The Troubled History of Psychiatry

Challenges to the legitimacy of the profession have forced it to examine itself, including the fundamental question of what constitutes a mental disorder.

By Jerome Groopman
May 20, 2019

Modern medicine can be seen as a quest to understand pathogenesis, the biological cause of an illness. Once pathogenesis—the word comes from the Greek pathos (suffering) and genesis (origin)—has been established by scientific experiment, accurate diagnoses can be made, and targeted therapies developed. In the early years of the aids epidemic, there were all kinds of theories about what was causing it: toxicity from drug use during sex, allergic reactions to semen, and so on. Only after the discovery of the human immunodeficiency virus helped lay such conjectures to rest did it become possible to use specific blood tests for diagnosis and, eventually, to provide antiviral drugs to improve immune defenses.

Sometimes a disease’s pathogenesis is surprising. As a medical student, I was taught that peptic ulcers were often caused by stress; treatments included bed rest and a soothing diet rich in milk. Anyone who had suggested that ulcers were the result of bacterial infection would have been thought crazy. The prevailing view was that no bacterium could thrive in the acidic environment of the stomach. But in 1982 two Australian researchers (who later won a Nobel Prize for their work) proposed that a bacterium called Helicobacter pylori was crucial to the onset of many peptic ulcers. Although the hypothesis was met with widespread scorn, experimental evidence gradually became conclusive. Now ulcers are routinely healed with antibiotics...

But what can medicine do when pathogenesis remains elusive? That’s a question that has bedevilled the field of psychiatry for nearly a century and a half. In “Mind Fixers” (Norton), Anne Harrington, a history-of-science professor at Harvard, follows “psychiatry’s troubled search for the biology of mental illness,” deftly tracing a progression of paradigms adopted by neurologists, psychiatrists, and psychologists, as well as patients and their advocates.

Her narrative begins in the late nineteenth century, when researchers explored the brain’s anatomy in an attempt to identify the origins of mental disorders. The studies ultimately proved fruitless, and their failure produced a split in the field. Some psychiatrists sought nonbiological causes, including psychoanalytic ones, for mental disorders. Others doubled down on the biological approach and, as she writes, “increasingly pursued a hodgepodge of theories and projects, many of which, in hindsight, look both ill-considered and incautious.” The split is still evident today.

The history that Harrington relays is a series of pendulum swings. For much of the book, touted breakthroughs disappoint, discredited dogmas give rise to counter-dogmas, treatments are influenced by the financial interests of the pharmaceutical industry, and real harm is done to patients and their loved ones. One thing that becomes apparent is that, when pathogenesis is absent, historical events and cultural shifts have an outsized influence on prevailing views on causes and treatments. By charting our fluctuating beliefs about our own minds, Harrington effectively tells a story about the twentieth century itself.


In 1885, the Boston Medical and Surgical Journal noted, “The increase in the number of the insane has been exceptionally rapid in the last decade.” Mental asylums built earlier in the century were overflowing with patients. Harrington points out that the asylum may have “created its own expanding clientele,” but it’s possible that insanity really wason the rise, in part because of the rapid spread of syphilis. What we now know to be a late stage of the disease was at the time termed “general paralysis of the insane.” Patients were afflicted by dementia and grandiose delusions and developed a wobbly gait. Toward the end of the century, as many as one in five people entering asylums had general paralysis of the insane.

Proof of a causal relationship between the condition and syphilis came in 1897, and marked the first time, Harrington writes, that “psychiatry had discovered a specific biological cause for a common mental illness.” The discovery was made by the neurologist Richard von Krafft-Ebing (today best known for “Psychopathia Sexualis,” his study of sexual “perversion”) and his assistant Josef Adolf Hirschl. They devised an experiment that made use of a fact that was already known: syphilis could be contracted only once. The pair took pus from the sores of syphilitics and injected it into patients suffering from general paralysis of the insane. Then they watched to see if the test subjects became infected. Any patient who did could be said with certainty not to have had the disease before. As it turned out, though, none of the subjects became infected, leading the researchers to conclude that the condition arose from previous infection with syphilis.

This apparent validation of the biological approach was influential. “If it could be done once,” Harrington writes, “maybe it could be done again.” But the work on syphilis proved to be something of a dead end. Neurologists of the time, knowing nothing of brain chemistry, were heavily focussed on what could be observed at autopsy, but there were many mental illnesses that left no trace in the solid tissue of the brain. Harrington frames this outcome in the Cartesian terms of a mind-body dualism: “Brain anatomists had failed so miserably because they focused on the brain at the expense of the mind.”

...unlike Freud, he was not dogmatic. He treated his patients, variously, with medications, talk therapy, hypnosis, and relaxation techniques, often combining several of these.

It was a pragmatic, empirical approach, trying to find what worked for each patient. I admired his humility and reflected that his field was not so unlike my own, where, despite a growing knowledge of the pathogenesis of cancer, one could not precisely predict whether a patient would benefit from a treatment or suffer pointlessly from its side effects. In some sense, everything my colleague and I did for the patient was in the end biological. Words can alter, for better or worse, the chemical transmitters and circuits of our brain, just as drugs or electroconvulsive therapy can. We still don’t fully understand how this occurs. But we do know that all these treatments are given with a common purpose based on hope, a feeling that surely has its own therapeutic biology. ♦

This article appears in the print edition of the May 27, 2019, issue, with the headline “Medicine in Mind.”New Yorker

Can I Get My Anti-Vaxx Sister’s Kids Vaccinated?

THE ETHICIST
By Kwame Anthony Appiah
May 14, 2019

I am the primary caregiver for my elderly mother, who has lupus and thus a compromised immune system. My sister has four young children, none of whom she has had vaccinated out of fear that vaccines cause autism.

My mother and I watch all four children regularly but have become increasingly uneasy in the face of outbreaks of measles and other communicable diseases. My mother and other relatives have implored my sister to reconsider her anti-vaccination stance. We have told her that if she doesn’t, we will have to stop watching her children, which would be a significant hardship for her. (My two older nephews were both denied entrance to a great local public school because my sister refuses to vaccinate, leading to even more babysitting time at my mother’s house.)

The health center where my mother receives regular care hosts a biannual, reduced-cost vaccination clinic. Would it be unethical for me to get the children inoculated there the next time such an event is held? I don’t want to alienate my sister, but at what point does the common good outweigh individual choice? Name Withheld


People with lupus are indeed more susceptible to infection, especially if they’re taking immunosuppressive drugs. So are older people, whose immune systems are less able to combat pathogens. Your mother is vulnerable for both reasons. Children who are not vaccinated are more likely to get diseases like measles, mumps and rubella and so more likely to transmit them to others. (The recent measles outbreak in an Orthodox Jewish community in Brooklyn began in part with an unvaccinated child who acquired the disease in Israel, and most, though not all, of those who then contracted it were unvaccinated.) The fact that your mother spends so much time with four unvaccinated nephews and nieces is a further source of risk.

And let’s repeat what shouldn’t need repeating. Despite the vociferations of anti-vaccination activists, the overwhelming scientific consensus strongly supports M.M.R. vaccination.

So I understand your wish to protect all these members of your family. I’m glad you’ve spent time trying to change your sister’s mind. Still, medical decisions for minor children are the responsibility of their custodial parents, and vaccinating her children behind her back would violate her right to make these decisions. If you can’t persuade her, you can’t overrule her.

I suppose there’s a chance that your sister would reconsider if you and your mother decided that you would no longer look after her kids otherwise. But given the nature of her convictions (and the fact that she wasn’t deterred by her kids’ being excluded from public education), she isn’t likely to respond to that pressure. Her problem isn’t what she’s doing, given what she believes; it’s what she believes. Many years of careful analysis show that the evidence for an autism link is simply nonexistent; nor can older children suddenly develop the disorder. Unfortunately, anti-vaxxers have the epistemological equivalent of a drug-resistant infection; the condition is stubbornly unresponsive to treatment.

The C.D.C. says that in the decade before a vaccine became available, in 1963, most children got measles by age 15; each year between three and four million people were infected, 48,000 were hospitalized, 1,000 came down with encephalitis and as many as 500 died. Unvaccinated children are free-riding on the responsible majority, without whom we would be headed back to that distressing situation. We have every reason to hope the anti-vaxxers don’t win the argument. So do what you can — but be mindful of what you can’t.

In my freshman year at college, I crossed paths with an upperclassman at a school club. We became Facebook friends sometime afterward but didn’t stay in touch. I never saw her again after that and over time, stopped seeing anything of hers on Facebook, too.

Recently, new posts of hers started popping up. She appears to have relocated to South America and is presenting herself as a self-healing mystic. Her posts feature lots of platitudes about “cosmic balance.” More recently, however, she has been asking for positive vibes because of an onslaught of C.I.A. brain attacks aimed at her. Lately, she implored her friends for donations.

Disturbing as it is to see this person suffering a mental breakdown in near-real time, I’ve felt conflicted about whether and how to act. I have no relationship with her; if not for social media, I wouldn’t even remember her. At the same time, her rants never seem to attract the help she needs — just more people affirming her preposterous claims. Do I have an obligation to help this person help themselves, and if so, what form should that help take? Name Withheld

A responsible estimate for psychotic disorders suggests a 3 percent lifetime prevalence. Which means you could probably find more people you’ve known over the years with these difficulties if you looked. This person is just one you happen to have learned about. And your connection to her is pretty remote. Of all the people who know her and her situation, you’re surely one of the least likely to be able to help her at reasonable cost in time and expense; an online message from someone she hasn’t seen in years isn’t likely to break through and persuade her to go see a doctor. In sum: No, you’re not obliged to act.

Even though you don’t have an obligation to act, however, it would be a good thing to try to do something. For one thing, these disorders are often highly treatable; there’s a good chance she would benefit from medical help. Trying to find and alert members of her family could benefit her more than anything you can do directly. It would probably be best for her to be brought back home, where there are people who can manage her care. But my bet is that her family already knows and hasn’t been able to make any headway with her. One symptom of certain psychoses is a specific inability — sometimes called anosognosia — to recognize that you’ve got a problem.

You might also consider alerting her online community to your interpretation of her situation and suggesting that someone who is in contact with her try to help. Given what you say about the responses to her posts, however, this may not produce results. And in her current mental condition, she’s quite likely to block you. A valuable thing about the internet is that if you’re someone who is marginalized and isolated in your community, it can connect you to an international network of people like you and assure you that you’re not alone. But that same ability to link people up to the like-minded can sustain tin-foil-hat beliefs — about how the C.I.A. is directing brain attacks, about how the Sandy Hook shooting was a hoax and, yes, about how vaccines cause autism. In the era of QAnon and Infowars, one person’s delusion can swiftly become everyone’s problem.
nyt

Kwame Anthony Appiah teaches philosophy at N.Y.U. His books include “Cosmopolitanism,” “The Honor Code” and “The Lies That Bind: Rethinking Identity.” To submit a query: Send an email to ethicist@nytimes.com; or send mail to The Ethicist, The New York Times Magazine, 620 Eighth Avenue, New York, N.Y. 10018. (Include a daytime phone number.)

Can We Live Longer but Stay Younger?

With greater longevity, the quest to avoid the infirmities of aging is more urgent than ever. Some view old age not as a fact to be endured but as a disease to be cured.

The “co-morbidities” for Alzheimer’s, the conditions that correlate most strongly with its onset, are the old-fashioned sins: obesity, a lack of exercise, bad diet—and the diabetes that these can produce. For all the cascades of research into longevity, the new science often seems to distill into old wisdom: be fit, stay thin, and you will look and feel younger longer.

By Adam Gopnik
May 13, 2019

Aging, like bankruptcy in Hemingway’s description, happens two ways, slowly and then all at once. The slow way is the familiar one: decades pass with little sense of internal change, middle age arrives with only a slight slowing down—a name lost, a lumbar ache, a sprinkling of white hairs and eye wrinkles. The fast way happens as a series of lurches: eyes occlude, hearing dwindles, a hand trembles where it hadn’t, a hip breaks—the usually hale and hearty doctor’s murmur in the yearly checkup, There are some signs here that concern me.

To get a sense of what it would be like to have the slow process become the fast process, you can go to the AgeLab, at the Massachusetts Institute of Technology, in Cambridge, and put on agnes (for Age Gain Now Empathy System). agnes, or the “sudden aging” suit, as Joseph Coughlin, the founder and director of the AgeLab describes it, includes yellow glasses, which convey a sense of the yellowing of the ocular lens that comes with age; a boxer’s neck harness, which mimics the diminished mobility of the cervical spine; bands around the elbows, wrists, and knees to simulate stiffness; boots with foam padding to produce a loss of tactile feedback; and special gloves to “reduce tactile acuity while adding resistance to finger movements.”

Slowly pulling on the aging suit and then standing up—it looks a bit like one of the spacesuits that the Russian cosmonauts wore—you’re at first conscious merely of a little extra weight, a little loss of feeling, a small encumbrance or two at the extremities. Soon, though, it’s actively infuriating. The suit bends you. It slows you. You come to realize what makes it a powerful instrument of emotional empathy: every small task becomes effortful. “Reach up to the top shelf and pick up that mug,” Coughlin orders, and doing so requires more attention than you expected. You reach for the mug instead of just getting it. Your emotional cast, as focussed task piles on focussed task, becomes one of annoyance; you acquire the same set-mouthed, unhappy, watchful look you see on certain elderly people on the subway. The concentration that each act requires disrupts the flow of life, which you suddenly become aware is the happiness of life, the ceaseless flow of simple action and responses, choices all made simultaneously and mostly without effort. Happiness is absorption, and absorption is the opposite of willful attention.

The annoyance, after a half hour or so in the suit, tips over into anger: Damn, what’s wrong with the world? (Never: What’s wrong with me?) The suit makes us aware not so much of the physical difficulties of old age, which can be manageable, but of the mental state disconcertingly associated with it—the price of age being perpetual aggravation. The theme and action and motive of King Lear suddenly become perfectly clear. You become enraged at your youngest daughter’s reticence because you have had to struggle to unroll the map of your kingdom.

The AgeLab is designed to alleviate this progression. It exists to encourage and incubate new technologies and products and services for an ever-larger market of aging people. (“Every eight seconds, a baby boomer turns seventy-three,” Coughlin observes.) Coughlin, who is in his late fifties, is the image of an old-fashioned American engineer-entrepreneur; he is bald in the old-fashioned, tonsured, Thurber-husband way, wears a bow tie and heavy red-framed glasses, and, walking a visitor through the lab, suggests a cross between Mr. Peabody and Q, from the Bond films, showing you the latest gadgets. His talk is crisply aphoristic and irrigated with an easy flow of statistics: each proposition has its instantly associated number.

“Where science is ambiguous, politics begins,” he says. “In the designation of some states, an older driver is fifty, in some eighty—we don’t even know what an older driver is. That ambiguity is an itch I wanted to scratch. Over the past century, we’ve created the greatest gift in the history of humanity—thirty extra years of life—and we don’t know what to do with it! Now that we’re living longer, how do we plan for what we’re going to do?”

Having picked the mug up, the suit wearer finds that setting the mug down gently on a nearby table is also a bit of a challenge. So is following Coughlin from room to room as he narrates all that the AgeLab has learned.

“Here’s a useful model for you,” he says. “From zero to twenty-one is about eight thousand days. From twenty-one to midlife crisis is eight thousand days. From mid-forties to sixty-five—eight thousand days. Nowadays, if you make it to sixty-five you have a fifty-per-cent chance you’ll make it to eighty-five. Another eight thousand days! That’s no longer a trip to Disney and wait for the grandchildren to visit and die of the virus you get on a cruise. We’re talking about rethinking, redefining one-third of adult life! The greatest achievement in the history of humankind—and all we can say is that it’s going to make Medicare go broke? Why don’t we take that one-third and create new stories, new rituals, new mythologies for people as they age?” (continues)

Brave New World Dept.

What You Should Read to Understand the Measles Epidemic

(And don't forget On Immunity: An Innoculation by Eula Biss)

NYT:

Who would ever have predicted that this winter’s grim medical headlines would address not the usual cold-weather pestilence — influenza — but pedestrian, forgettable old measles?

Just about everybody, that’s who. Experts have been tracking the worldwide resurgence of measles for decades now, and it was only a matter of time before the scattershot outbreaks of years past turned into this year’s newsworthy explosions.

Readers curious about this infection rising phoenixlike from its own ashes will find both less and more in the library than they may want. Aside from a few textbooks and pamphlets, I couldn’t find a whole book devoted to measles — not since the 10th century A.D., that is, when the Persian physician Al-Razi wrote “The Smallpox and Measles” to differentiate the two.

Still, quite a few recent books deliver the basics, including information on childhood infections and their medical dangers, the various ways we have learned to thwart those dangers and the ways in which those efforts have in turn been thwarted. Readers intrigued enough by vaccination to want more details on the workings of the human immune system and its potential for both harm and good will find new books discussing just that topic.

For a detailed review of diseases, vaccines and the objections the anti-vaccine lobbyists have brought to the table, books by the prolific Paul Offit are a good place to start. Offit is a pediatrician and infectious disease expert in Philadelphia whose longtime, eloquent advocacy of vaccination has made him a permanent target of anti-vaccine lobbyists — his book signings have sometimes been canceled because of credible death threats.

Offit’s “Deadly Choices” (2010) outlines the often-forgotten complications of childhood infections and rebuts the various objections of the anti-vaxxers point by point. “Autism’s False Prophets” (2008) concentrates on the thoroughly debunked assertion that the neurological condition autism results from childhood vaccines.

But it is “Bad Faith” (2015), Offit’s analysis of the tension between religious fundamentalism and vaccination, that speaks most directly to this year’s headlines with a short, unforgettable section on measles. During the winter of 1990-91, more than 1,400 adults and children in Philadelphia developed measles, and nine children, all unvaccinated, died. Offit’s dispassionate, methodical summary of the religious and political theories that enabled that giant outbreak simmers with anger. Living through that epidemic, he has since written, “was like being in a war zone.”

If expert opinion from a war zone is not an appealing perspective on the subject, readers will find similar territory covered in an utterly different voice by Seth Mnookin in his excellent “The Panic Virus” (2011). A journalist with no skin in the vaccine game — other than the fact that he was a new father when he wrote the book — Mnookin just wanted to explore the minefield for himself. As he tentatively lays out vaccine pros and cons he becomes convinced of the fallacies and dangers in the anti-vaccine movement’s rhetoric. His reflections on the actress Jenny McCarthy, whose transformation into anti-vaccine advocate revived a fading Hollywood career, make for a fun, snarky read, but the enduring importance of Mnookin’s book lies in its methodical science-based rebuttals of wild rhetoric.

If histrionic behavior and snark appeal to you, you can get quite a dose of both from the stories of some of the vaccine scientists themselves. Offit’s “Vaccinated” (2007) profiles one of the 20th century’s foremost vaccinologists, Merck’s powerful and spectacularly foul-mouthed Maurice Hilleman, and sketches out the climate of fierce scientific competition and politics in which he thrived.

The science journalist Meredith Wadman took a deep dive into similar material and created a real jewel of science history. Wadman’s “The Vaccine Race” (2017) brims with suspense and now-forgotten catastrophe and intrigue, all beginning in the 1950s and 1960s, when, as she writes, the chase for new vaccines “was as hot as today’s quest to unravel the profound mysteries of the human genome.”

The first vaccinologists were accustomed to working in happy solitude, policed by conscience alone — or not, as the case may be (some were really wildly unprincipled). Soon enough, though, the scientists were joined in their projects by academics and salesmen, then by corporate executives, then by congressmen and lawyers. All were forced to navigate the terrible early vaccine disasters, when contaminated products transmitted disease rather than protection, and all struggled with the need to reconcile centuries-old public health tools, like quarantine, with new ones like mandatory vaccination and informed consent. Wadman’s smooth prose calmly spins a surpassingly complicated story into a real tour de force.

Vaccination was only the first organized effort to harness the immune system for medical purposes. In the last two decades many other techniques have been devised, foremost among them the engineered proteins called monoclonal antibodies. These are the pricey drugs with unpronounceable names ending in “-mab” now being hawked incessantly on television for diseases from eczema to cancer. The story of the science behind these drugs and other sophisticated immunologic tools is just beginning to be written.

In his new book, “The End of the Beginning” (Pegasus, $27.95), the immunologist Michael Kinch builds on the narrative he began with last year’s “Between Hope and Fear.” That book provides a chatty, looping profile of the immune system and the historical origins of modern vaccine science, all contained in a narrative draped like a Christmas tree with sparkly digressions into biography, philosophy and historical gossip.

Kinch now changes focus slightly to review cancer biology and the promise of immune-mediated treatments. A professor at Washington University in St. Louis, he spent some of his early career at a biotechnical company and can speak with authority about the mixed promise of monoclonal antibodies for cancer treatment — some tumors vanish with these agents while others are utterly untouched, and none of the drugs is without side effects.

Kinch’s narrative is as loose and lavishly ornamented as ever, while his material is, if anything, even more scientifically complex. Some readers may enjoy the bumpy, glittery, distraction-filled ride. Others, presumably those of us with dull linear minds, will wish he would just settle down, even for a single chapter, and say what he has to say in a dull, straightforward way.

Matt Richtel wanders different paths in the same territory with “An Elegant Defense” (Morrow/HarperCollins, $28.99), also published this spring. A reporter for The New York Times, Richtel became interested in immunology after a childhood friend developed Hodgkin’s lymphoma in his early 40s. Hodgkin’s is one of the more curable cancers of adulthood, but Jason Greenstein was in the unlucky minority of patients who have terrible, prolonged downhill courses. Richtel told portions of Jason’s story in a Science Times series on the promise and perils of immunologic therapy: With a last-ditch experimental monoclonal antibody treatment, Jason’s huge, disfiguring tumors melted away like warming ice cubes — a visible miracle, if sadly short-lived.

Jason died in 2016. Richtel’s deep affection for his irrepressible friend animates much of his book, and his stories of three other individuals whose illness or wellness can be ascribed to their unique immunologic makeup are interesting enough, if less affecting. But when Richtel attempts to explain the basic science underlying autoimmune disease and immunologic treatment, he is palpably out of his depth. Dozens of different immune cells and chemicals keep us healthy and can also make us grievously sick; their habits and functions are often opaque and the nomenclature is beyond confusing. Even a professional narrator like Richtel, forced to operate without tables and figures, is bound to get all tangled up in his prose and generate a few real bloopers. That’s why some wise educator long ago created textbooks.

AUTISM’S FALSE PROPHETS: Bad Science, Risky Medicine, and the Search for a Cure, by Paul Offit. BAD FAITH: When Religious Belief Undermines Modern Medicine, by Paul Offit. DEADLY CHOICES: How the Anti-Vaccine Movement Threatens Us All, by Paul Offit. VACCINATED: One Man’s Quest to Defeat the World’s Deadliest Diseases, by Paul Offit. Offit’s multivolume bible of science-based pro-vaccine thought.

THE PANIC VIRUS: A True Story of Medicine, Science, and Fear, by Seth Mnookin. An impartial journalist reviews the evidence.

THE VACCINE RACE: Science, Politics, and the Human Costs of Defeating Disease, by Meredith Wadman. Immensely readable story of the scientific and political scrambles accompanying 20th-century vaccine development.

BETWEEN HOPE AND FEAR: A History of Vaccines and Human Immunity, by Michael Kinch. THE END OF THE BEGINNING: Cancer, Immunity and the Future of a Cure. An immunologist explains it all, at length and with lots of detours.

AN ELEGANT DEFENSE: The Extraordinary New Science of the Immune System, by Matt Richtel. Read it for the stories of patients helped and harmed.

By Abigail Zuger
April 17, 2019

Michael Pollan: Not So Fast on Psychedelic Mushrooms

Hallucinogenic psilocybin has a lot of potential as medicine, but we don’t know enough about it yet to legalize it.

By Michael Pollan

Mr. Pollan is the author of “How to Change Your Mind: What the New Science of Psychedelics Teaches Us About Consciousness, Dying, Addiction, Depression, and Transcendence.”

Only a few days ago, millions of Americans probably had never heard of psilocybin, the active agent in psychedelic mushrooms, but thanks to Denver, it is about to get its moment in the political sun. On Tuesday, the city’s voters surprised everyone by narrowly approving a ballot initiative that effectively decriminalizes psilocybin, making its possession, use or personal cultivation a low-priority crime.

The move is largely symbolic — only 11 psilocybin cases have been prosecuted in Denver in the last three years, and state and federal police may still make arrests — but it is not without significance. Psilocybin decriminalization is expected to be on the ballot in Oregon in 2020 and a renewed petition drive is underway in California to put it on the ballot there. For the first time since psychedelics were broadly banned under the 1970 Controlled Substances Act, we’re about to have a national debate about the place of psilocybin in our society. Debate is always a good thing, but I worry that we’re not quite ready for this one.

No one should ever be arrested or go to jail for the possession or cultivation of any kind of mushroom — it would be disingenuous for me to say otherwise, since I have possessed, used and grown psilocybin myself. Like many others, I was inspired to do so by the recent renaissance of research into psychedelics, including psilocybin.

Scientists at places such as Johns Hopkins, New York University, U.C.L.A.-Harbor Medical Center and Imperial College in London, have conducted small but rigorous studies that suggest a single psilocybin trip guided by trained professionals has the potential to relieve “existential distress” in cancer patients; break addictions to cigarettes, alcohol and cocaine; and bring relief to people struggling with depression. Psychiatry’s current drugs for treating these disorders are limited in their effectiveness, often addictive, address only symptoms and come with serious side effects, so the prospect of psychedelic medicine is raising hopes of a badly needed revolution in mental health care...

A Novel About Surrogacy, Set at a ‘Farm’ Where the Crop Is Human Babies

THE FARM
By Joanne Ramos

Commercial surrogacy — the birthing of another woman’s baby in exchange for cash — is an act of benevolence, or of exploitation. It celebrates life. It commodifies life. It’s a moral outrage. A blessing, a gift. It pays women fairly for their hard work and altruism. It reduces women to vessels, turning their bodies, and babies, into merchandise.

So many factors — gender, race, religion, class — may determine where you come down on the surrogacy debate. So may your media diet. Perhaps you’ve heard disturbing tales about “baby factories” in India or Ukraine. Or maybe you’ve read uplifting profiles of women who call surrogacy the most meaningful job they’ve done. Joanne Ramos plays with many of these notions in her debut novel, “The Farm,” which imagines what might happen were surrogacy taken to its high-capitalist extreme.

The titular “farm” is Golden Oaks, a “gestational retreat” in upstate New York that caters to the ultrarich. The concept: Clients pay for Hosts to carry their children; those Hosts, selected via a rigorous vetting process, move into Golden Oaks for the duration of their pregnancies. There, they are surveilled — er, pampered — 24/7, to ensure that the (very expensive) unborn children they’re incubating will reach maximum potential. In exchange for their service, Hosts receive a modest stipend and, upon successful delivery, a big ol’ bonus. It’s a win-win for everyone! What could go wrong? (continues)

Bards of medicine-"a delicate business"

...there may be something bardic about these modern writers/doctors — Sacks, Ofri, Atul Gawande, Daniel Kahneman, James Gleick, Jerome Groopman, Abraham Verghese, Rebecca Skloot, even Mary Roach. They are searching for meaning and coherence within particular lives touched by random afflictions and the dizzying advances in science, rather than in any form of divine providence. As Sacks himself has said, “I would hope that a reading of what I write shows respect and appreciation, not any wish to expose or exhibit for the thrill ... but it’s a delicate business.”

From

Oliver Sacks’s Final, Posthumous Work 

A review of 

EVERYTHING IN ITS PLACE
First Loves and Last Tales
By Oliver Sacks

The word “Oneirism” is more than just an obscure exception to the “i” before “e” rhymelet. It also exemplifies the exceptionally advanced and sometimes stymying lexical breadth of Oliver Sacks’s writing — never more challenging than in this last, posthumous book, a collection of previously uncollected and/or unpublished essays. (“Oneiric,” in case you were wondering, means “related to dreams or dreaming.”) The book’s many other linguistic rarities include “festination,” “bradykinesia,” “metanoia,” “achromatopsia.” Occasionally Sacks pauses for a definition. More often he doesn’t.

This is a good thing. Many of these words are specific to Sacks’s medical specialty, neurology, as chronicled in his often best-selling books (“The Man Who Mistook His Wife for a Hat,” “A Leg to Stand On,” “Awakenings,” this last adapted into a film). Their meanings could have been spelled out, perhaps, but often only with condescendingly grade-school diction. In other words, this obscure terminology serves to honor the reader. If you don’t know our meanings, these terms imply, trust us that we are carefully chosen, as we trust you to look us up.

“Everything in Its Place”: a lame title. Especially since the topics here are actually a wonderfully odd lot, despite the worthy effort to group them into sections — “First Loves,” “Clinical Tales” and “Life Continues.” Why not name the whole book after its essay “Anybody Out There?,” about the possibility of extraterrestrial life (“It is not clear whether life has to ‘advance,’ whether evolution must take place”). Or after“Summer of Madness,” an account of the thrilling but dangerous euphoria of a young woman named Sally who, in the manic stage of her manic depression, “breaks.” After haranguing strangers in the street, shaking them, demanding their attention, she suddenly runs headlong into a stream of traffic, convinced that she can bring it to a halt by sheer willpower.

As it happens, this essay provides Sacks the chance to address a truly serious literary issue — one that troubled Sally’s father, Michael Greenberg, as he considered writing about his daughter’s illness. (He finally did, more than a decade after this onset of her mania, in an excellent, unflinching memoir called “Hurry Down Sunshine.”) It troubles Sacks, too: “The question of ‘telling,’ of publishing detailed accounts of patients’ lives, their vulnerabilities, their illness, is a matter of great moral delicacy, fraught with perils and pitfalls of every sort...”