Tuesday, January 24, 2012

Le Mur: A French Model for the US Autism Community

The French documentary film Le Mur, The Wall: Psychoanalysis on Trial in France, could well provide an object lesson for how parents and professionals in the US could deal with stone walling and obfuscating by American health insurance companies and state Medicaid programs. 

Sophie Robert, a young French documentary film maker became aware of the deplorable state of services to children with autism in France, that has for many years been dominated by the out-dated and widely rejected views of psychoanalysis, within the scientific community.  She interviewed numerous well known psychiatrists who are psychoanalysts about their psychosexual views of autism, which were shockingly out of touch with objective reality, which heaped blame on the mothers of children with autism.  It was Bruno Bettelheim on steroids. Since those psychiatrists control payment for most services to children with autism in France, she decided to make a film that portrayed their disturbing views in their own words, and distributed it widely in France and via YouTube throughout the world.   

The film, Le Mur, has created a minor sensation in France as well as throughout much of the world.  It will be shown this week at the Assn for Behavior Analysis Intl Conference in Philadelphia 4-5pm this Friday, January 27th, the day after which a trial verdict will be announced regarding Sophie’s film in a court in Lille, France brought by French psychoanalysts trying to block showing the film in France. A Press Conference will be held in NYC the day before regarding the film and its impact.  Many of us are receiving frequent email contacts from French journalists about ABA services for children with in the US and about the film.   Sophie’s efforts are widely supported within the French autism parent community.

Right now as we speak, private health insurance companies and state Medicaid programs throughout the US are devising yet more ways to deny insurance coverage for ABA services to children with autism, which as most of you know, has been demonstrated in over 30 studies to be a highly effective way of preserving and promoting skills of children with autism spectrum disorders.  At least half end up functioning similar to their same age peers.  The evidence is unequivocal, for example compared to the evidence for the efficacy of Risperdal and Prozac, psychotropic medications, which in FDA approved studies produce modest improvements among some children with autism and behavior challenges, and only in a handful of studies.  Nonetheless, insurance companies seem willing to pay for those medications.

The US needs its very own courageous Sophie Roberts to take on the health insurance industry and state Medicaid programs which are attempting to compensate for their economic woes on the backs of children with autism, whose futures depend critically on receiving the appropriate effective services between 2 and 7 years of age.

I can see it now.  The video would begin with a grainy old black and white film shot in a state institution of what happened to young people with autism before the advent of ABA early intervention in 1987. [ See http://www.mnddc.org/parallels2/one/video/changes.html ]  The old video was shown on the evening Walter Cronkite show in 1968.   Then the image would cut to insurance executives squirming before the camera trying to figure out how to get away with lying about the lack of evidence for the effectiveness of ABA treatment.   The interviewer would show them a clip of the old film and ask them if they realize that is what would happen to today’s children with autism without effective treatment.  They would deny it, of course, despite the concrete evidence otherwise.  Or the state Medicaid Director whose job is figuring out how to slash services to save money, would reveal his or her lack of familiarity with either autism or what ABA treatment really is, or what the evidence shows.   

The video would close with several clips of children during the later phases of ABA treatment, some in regular school classrooms, others participating in community outings with their families.  The final frame would thank Sophie Robert and her parent collaborators for their courage and inspiration.

Friday, January 20, 2012

Republican Values Based on Presidential Debates

I have abstracted these values from listening to the Republican Presidential debates.

1. Each person is entirely on his own, including children, and is entitled only to what income s/he has personally obtained through inheritance, earned through personal work (which is tough  when you're 5), profits from others' work via business ownership, or through gambling on wall street hedge funds.

2. No governmental agency, local, state, or federal,  has any right to demand any potion of such income for the common good, in the form of taxes.  No one had any obligation to contribute to the common good. None.

3. It is entirely appropriate to shelter as much of one's money as possible in off shore banks to avoid paying taxes to the country in which s/he is a citizen.

3. Children have a right to only the most rudimentary public education as might be provided in a developing country.  If their parents want a better education they should pay for it themselves. 

4. Public Schools must teach Evangelical religion and the entire curriculum, including science, must be consistent with these beliefs. If some parents disapprove they can pay for a private school.

5. Poor people, racial and ethnic minorities, elderly people, people with disabilities and college students are free to vote within very limited time slots, and with fewer voting stations than affluent White suburban people, so long as they bring a birth certificate, state issued ID, and proof of residence and are able to stand in line for hours waiting to vote, despite  their age or disability.  If they can't stand in line that long, tough.   If they don't have a birth certificate or can't get to a drivers license office to get an ID, too bad. That's their problem. Suck it up.

6. Labor unions should be illegal.  Workers are lucky to have a job and should stop whining.

7. Sex is filthy unless it is for having babies or undertaken by Republicans.  Private Sexual behavior of democratic officials or candidates is disgusting and  must be made public in excruciating  detail, and the individuals involved prosecuted or at least persecuted.  Outrageously distasteful sexual conduct of Republicans is sacrosanct and beyond discussion.

8. Discrimination based on sex, race,  ethnicity, religion, age, disability, or sexual orientation, is up to the judgement of each individual Republican.

9. The United Nations and other  International organizations are unconstitutional and any president who signs such an agreement should be impeached or hung.

10. Likud, Kadima and ultra-orthodox Israelis should be accorded US citizenship and be honorary members of the Republican Party.

11. People  who are not of Northern  European heritage cannot be trusted.

12. Corporations are people and have the same rights as people, but none of the obligations.

13. It is appropriate for corporations to own Presidents, members of Congress, and Federal Judges, including the members of the Supreme Court.

14. Like we said before, sex iis really dirty, which is why we are so thrilled with it.

If you don't agree with these values you are without a doubt, an atheistic, communist trans-sexual, facist, Muslim, Hippie, totalitarian and should be jailed in a secret prison in Turkey, beaten by guards, water boarded, then deported to North Korea.  Have a nice day

Monday, January 16, 2012

The "J" Word

Some young African American musicians object to the word “Jazz” to refer to that archetypal American Black music that is the basis for nearly everything else musical in this country. They reject the word because it was associated with their ancestors performing music in brothels, bars and speak easies, and young black musicians of the 50s and 60s with needles in their arms. The "J" word is like the "N" word to them. 

That would be a bit like people in Spain seeking to disown the word “Flamenco” to refer to that uniquely Adalusian gypsy music, that was originally played in cabarets and street side bars.  

It is built around the juerga, an informal, spontaneous gathering that included dancing, singing, palmas (hand clapping), or simply pounding in rhythm on an old orange crate or a table. Flamenco, in this context, is organic and dynamic: it adapted to the local talent, instrumentation, and mood of the audience.  

Or perhaps the people of Argentina should seek to disown the word, Tango, to refer to that uniquely native Argentine musical dance form. The word "tango" acquired the standard meaning of the place where African slaves and free blacks gathered to dance. 

It was there the compadritos took the tango back to the Corrales Viejos—the slaughterhouse district of Buenos Aires—and introduced it in various low-life establishments where dancing took place: bars, dance halls and brothels. It was here that the African rhythms met the Argentine milonga music (a fast-paced polka).  

Charlie Parker & Miles Davis
John Coltrane
Indigenous music of the poorest peoples of various societies have emerged as the quintessential music of each of their respective cultures and have become essential to their national identity.  I will stop using the word “jazz” when incomparable musicians like  Wayne Shorter, Roy Hargrove and saxophonists, Sonny Rollins, Joshua Redman and bassist Christian McBride decide to hang up their chops and take to the rocking chair.  

Thelonius Monk
When they all forget the lessons they learned from Bird, Dizz, Miles, Trane, Art, Max, Elvin, Oscar and yes, yes of course Monk, then I’ll stop talking about jazz.  What would I do without Miles’s Green Haze, Coltrane’s Blues to Elvin or Monk’s Round Midnight or Tristano's Requiem.   Until then, I’ll keep treasuring jazz as the most essential musical part of my life. 

Wednesday, January 4, 2012

Scientific Legacy: Behavioral Pharmacology

With the death of Joseph V. Brady at the end of July 2011, many tributes have been pronounced and continue to be made throughout this year.  Joe was a major figure in post-WWII psychology and neuroscience.  As a post-doctoral fellow with Joe fifty years ago, his passing has provided the occasion to give a good deal of thought to the time I worked with him at the University of Maryland in College Park.  Joe Brady’s own scientific publications are remarkable for their importance in their own right.  He was one of the founders of physiological psychology, now called neuroscience.  He was a founder of the field of behavioral pharmacology, the scientific study of the behavioral actions of drugs.  He was one of the first Board members of the Society for the Exprimental Analysis of Behavior and it's hallmark journal.  Perhaps the most remarkable legacy Joe Brady has been the wide range of careers he has launched, directly and indirectly. 
Joseph V. Brady
I learned an enormous amount from working with Joe Brady.  I learned about science, of course, but I learned much more about strategy of doing science.  Among the more important lessons were: (1) surround yourself with the brightest, most talented people you can find and don’t be threatened by anyone; (2) give them enough support to do their work, but not too much.. they should be a little hungry, (3) encourage unorthodox ideas and don't dump on people for trying out novel extrapolations of theory, (4) exploit the basic principles of functional scientific analysis and ignore people's disciplinary backgrounds as long as they are effective in their work, and (5) let your science do the talking.
Bob Schuster 2010
Bob Schuster was Joe Brady's graduate student while I was a post-doctoral fellow sharing the laboratory.  The two of us collaborated on one of the first compelling animal models of opiate addictive behavior, which led eventually to adoption in a simplified form throughout the world.  In 1964 and 65 Bob (Charles R.) Schuster and I wrote the first textbook in the field Joe helped establish, Behavioral Pharmacology.   Not long ago I ran across a type written leather bound copy in a used bookstore that I had used to teach the first behavioral pharmacology course to one of the first groups of graduate students at the University of Minnesotan (pictured here), before the published version was available.  I wanted to try it out to see how well it was received, and whether it would have any impact on the fledgling graduate students.
Leather Bound Pre-Publication Copy of Behavioral Pharmacology
Among the first students to read the type written manuscript were Richard A. Meisch, John G. Grabowski and George E. Bigelow, who later in each of their own right have gone on to be leaders in behavioral pharmacology and addiction.  At about the time the book was published by Prentice Hall in 1968, Roland R. Griffiths was among the group of new students to this nascent field.  Roy W. Pickens, recently from Mississippi where he had completed his doctoral training joined us and reacted to the new book.  He later went on to a leadership role at the National Institute on Drug Abuse.  Others who became well known after serving as test subjects for our book, included pharmacologist Sheldon Sparber, Don Cherek and James E. Smith, who became a pharmacology department chair.  Psychiatrist and pharmacologist Richard Meisch has been involved in an addiction research center at the Univeristy of Texas, Houston, as was John Grabowski until a year or so ago.  George Bigelow and Roland Griffiths went to work with Joe Brady at Johns Hopkins after leaving Minnesota.  Many others followed, including David B. Gray, Alice M. Young, Jack Henningfield, David Penetar, Alan Poling, Deborah Slechta, Patrick Beardsley, Thomas Kelly, Michael Nader, Carolyn Cohen, and David Jewett, making significant contributions to the field.  Their names are familiar to anyone in the field for their important work.

In his generous Forward to our book Joe Brady wrote, “This volume bears eloquent testimony to the emerging promise of wedding of scientific disciplines” endeavors to which Bob Schuster and I devoted most of our professional lives.  Joe taught us well, indeed and Bob and I took his teaching to heart.  That our field has lost both Joe Brady and Bob Schuster this past year is deeply saddening, but their work lives on in those who had the wonderfully good fortune to profit from their wisdom, which I suppose is as much legacy for which one might hope.