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Letters

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Israel, fixing foreign policy, University governance

September-October 2006

Prescription Psychiatry

Ashley Pettus touches on some real conundrums for mental-health treatment (“Psychiatry by Prescription,” July-August, page 38). The nationwide shortage of trained cognitive-behavioral therapists means that patients with mild to moderate anxiety or depression who could benefit from this approach are more likely to get medication; and the scarcity of psychiatrists across the country dictates that much of the prescribing is done by general practitioners, who may not have the training or allowable session-length to do so optimally.

But as a clinical psychologist (with no relationship to the pharmaceutical industry) and a researcher in risk and prevention of childhood psychopathology, I object to the contention that the moral issue here is that too many people are treated.To a layperson, the introductory questions on health surveys may seem like they could apply to anyone, but the people suffering from mental illness and the clinicians who work with them know full well the obvious, real differences between ordinary sadness, worry, or distraction and clinical depression, anxiety disorders, or ADHD.

The rationale for making the public aware of these disorders and for treating even mild or “subthreshold” cases (that fall short of full diagnostic criteria), appears in the sidebar on page 91, “A Deadly Emotional Disease”: mild cases, untreated, can snowball into more severe cases, and these can inflict real damage and suffering—on individuals, on their families, on their school or work productivity, on their physical health (in depression), and—in the proportion of cases that result in driving accidents (for ADHD) or in suicide—on their very lives.The true moral predicament for those of us who work in this area is how to get treatment to more of those who need it.

Dina Hirshfeld-Becker ’84
Assistant professor of psychology
Harvard Medical School
Boston

Pettus beautifully conveys some of the complexities and problems involved with psychiatric diagnosis and drugs. As a clinical and research psychologist who has been doing research on these subjects for more than 20 years, I wish to add a few important points:

It is untrue that the DSM (diagnostic manual) has “given us reliability,” as Stephen Hyman says, because the very poor likelihood that two therapists assign the same label to the same patient has been well and repeatedly documented.

To write that drugs like Prozac and its cousins are “relatively safe and effective,” without pointing out the increased risks of suicide attempts, other violent behavior, and sexual problems, as well as the pitifully poor standards the FDA requires drug manufacturers to meet in order to get antidepressants approved, is problematic.

Although I agree that it is important to catch serious emotional problems early, it is not the case, as some argue, that the advantage of early detection “far outweighs the danger of over-counting,” as any psychiatrically labeled person who has—solely because of being given a psychiatric label—lost custody of a child, a job, health insurance, or the right to make decisions about their medical and legal affairs can tell you. What is essential is to acknowledge that psychiatric diagnosis is not a science. In doing the research (partly as an insider on two DSM committees) for two books about this subject, I have repeatedly been shocked by the ways that the DSM authors ignore, distort, or even lie about what the science shows.

Paula J. Caplan, Ph.D. ’69
Lecturer, department of psychology
Cambridge


 

Pettus was right to question whether emotional states like shyness and fear of public speaking are diseases. Fear of public speaking is so common that corporations spend millions on training programs to help people overcome this aversion. One of the “cures” (instead of a pill) is to train them in the use of PowerPoint slides—a crutch that calms the nerves of the speaker and also numbs the audience to the point where they don’t even notice you.

She goes a little far when her report seems to imply psychiatry is neglecting truly ill patients, such as those with bipolar disorder and schizophrenia—as if doctors’ offices were so full of shy people, the psychotic patients can’t get an appointment.

Peggy Troupin, Ph.D. ’74
|
New York City


Missing from the article is an understanding of the experience of those affected by depression plus anxiety. In 1958, a freshman, I was informed by the Health Services that I was depressed. As an aspiring poet and musician, I was actually proud of my depression. By the beginning of my junior year, my mental state had deteriorated, and on December 24, 1960, at home in Washington, D.C., I took two handfuls of sleeping pills and woke up in the hospital four days later.

Taking the semester off, benefiting from psychiatric counseling, I returned to functionality, repeated my junior year, and went on to land a job in Rome, where I lived for the next three years.

My social persona is sunny and enthusiastic, and people have admired, and are occasionally envious of, my life over the past 40 years, which has included its successes and failures. Nevertheless, despite three different courses of psychiatric treatment (one Freudian and two cognitive), there remained a steady and corrosive undercurrent of daily feelings of hopelessness, anxiety, insomnia, narcissistic fragility with regard to criticism of any kind, bouts of frustration and rage, and panic attacks (e.g., being caught in New York City traffic in a taxi). Until….

Until my wife read a newspaper article about pharmaceutical treatment of depression and said, “Jimmy, this sounds like you.”

Taking antidepression medicine—in this case, Wellbutrin—didn’t make a dramatic overnight difference, but the cumulative effect of the past two years has been significant. Of course, I have fears of mortality, anguish about our political leadership, occasional irritation with clients and family and traffic. But if there is traffic when I’m in a cab, I now take a nap. If someone points out a mistake I’ve made, it’s just a mistake, not a cosmic judgment. When I wake up in the morning, it’s the morning of a new day. I don’t feel, as before, as if I were down in a well and 30 percent of my energy that day will be spent just trying to climb out.

Perhaps there is some overuse of these drugs, and not everyone has a purely positive experience. But they can make such a difference in the quality of one’s life that it is time for the medical profession to look less at attitudes from the past, and less at protecting its own position of importance, and open its understanding to those involved, who include not just the depressed, but their families and friends.

James Lichtenberg ’62
New York City

 

Montage, and a Makeover


You will find two changes beginning in this issue of Harvard Magazine.

First, the familiar Browser section, principally devoted to reviews of books, has been succeeded by the more broadly conceived Montage. Its subtitle, ìArt, books, diverse creations,î gives you some sense of the enterprise: continued reporting on and criticism of written works, of course (in reviews, Off the Shelf, and Open Book), but also coverage of the full range of creative work by alumni, faculty, staff, and students in the extended Harvard community. There will be articles on the making of music and movies, on drama and dance, on poets and potters, and on an array of ventures and venues we have only begun to pursue. We plan to explore how creative work is done, and to assess (not merely publicize) some of the most interesting results. Montage debuts on page 21. We welcome comments at [email protected]; submit suggestions for possible future topics to [email protected].

Second, launching Montage prompted the editorial staff to revisit other sections of the magazine. To reduce clutter and enhance clarity, all recurring sections now feature common headline typefaces from the Centaur and Gill Sans lineages. (The former, used in the title for the letters section, above, has indirect Harvard roots: it was created in 1914 by Bruce Rogers, who served as printing adviser to Harvard University Press, principally between 1920 and 1928. See "Bruce Rogers and his Centaur" for more about his work.) Further, because Montage and John Harvardís Journal both contain many separate articles, each now comes with a brief table of contents, to help guide you to what we hope you find the interesting and informative material within. In that spirit, we invite your ideas about other improvements.

~The Editors

Wrong on Israel

I write with the utmost horror in reaction to “Israel and Academia” (July-August, page 62). Positioned as a news article, it reflects a not-so-subtle editorial endorsement of John J. Mearsheimer’sand Stephen M. Walt’s controversial and academically amateurish attack in the London Review of Books on Israel and her supporters in the United States. The piece is replete with signs of this bias.

Matthew Botein ’95, M.B.A. ’99
Boston

 

I am appalled that Harvard Magazine chose to publish this piece. To quote someone who writes that Israel is “a small, controversial Mediterranean client state” makes the magazine sound more like Aljazeera and less like a publication worthy of the Harvard name.

The political system in the United States relies heavily on lobbying conducted on behalf of a huge array of interests. Unlike the “Israel lobby,” many of these interests are actually antithetical to U.S. policy. While in certain instances, of course, Israel’s agenda diverges from that of the United States, we ignore at our peril that Israel is, and will very likely remain, the only democracy in the Middle East. For a country that has spent, over three years, several trillion dollars [sic], and, most importantly, thousands of young American lives in an attempt to create a democracy in Iraq, the United States would do well to remain steadfast in its relationship with one of its few true friends.

Henry Rascoff ’92, M.D.
New Rochelle, N.Y.


 

I was not entirely surprised to find in Harvard Magazine a biased comment on the biased paper. Your third sentence gives you away: “The paper explained a policy based on ‘unwavering support for Israel’ that has ‘inflamed Arab and Islamic opposition’ and ‘jeopardized’ United States security.” Are you saying that the paper sought to establish that there is such a policy? No, your sentence assumed that such a policy actually exists. The fact is that such a clear-cut policy has never existed, as the oil lobby and the lobby made up of hundreds of ex-State Department and CIA Arabists well know. That Walt and Mearsheimer purport otherwise is something the bias of which I leave to your readers’ interpretation. Of the many critics of the paper, you refer only to Alan Dershowitz and you refer to him disdainfully: “he heatedly characterized….” If your writer actually read the Dershowitz response, your readers might have known that the paper was characteristically detailed and scrupulous.

Of course, one of those who wrote in support of the paper, Tony Judt of NYU, is “acclaimed.” Michael Massing avers that, though the paper had “thin documentation,” it was “entirely correct.” Is this the sum of the commentaries on what was trumpeted as an academic research paper? You did not have to go much further afield to find vigorous critics. The New Republic, of which I am editor-in-chief (having also taught at Harvard for 39 years) published three articles on the Walt-Mearsheimer piece. I invite readers of Harvard Magazine to consult these in the library or on the Web.

Martin Peretz, Ph.D. ’66
Cambridge

 

Power on Foreign Policy

I find it remarkable that Professor Samantha Power failed once to mention the relationship between Israel and the United States (“Fixing Foreign Policy,” July-August, page 26). While pretty much the entire world recognizes that that relationship not only was a significant factor in 9/11 and a significant factor in the war with Iraq, it is almost never mentioned by those who try to enlighten us as to what is wrong. Could it be that there might be a scintilla of truth in the Mearsheimer/Walt thesis?

There is one advantage to keeping one’s head in the sand. When the inevitable disaster strikes, and it is going to, at least one will not see it coming.

Robert E. Bradney, J.D. ’50
Jacksonville, Ill.

 

Power’s essay is very persuasive, but I believe the thought must be carried even further. It must contemplate the likely consequences if the policy is not “fixed.”

The very focus of our foreign policy and the constant emphasis on it discourages such thinking. Since 9/11 the national focus has been on the tactic, terrorism, rather than on the goal of those behind that terrorism. The expressed intent of Bin Laden and many who are like-minded is not to punish the United States with a few attacks, horrific as they might be, but to destroy it, the Great Satan. September 11 convinced most Americans that we are vulnerable to terrorist attacks. It has not disabused us of the idea that, unlike all great nations of the past, we cannot be overthrown.

Is such downfall possible in the not too distant future? Yes. Is it inevitable? No. It can happen if the broken aspects described by Power are not fixed. The fatal flaw of the Bush administration’s policymakers is not that they exaggerate the danger but that they underestimate it and, therefore, use it for political advantage rather than confronting it.

The one great success claimed by the administration is that there have been no more attacks in the United States since 9/11. This leads many voters to support them. One hopes that improved intelligence activity is at least partially responsible for this. But another possible cause must be considered. The current policies are causing attenuation, isolation, division, and fantasy, all making achievement of Bin Laden’s goal more likely. Another terrorist attack within this country would bring at least temporary international support for the United States and unity within the country. Would someone wishing to destroy us want that to happen?

David A. Durfee ’51
Bennington, Vt.

 

There is a huge missing piece in our international relations that is ignored by Power—our failure to recognize and deal with the legitimate grievances of the world Islamic community. With the possible exception of Kosovo, most of our foreign policy appears antagonistic toward Islam—in Chechnya, the Philippines, East Timor, Palestine. Good Muslims don’t believe in terror, but they hesitate to help reduce it or turn in its leaders, given this larger anger. We have supported dictatorial regimes coopting Islam for their own purposes, and fallen for the perverse argument that addressing grievances rewards terror. If any country other than Israel engaged in the kind of aggression in the West Bank and Gaza, culminating in the sheer trashing of Gaza, the international community would do something.

James Morgan, Ph.D. ’47
Ann Arbor, Mich.


Power writes with great clarity about the decline in U.S. hegemony resulting from the several mistakes of the Bush administration, most importantly the initiation and continuation of our involvement in Iraq. Her concept that our government would be more effective if, rather than trying to exert power, it tried to exert influence, is particularly pertinent.

However, the dilemma she presents to Democrats, the difficult question of how do we get out of Iraq, deserves additional comment. Most areas of Iraq are subject to the whim of whoever has weapons in a given place in a given moment. Viewed in this light, withdrawal of coalition forces may very well have limited effect on the subsequent development of a peaceful country. Indeed the removal of what perhaps most Iraqis feel to be an occupying force could be beneficial. Who today would argue that we should not have gotten out of Vietnam?

The concepts being proposed by Peter W. Galbraith ’73, K ’78 (The End of Iraq: How American Incompetence Created a War without End, Off the Shelf, July-August, page 20), that recognize the tripartite power zones of the Kurds, the Sunnis, and the Shia, offer some hope that Iraq will not simply continue to degenerate and become another failed state.

Stephen J. Seligman ’52
Briarcliff Manor, N.Y.

 

Recalling the Republic

I am somewhat astonished at the parallel not cited in Joseph Nye’s critique (“On Not Going It Alone,” July-August, page 19) of Michael Mandelbaum’s The Case for Goliath: How America Acts as the World’s Government in the 21st Century. It is a parallel omitted in other articles suggesting the Roman model for U.S. global hegemony. Has no one considered the consequences that the Goliath model offers for the maintenance of democracy in the United States itself?

How can we ignore the simultaneous emergence of the Roman empire and the disappearance of the Roman republic? Are we to assume that this sequence was accidental? I think not. The common ingredient in both changes was abandonment of the rule of law in favor of might-makes-right. Is this no danger for the United States? Do we really believe our nation can retain its commitment to freedom without reliance on the supremacy of law?

Robert T. Willner ’52
Rickreall, Ore.

 

It shakes one’s confidence in Harvard Magazine’s commitment to accuracy to read in one article [Nye’s] that “our defense expenditure is equal to that of the next 17 countries combined” and in another [Powers’s] that “the U.S. military budget exceeds that of the next 30 powers combined.” Which is it?

J.E. Devlin, M.A.T. ’61
Oneonta, N.Y.

 

Joseph Nye responds: Both are correct. The problem lies in the roughness of estimates of international defense expenditures. In the latest listing by the respected Globalsecurity.org, the United States counts for $466 billion of a global total of roughly $950 billion. But some of their figures are for 2004; others are estimates from several years earlier. Moreover, many countries deliberately mislead on defense expenditure: most analysts think that China’s military budget (the second largest) is several times larger than it reports. If one takes the higher end of estimates for China, it takes about 17 countries to equal the United States. If one takes a lower estimate for China, it takes about 30, including countries like Pakistan and Chile with budgets under $3 billion. Such small numbers become lost in the “noise” of variation in the estimates for China. More important is the fact that the United States represents nearly half of total expenditures, which makes it difficult for other countries to organize against it. That is the larger point that Samantha Power and I were trying to make. Samantha Power adds: In all comparisons, countries without data are left off the list, and for closed countries like China, any data are specious. In addition, different data sets gather the data at different times during the calendar year. Supplemental appropriations are but one more testament to the fluidity of military (and other) budgets. My statistics came from the International Institute of Strategic Studies and U.S. Department of Defense, as compiled by the Center for Arms Control and Non-Proliferation; they include U.S. military expenditures in Iraq and Afghanistan, giving the United States a total “military budget” of $522 billion (www.armscontrolcenter.org/archives/002244.php). I used this data set because it relied principally on 2005 figures.


On Nailing…the Proctor

I was surprised to find reference in “Yesterday’s News” (May-June, page 72) to an event that occurred in “one of the freshmen entries” in 1956 and was reported in this magazine at the time. Your recounting of the event perpetuates and adds inaccuracies, and I must set the record straight for posterity. We residents of Thayer North did not lock the proctor in his room, but rather in the bathroom, so that he had special amenities. Although the illustration accompanying your report suggests that we did this haphazardly, we planned and executed the action with the utmost care and precision. We were not whiling “away the long and lazy reading period days,” but expressing our displeasure with a proctor who was not student-friendly. I will admit, 50 years later, that this was an inappropriate act of chutzpah, but suggest that “therapeutic psychiatry” was more likely needed by people other than “these freshmen.”

Peter V. Tishler ’59, M.D.
Plymouth, Mass.


Credit Due

Neurons Sort Nouns (July-August, page 15) does a fine job of describing the results of a recent fMRI study (of which I was an author) on the representation of nouns and verbs in the brain. But it gives me far too much credit for those results, and for the study itself—at the expense of my collaborator, Lauren Moo, and my advisor, Alfonso Caramazza, without whose ideas the research would not even have been conceived. I’m afraid the article conveys the false impression that I came up with the problem—and the solution—all on my own.

Kevin Shapiro ’00
Cambridge

 

University Governance

Governing Harvard (May-June, page 25) was quite interesting, particularly regarding accountability and transparency. While the article understandably focused on the Corporation rather than the Board of Overseers, some history I was involved in with the Overseers is a useful add-on.

In the mid 1980s, when divestment from South Africa was a huge issue at Harvard and other campuses, a group of us formed Harvard/Radcliffe Alumni/ae Against Apartheid, with the aim of electing pro-divestment candidates to the board, using the petition process. Over a three-year period, we elected four Overseers: Gay Seidman ’78, Consuela Washington, J.D. ’73, Peter Wood ’64, Ph.D. ’72, and Archbishop Desmond Tutu, LL.D. ’79.

All hell broke loose among the Governing Boards and the Harvard Alumni Association (which crafts the official slate). The result: changing the rules to make it more difficult to elect petition candidates (for example, by decreasing from 10 to eight the candidates on the official slate, effectively to increase the number of votes a petition candidate needs to win).

And of course Harvard never divested from South Africa (although once democracy was established, the University gave an honorary degree to Nelson Mandela).

There’s a lot more to this story that reveals the very opposite of accountability and transparency. Should magazine readers want greater detail, my chapter (coauthored with Robert Paul Wolff), “Democracy, Harvard-Style: The (S)Election of Overseers,” can be found in the collection How Harvard Rules (1989), edited by John Trumpbour.

Chester W. Hartman ’57, Ph.D. ’67
Washington, D.C.

 

Errata

In “Taming the Rhine (July-August, page 32), a reference in a paragraph on page 37 to the Rhine flooding in 1997 should have been to the Oder River. Reader George E. Ehrlich ’49 was the first of several to point out that “Liebensraum” should have been “Lebensraum.” Jay M. Pasachoff ’63 wrote, “I was disappointed to find Harvard Magazine on page 36 misspelling ‘desiccation’ (with the normal misspelling of ‘dessication’).” Burton White ’57, M.D., found errors in “Psychiatry by Prescriptionî (page 38): Dexedrine, described as ìa stimulant found in the drug Ritalin,î is in fact a completely different drug; the drug Effexor, listed as an SSRI, is in fact an SNRI; and fluoxetine was misspelled.

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Harvard Magazine welcomes letters on its contents. Please write to “Letters,” Harvard Magazine, 7 Ware Street, Cambridge 02138, send comments by e-mail to [email protected] or fax us at 617-495-0324. Letters may be edited to fit the available space.