficit/hyperactivity disorder] patient-advocacy group), and $69,250 to the American Foundation for Suicide Prevention.
And that’s just one company in three months; one can imagine what the yearly total would be from all companies that make psychoactive drugs. These groups ostensibly exist to raise public awareness of psychiatric disorders, but they also have the effect of promoting the use of psychoactive drugs and influencing insurers to cover them. Whitaker summarizes the growth of industry influence after the publication of the DSM-III as follows:

In short, a powerful quartet of voices came together during the 1980’s eager to inform the public that mental disorders were brain diseases. Pharmaceutical companies provided the financial muscle. The APA and psychiatrists at top medical schools conferred intellectual legitimacy upon the enterprise. The NIMH [National Institute of Mental Health] put the government’s stamp of approval on the story. NAMI provided a moral authority.

like most other psychiatrists, Carlat treats his patients only with drugs, not talk therapy, and he is candid about the advantages of doing so. If he sees three patients an hour for psychopharmacology, he calculates, he earns about $180 per hour from insurers. In contrast, he would be able to see only one patient an hour for talk therapy, for which insurers would pay him less than $100. Carlat does not believe that psychopharmacology is particularly complicated, let alone precise, although the public is led to believe that it is:

Patients often view psychiatrists as wizards of neurotransmitters, who can choose just the right medication for whatever chemical imbalance is at play. This exaggerated conception of our capabilities has been encouraged by drug companies, by psychiatrists ourselves, and by our patients’ understandable hopes for cures.
His work consists of asking patients a series of questions about their symptoms to see whether they match up with any of the disorders in the DSM. This matching exercise, he writes, provides “the illusion that we understand our patients when all we are doing is assigning them labels.” Often patients meet criteria for more than one diagnosis, because there is overlap in symptoms. For example, difficulty concentrating is a criterion for more than one disorder. One of Carlat’s patients ended up with seven separate diagnoses. “We target discrete symptoms with treatments, and other drugs are piled on top to treat side effects.” A typical patient, he says, might be taking Celexa for depression, Ativan for anxiety, Ambien for insomnia, Provigil for fatigue (a side effect of Celexa), and Viagra for impotence (another side effect of Celexa).

As for the medications themselves, Carlat writes that “there are only a handful of umbrella categories of psychotropic drugs,” within which the drugs are not very different from one another. He doesn’t believe there is much basis for choosing among them. “To a remarkable degree, our choice of medications is subjective, even random. Perhaps your psychiatrist is in a Lexapro mood this morning, because he was just visited by an attractive Lexapro drug rep.” And he sums up:

Such is modern psychopharmacology. Guided purely by symptoms, we try different drugs, with no real conception of what we are trying to fix, or of how the drugs are working. I am perpetually astonished that we are so effective for so many patients.
While Carlat believes that psychoactive drugs are sometimes effective, his evidence is anecdotal. What he objects to is their overuse and what he calls the “frenzy of psychiatric diagnoses.” As he puts it, “if you ask any psychiatrist in clinical practice, including me, whether antidepressants work for their patients, you will hear an unambiguous ‘yes.’ We see people getting better all the time.” But then he goes on to speculate, like Irving Kirsch in The Emperor’s New Drugs, that what they are really responding to could be an activated placebo effect. If psychoactive drugs are not all they’re cracked up to be—and the evidence is that they’re not—what about the diagnoses themselves? As they multiply with each edition of the DSM, what are we to make of them?

In 1999, the APA began work on its fifth revision of the DSM, which is scheduled to be published in 2013. The twenty-seven-member task force is headed by David Kupfer, a professor of psychiatry at the University of Pittsburgh, assisted by Darrel Regier of the APA’s American Psychiatric Institute for Research and Education. As with the earlier editions, the task force is advised by multiple work groups, which now total some 140 members, corresponding to the major diagnostic categories. Ongoing deliberations and proposals have been extensively reported on the APA website (www.DSM5.org) and in the media, and it appears that the already very large constellation of mental disorders will grow still larger.

In particular, diagnostic boundaries will be broadened to include precursors of disorders, such as “psychosis risk syndrome” and “mild cognitive impairment” (possible early Alzheimer’s disease). The term “spectrum” is used to widen categories, for example, “obsessive-compulsive disorder spectrum,” “schizophrenia spectrum disorder,” and “autism spectrum disorder.” And there are proposals for entirely new entries, such as “hypersexual disorder,” “restless legs syndrome,” and “binge eating.”

Even Allen Frances, chairman of the DSM-IV task force, is highly critical of the expansion of diagnoses in the DSM-V. In the June 26, 2009, issue of Psychiatric Times, he wrote that the DSM-V will be a “bonanza for the pharmaceutical industry but at a huge cost to the new false positive patients caught in the excessively wide DSM-V net.” As if to underscore that judgment, Kupfer and Regier wrote in a recent article in the Journal of the American Medical Association (JAMA), entitled “Why All of Medicine Should Care About DSM-5,” that “in primary care settings, approximately 30 percent to 50 percent of patients have prominent mental health symptoms or identifiable mental disorders, which have significant adverse consequences if left untreated.”6 It looks as though it will be harder and harder to be normal.

At the end of the article by Kupfer and Regier is a small-print “financial disclosure” that reads in part:

Prior to being appointed as chair, DSM-5 Task Force, Dr. Kupfer reports having served on advisory boards for Eli Lilly & Co, Forest Pharmaceuticals Inc, Solvay/Wyeth Pharmaceuticals, and Johnson & Johnson; and consulting for Servier and Lundbeck.
Regier oversees all industry-sponsored research grants for the APA. The DSM-V (used interchangeably with DSM-5) is the first edition to establish rules to limit financial conflicts of interest in members of the task force and work groups. According to these rules, once members were appointed, which occurred in 2006–2008, they could receive no more than $10,000 per year in aggregate from drug companies or own more than $50,000 in company stock. The website shows their company ties for three years before their appointments, and that is what Kupfer disclosed in the JAMA article and what is shown on the APA website, where 56 percent of members of the work groups disclosed significant industry interests.

‘Give me the first thing that comes to hand’; lithograph by Grandville, 1832

he pharmaceutical industry influences psychiatrists to prescribe psychoactive drugs even for categories of patients in whom the drugs have not been found safe and effective. What should be of greatest concern for Americans is the astonishing rise in the diagnosis and treatment of mental illness in children, sometimes as young as two years old. These children are often treated with drugs that were never approved by the FDA for use in this age group and have serious side effects. The apparent prevalence of “juvenile bipolar disorder” jumped forty-fold between 1993 and 2004, and that of “autism” increased from one in five hundred children to one in ninety over the same decade. Ten percent of ten-year-old boys now take daily stimulants for ADHD—”attention deficit/hyperactivity disorder”—and 500,000 children take antipsychotic drugs.

There seem to be fashions in childhood psychiatric diagnoses, with one disorder giving way to the next. At first, ADHD, manifested by hyperactivity, inattentiveness, and impulsivity usually in school-age children, was the fastest-growing diagnosis. But in the mid-1990s, two highly influential psychiatrists at the Massachusetts General Hospital proposed that many children with ADHD really had bipolar disorder that could sometimes be diagnosed as early as infancy. They proposed that the manic episodes characteristic of bipolar disorder in adults might be manifested in children as irritability. That gave rise to a flood of diagnoses of juvenile bipolar disorder. Eventually this created something of a backlash, and the DSM-V now proposes partly to replace the diagnosis with a brand-new one, called “temper dysregulation disorder with dysphoria,” or TDD, which Allen Frances calls “a new monster.”7

One would be hard pressed to find a two-year-old who is not sometimes irritable, a boy in fifth grade who is not sometimes inattentive, or a girl in middle school who is not anxious. (Imagine what taking a drug that causes obesity would do to such a girl.) Whether such children are labeled as having a mental disorder and treated with prescription drugs depends a lot on who they are and the pressures their parents face.8 As low-income families experience growing economic hardship, many are finding that applying for Supplemental Security Income (SSI) payments on the basis of mental disability is the only way to survive. It is more generous than welfare, and it virtually ensures that the family will also qualify for Medicaid. According to MIT economics professor David Autor, “This has become the new welfare.” Hospitals and state welfare agencies also have incentives to encourage uninsured families to apply for SSI payments, since hospitals will get paid and states will save money by shifting welfare costs to the federal government.

Growing numbers of for-profit firms specialize in helping poor families apply for SSI benefits. But to qualify nearly always requires that applicants, including children, be taking psychoactive drugs. According to a New York Times story, a Rutgers University study found that children from low-income families are four times as likely as privately insured children to receive antipsychotic medicines.

In December 2006 a four-year-old child named Rebecca Riley died in a small town near Boston from a combination of Clonidine and Depakote, which she had been prescribed, along with Seroquel, to treat “ADHD” and “bipolar disorder”—diagnoses she received when she was two years old. Clonidine was approved by the FDA for treating high blood pressure. Depakote was approved for treating epilepsy and acute mania in bipolar disorder. Seroquel was approved for treating schizophrenia and acute mania. None of the three was approved to treat ADHD or for long-term use in bipolar disorder, and none was approved for children Rebecca’s age. Rebecca’s two older siblings had been given the same diagnoses and were each taking three psychoactive drugs. The parents had obtained SSI benefits for the siblings and for themselves, and were applying for benefits for Rebecca when she died. The family’s total income from SSI was about $30,000 per year.9

Whether these drugs should ever have been prescribed for Rebecca in the first place is the crucial question. The FDA approves drugs only for specified uses, and it is illegal for companies to market them for any other purpose—that is, “off-label.” Nevertheless, physicians are permitted to prescribe drugs for any reason they choose, and one of the most lucrative things drug companies can do is persuade physicians to prescribe drugs off-label, despite the law against it. In just the past four years, five firms have admitted to federal charges of illegally marketing psychoactive drugs. AstraZeneca marketed Seroquel off-label for children and the elderly (another vulnerable population, often administered antipsychotics in nursing homes); Pfizer faced similar charges for Geodon (an antipsychotic); Eli Lilly for Zyprexa (an antipsychotic); Bristol-Myers Squibb for Abilify (another antipsychotic); and Forest Labs for Celexa (an antidepressant).

Despite having to pay hundreds of millions of dollars to settle the charges, the companies have probably come out well ahead. The original purpose of permitting doctors to prescribe drugs off-label was to enable them to treat patients on the basis of early scientific reports, without having to wait for FDA approval. But that sensible rationale has become a marketing tool. Because of the subjective nature of psychiatric diagnosis, the ease with which diagnostic boundaries can be expanded, the seriousness of the side effects of psychoactive drugs, and the pervasive influence of their manufacturers, I believe doctors should be prohibited from prescribing psychoactive drugs off-label, just as companies are prohibited from marketing them off-label.

he books by Irving Kirsch, Robert Whitaker, and Daniel Carlat are powerful indictments of the way psychiatry is now practiced. They document the “frenzy” of diagnosis, the overuse of drugs with sometimes devastating side effects, and widespread conflicts of interest. Critics of these books might argue, as Nancy Andreasen implied in her paper on the loss of brain tissue with long-term antipsychotic treatment, that the side effects are the price that must be paid to relieve the suffering caused by mental illness. If we knew that the benefits of psychoactive drugs outweighed their harms, that would be a strong argument, since there is no doubt that many people suffer grievously from mental illness. But as Kirsch, Whitaker, and Carlat argue convincingly, that expectation may be wrong.

At the very least, we need to stop thinking of psychoactive drugs as the best, and often the only, treatment for mental illness or emotional distress. Both psychotherapy and exercise have been shown to be as effective as drugs for depression, and their effects are longer-lasting, but unfortunately, there is no industry to push these alternatives and Americans have come to believe that pills must be more potent. More research is needed to study alternatives to psychoactive drugs, and the results should be included in medical education.

In particular, we need to rethink the care of troubled children. Here the problem is often troubled families in troubled circumstances. Treatment directed at these environmental conditions—such as one-on-one tutoring to help parents cope or after-school centers for the children—should be studied and compared with drug treatment. In the long run, such alternatives would probably be less expensive. Our reliance on psychoactive drugs, seemingly for all of life’s discontents, tends to close off other options. In view of the risks and questionable long-term effectiveness of drugs, we need to do better. Above all, we should remember the time-honored medical dictum: first, do no harm (primum non nocere).



Jean Baudrillard: Radical Thought

originally published by C Theory

Radical Being

Rachel K. Ward

The most powerful instinct of man is to be in conflict with truth, and with the real. –Jean Baudrillard, “Radical Thought,” 1995

The following text addresses some apparent contradictions of the work of Jean Baudrillard. He consistently confronted the dialectic of reality and illusion, negating their incompatibility. He reconciled the two through concepts of disappearance and destiny, with the disappearance of one, the other yields to destiny. His value set — paradoxical truth, inevitable destiny — was incompatible with the highly subjective, postmodern establishment of his era. It was only through veiling his intentions with provocative contemporary topics that the elite appluaded him. In Seduction (1979), Baudrillard reveals his method when citing Nietzsche, “We do not believe the truth remains true once the veil has been lifted.” Bauldrillard was one of the last to work behind the curtain. His radical assertion of truth was intentionally obscured which led to considerable misunderstanding and criticism of his larger oeuvre.

***

What more can the king’s successor do than what has already been done? – Ecclesiastes 2:12

In a frequently cited portion of Simulacra and Simulation (1981), Baudrillard refers to the Old Testament book of Ecclesiastes: “The simulacrum is never that which conceals the truth–it is the truth which conceals that there is none. The simulacrum is true.” Neither the word “simulacrum” in any variation, or the word “truth,” appears in Ecclesiastes. The book is considered a book of wisdom similar to Proverbs, to which Baudrillard simply adds. But it is in this gesture that we find the key to understanding Baudrillard. The phrase is ambiguous, that truth conceals that there is no truth, or by another reading, that there is no copy. This duplicity of truth and its image is the paradoxical unity of reality and illusion. The two are for Baudrillard insuperable and together are the basis of “Radical Thought,” his 1995 text for CTheory.

***

rad·i·cal
1) of, relating to, or proceeding from a root
2) very different from the usual, extremist

The 13th century Latin word “radical” originally meant “from a root,” and now also means “extremist,” through either a fundamental adherence to “a root,” or a severe expression of it. “Radical love” for example, can be the word in its original sense by an absolute commitment to unconditional affection toward others. It can also be a call for fundamental or revolutionary changes to contemporary adaptations of love’s meaning. The apparent double sense is resolved by seeing that both are equally radical, or of equal force, because neither form compromises love’s meaning. “Radical” then could be said to be an absolute stance on integrity of meaning. Baudrillard makes this extreme word choice at a historical moment when absolutes were dismissed.

Since the publication of Baudrillard’s “Radical Thought,” the amount of communication has increased but the state of intellectual thinking is relatively the same. “Today, it is difficult,” explains Baudrillard, “to be more apathetic and more indifferent than the facts themselves. The world in which we operate today is apathetic, indifferent to its own life, without passion, and deadly boring.” Our indifference has perhaps only increased with our digital abundance. With this climate, the noblesse oblige is radical thought, or as I expand it here — activated thought via being. But Baudrillard writes “our point is not to defend radical thought. Any idea that can be defended is presumed guilty. Any idea that does not sustain its own defense deserves to perish. But we have to fight against charges of unreality, lack of responsibility, nihilism, and despair.” We fight against false assumptions about reality, breaking the false dialectic of reality and illusion. If as Baudrillard proposes, “language and writing are a matter of illusion,” then the best thought aims for reality, not about reality but in becoming. This means that the significance for thought is not in its reception or even its legacy, but in its capacity for transfiguration.

***

No branch can bear fruit by itself; it must remain in the vine. – John 15:4

There is almost no greater security than genuine connectedness to physical and symbolic roots. Perhaps also nothing better explains your singularity than the very roots by which you have grown. Your roots are your essence, displayed in all your expressions. We live together, however, in a moment when cutting roots is common and creating a new identity is increasingly the norm. Through deconstruction we cut down the shared historical and ideological roots. Baurdillard states, “Only fracture, distance and alienation safeguard the singularity of this thought.” It is that fracture, the cutting away of the extensions of the Enlightenment, that re-exposes the root. While some have treated this fracture with eschatology, mourning the loss of meaning, others see it as the return to truth.

Baudrillard explains, “Writing aims at a total resolution, a poetic resolution as Saussure would have it, a resolution marked by a rigorous dispersion in the name of God.” This phrase is followed by, “If the thought enunciates an object as a truth, it is only as a challenge to this object’s own self-fulfillment.” This is no accidental reference for Baudrillard. Writing –in the name of God– challenges self-fulfillment. In the play of this text, the notion of intentionality and destiny are not only evoked here but essential to truth as meaning.

***

Out of love for the truth and the desire to bring it to light, the following propositions will be discussed. – Martin Luther, The 95 Theses, Disputation on the Power and Efficacy of Indulgences, 1517

Radical thought in “the name of God” is the basis of radical theology. In 1517, Martin Luther wrote his 95 theses to the Castle Church in Wittenburg Germany, opposing the Roman Catholic Church practice of allowing members to purchase pardons for sins. In democratic capitalism we purchase treasures on earth and seek pardons from taxes. Baudrillard stated that we are “in the shadow of the Enlightenment and of modernity, in the heroic ages of critical thought. But that thought, which operated against a form of illusion — superstitious, religious, or ideological — is substantially over.” It is over not because what we have cut away, superstition, religion and ideology, cease to exist but rather because we no longer care enough to oppose them.

The prevailing thought du jour is an always already state of exemption from faith or any other metaphysical accountability. Agnosticism is fashionable and with it, indifference. With radical thought however we return to the assertion of absolute meaning and thus the cultural theory forbidden — absolute truth. Baudrillard writes, “here the very definition of radical thought: an intelligence without hope, but a fortunate and happy form.” Radical thought is willing acceptance of truth, with joy, something also antithetical to contemporary thought.

***

We have elsewhere observed, that however subtle the evasions devised by philosophers, they cannot do away with the charge of rebellion, in that all of them have corrupted the truth of God. – John Calvin, Institutes on the Christian Religion 1, Part 9, 1536

Baudrillard began “Radical Thought,” with Stevenson’s quote, “the novel is a work of art not so much because of its inevitable resemblance with life but because of the insuperable differences that distinguish it from life.” Baudrillard implies that philosophy is a work of art, not so much in its resemblance to truth but because of the insuperable differences that distinguish it from truth. Philosophy is a language game, and ideology and theory are its contemporary matches. During his lifetime, Baudrillard was never accepted as an author of philosophy and cultural theory, in some cases due to his dogmatic undertones, at times due to his denial of human agency. These same attributes describe radical Protestant John Calvin. Calvin, like Baudrillard, produced a prolific amount of writing. In Part 5 of Calvin’s evangelical “Institutes of the Religion” he expresses: “In the present day not a few are found who deny the being of a God, yet, whether they will or not, they occasionally feel the truth which they are desirous not to know.” Calvin’s assertion of truth was based on the root of scripture, “Scripture bears upon the face of it as clear evidence of its truth, as white and black do of their colour, sweet and bitter of their taste.” Yet the word is not alone, he explains “Our conviction of the truth of Scripture must be derived from a higher source than human conjectures, judgments, or reasons; namely, the secret testimony of the Spirit.”

Baudrillard said little more than “God exists,” and that “language is illusion.” But importantly to Calvin, scripture is not language, thus not illusion. Scripture and Spirit are truth, not by transcendence but by co-presence in the same way Baudrillard saw the unity of reality and illusion. Baudrillard writes “radical thought comes neither from a philosophical doubt nor from a utopian transference (which always supposes an ideal transformation of the real). Nor does it stem from an ideal transcendence…it is a non-critical, non-dialectical thought. So, this thought appears to be coming from somewhere else.” The non-dialectical truth, that breaks the assumptions of reality and illusion, originates “somewhere else.”

***

The truth is a snare: you cannot have it, without being caught. You cannot have the truth in such a way that you catch it, but only in a way that it catches you. – Søren Kierkegaard

If we are able to learn from Baudrillard we can take radical thought into radical being. Radical being is Abraham’s will to sacrifice Isaac. His behavior makes no sense to reason amidst values of fatherhood, family, honor and justice. His thought is as Baudrillard stated — not in hope, but happy in form, as truth as action. The root of faith then is truth that precedes action and follows it, so to reconcile non-sense with the sense that follows. Baudrillard explains, “radical thought is at the violent crossing point of sense and non-sense, of truth and non-truth, of the continuation of the world and the continuation of nothingness.”

Though “radical thought bets on the illusion of the world,” suggests Baudrillard, it “bets” that there is more to the illusion. Radical thought relies on truth in absolute form and thus both real and intangible to our conditional world. Truth cannot be fully understood; thus we connect to one another by recognizing the absence of tangible truth, or the sense of nothingness. Baudrillard writes, “The absolute rule of thought is to return the world as we received it: unintelligible. And if it is possible, to return it a little bit more unintelligible. A little bit more enigmatic.” Breaking the false dialectic of reality and illusion is not by defending reality. This was the failed strategy of the Enlightenment. Rather by betting on illusion, and its ultimate disappearance, the truth presents itself. Gravity for example, does not reveal itself through thought or descriptions. Only by releasing our human grasp on some thing and entering into the space of unknowing can an object fall and gravity be revealed.

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What a man desires is unfailing love truth.,
Proverbs 19:22

To Baudrillard, the ultimate prize is “when an idea disappears as an idea to become a thing among other things. That’s where it finds its completion. Having become con-substantial with the surrounding world, the idea no longer has to appear as an idea …A vanishing of the idea through a silent dissemination.” The objective of radical thought then is to decompose into the soil but survive in being. The ultimate prize is when understanding is lived. If the “instinct of man is to be in conflict with truth, and with the real,” then the destiny of man is to live at rest with truth.

Baudrillard does not ask for a production of radical thought but that we allow radical truth as being. This implies that thought is not the end. We are already free of an outdated dialectic of reality and illusion and can live enigmatically with a truth that overdetermines both. This is not the end-game of illusion, which will always be interwoven with reality, but rather a possible end game of postmodenrity.

Terence McKenna

C Theory: The View of a Boulevard in Paris

Ralph E. Melcher

The subject of one of Louis Daguerre’s first photographic images is a View of the Boulevard du Temple, Paris, c. 1839.

Jose Arguelles died a couple of weeks ago. Along with Terence McKenna, Jose was a leading revolutionary in the realm of temporal politics. His vision of art and culture led him into the convoluted mathematical links between symbols in the Mayan Calendar, the hexagrams of the I Ching and the structure of DNA. Out of this exploration and the deep psychedelic visions of an artist and born trickster came the art ‘event’ that began as email networking and evolved into a major media event in the late eighties: Harmonic Convergence.

During the same period, following a slightly different trajectory, Terence McKenna wove together the synchronies of the I Ching with intricate mathematical constructs that mapped the occurrences of ‘novelty’ throughout history in a fractal image that he called the ‘Timewave.’ Both Jose and Terence saw as their missions to offer radical challenges to conventional conceptions about the passage of time. While Jose launched an assault on the Gregorian calendar, which he felt was a dangerously artificial construct at dissonance with the orders of nature, Terence saw time itself as a medium of perception that moved inexorably toward ultimate convergence at a moment that he referred to as the ‘transcendental object.’

I knew both of these men at different periods in my own life. They were opposites in nature, Jose being the romantic visionary believer and Terence a curious mixture of mystic provocateur and radical skeptic. I couldn’t fully embrace their visions, but both of them brought me around again and again to questioning my own experiences involving time and the unfolding of perception.

We speak of time as ‘passing’ as if it were the scenery we watch out of a train window or else something that flows toward or away from a particular destination. Language and art are methods we use to encapsulate time and to construct the house that we inhabit and call ‘reality.’ With the tools of word and image we build our civilizations.

Text flowing across the page captures the flow of time as a chain of symbols that ‘stand for’ sounds. When assembled in longer chains these stand for concepts, and these act as a screen that filters our every perception of the universe as it is.

Through text we ‘interpret’ reality, and in civilizations built from text power and authority is held by a priesthood of politicians, statesmen and those who do business. Various interpretations of perception become dominant largely through the application of force. So are religions and nations created, as are the wars that rage along their borders.

Reality as filtered through text is experienced as fragmented and linear. Removed from the context of nature where time is experienced as flow, the world of textual time passes as the hands of a clock, segmented into the number of tasks accomplished within arbitrary intervals: the number of words per minute, the number of stars in the heavens, the number of angels on the head of a pin, etc. Thinking is distilled into orders of logic while the life of the mind is steadily divorced from an immediate experience of the senses. As the world of art is separated from the world of utility, so our being is divided against itself, leading to the monstrous crimes that humans commit against nature and each other.

In a world built from text the artist acts against the barrier symbolic language erects between thought and direct experience. Using artifact, image and word, the goal of the artist is to trick or to urge the mind into an alternative experience of time. Sensory elements are arranged with the intent to subvert our sense of time as the logical progression of routinized task intervals, and so release us from the bonds of artificial time into the possibility of direct experience. Old habits die hard.

When in 1838 an alchemist/scientist/inventor named Louis Daguerre displayed the first examples of a process that combined the light of the sun, the silver of the moon and the vapors of mercury to produce the earliest photographs, civilization crossed the threshold into an entirely new relationship with time. In that moment of the first photographic image a door opened between worlds and a parallel universe of captured time began to flood across boundaries erected by the language of written symbols. With the exponential accumulation of images since the time of silver on metal plates exposed to light and mercurial gases, to today’s unlimited digital replications, the realm of imagination has risen as a flood that threatens everything that civilizations once accepted as true.

Our relation to the image is both more direct and more complex than our relation to script. Whereas the written word reveals its meanings through a structured progression of symbols, the image invades our consciousness through an instantaneous confluence in which the present meets the past, the moment of perception merges with the moment of capture and the content of memory is activated through a release of emotion. The image itself is an artifact of both action and emotion, which can be seen as defining elements of our sense of time.

As our moments recede into the past their content becomes myth. In the photograph a moment is converted instantly to myth. The photograph is myth given shape. We all now live in an endless castle whose walls are plastered with layer upon layer of myth.

We live in a moment when all of time and space, past, present and future bleeds into the present through the revelations of image. Single images provoke massive revolutions. Governments are overthrown by the acts of individuals captured in pictures and replicated endlessly across borders. Images are magical talismans to summon collective emotions and reshape the public conscience. Even the wizards of media and myth can’t predict what will act as a trigger for change.

The world is in a state of constant war. The oceanic realm of image and myth traps us in a plane of perception referred to by mystics as the ‘Astral,’ where wild and massive spirits and dreams roam on the currents of imagination and are shaped and reshaped in winds that sweep the blind borders between emotion and reason. Arising out of universal codes that transcend all familiar borders of language and nation the digital image sweeps us all into chaotic struggles where opposing powers draw to themselves the cloaks of our projected desires and like sorcerers they try to shape our dreams. In such a world all of us who contribute to the discourse are sorcerers.

In a world made of dreams people are united in their quest for freedom. We who watch are inspired by their courage. In other precincts too many of us live in a shadow where people strive alone for personal attention in order to fill a void inside of themselves. In a society that has lost its moorings the attention we receive can lead to a deeper sense of alienation or else to affiliation with forces that thrive on lust, fear or hatred. One can survey the Internet and find plenty of evidence to fulfill Yeat’s vision where, “…The blood-dimmed tide is loosed, and everywhere…The ceremony of innocence is drowned…” For good reasons the mystics cautioned those who entered the astral realm, and after almost two centuries of war and technological revolution every one of us is immersed in it.

We are growing more sophisticated in our understanding of the language of images and perhaps less susceptible to their ability to alienate us from our own experience. Our challenge is to understand the language so that we are no longer numbed and overwhelmed by it.

Neither Jose Arguelles or Terence McKenna lived to see whether the confirmation of their theories about time would be confirmed. They presumed to have uncovered the maps that pointed us toward doom or revelation. They tried to break us from the trance where we watch helplessly as society plunges forward and plagues of fear emerge out of the dissonance created in alienation from our own experience. Many who are caught in the tides of the imaginary are brought to despair, confusion and self loathing. Others are victims of impossible inflation turned into ego-lust and greed. We grow terrified of each other.

Opposing this are years of subversion by the prophets of conscious revolution. We grow more sophisticated in our understanding of the language of time itself. Many of us are seeing through the language of the image so that we perceive the real world beneath the projected dream. Many of us, through the shock of change itself are being broken out of the collective trance. Yet, there are no maps that can guide us out of our wonderland. Each of us can only try to distinguish the life around us from the always fading text and images of a dream.

Time flows neither forward or back. It’s only what we experience in the present that’s real. We all hope for a better future, yet hope is a projection that can lead us into delusion. Like Daguerre’s image of a street in Paris, all images fade in time. Perhaps our image of the future can pull us toward what we wish. This is the work of magic. But the key to working the magic of the image is our ability to let it go. Better than hope is the power of clear intention, for intention works only in the moment of its experience.

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Ralph Melcher is an essayist and poet living in Santa Fe, New Mexico. His work has appeared in Fish Drum Magazine, Annals of the Earth, Salon, EMagazine and CTheory. He has worked as book editor, publisher and grocer and he travels in archetypal realms involving deep psychology, film and digital media.