GOD MOLECULES
David Biello’sSearching for God in the Brain” discusses the neural circuitry involved in religious experience. Based on my team’s research, I believe that the body’s naturally occurring hallucinogenic molecules are a more fundamental cause of spiritual experience—whether that experience is self-willed or brought about by external means. The powerful hallucinogen DMT has been found in human blood, lung and brain. Clinical research we performed in the 1990s with DMT, which also occurs naturally in many plants, led us to propose a role for the brain-based compound in mystical states. The human body’s hallucinogens may also contribute to other cognitive effects, such as psychosis.

Rick Strassman
University of New Mexico

FAIRLY UNBALANCED
As a person who has lived with recovered memories for 17 years, I was initially interested in but ultimately disappointed by “Brain Stains,” by Kelly Lambert and Scott O. Lilienfeld.

The article lacks the perspective of an individual who has seriously considered the possibility of false memories but come to the conclusion that his or her own are not fabrications. Instead the authors quote research that is highly questionable—particularly the findings that showed that 100 percent of patients reported torture or mutilation and estrangement from extended families. From my own experience and from what I have heard from others, it is evident that the sampling was biased and does not accurately reflect all recovered memories.

Irresponsible therapists may create false memories, causing serious harm. This issue clearly needs to be addressed. But let us not determine, therefore, that there are no true recovered memories.

Eve Richardson
Toronto

I am writing to express my dismay at what I consider to be very biased writing in “Brain Stains.” The 1990s saw a huge push by some to debunk the diagnosis of dissociative identity disorder (DID) and the clinicians who treated DID patients. In response to that effort, many professionals endeavored to address the issues from a more balanced middle ground. Among other results from that decade was the book Memory, Trauma Treatment, and the Law, by Daniel Brown, Alan W. Scheflin and D. Corydon Hammond (W. W. Norton, 1998). Lambert and Lilienfeld would have benefited by taking advantage of the authors’ well-balanced presentation of the issue.

Instead your magazine has promulgated an inflammatory, biased presentation of traumatic memory therapy. I ask that you invite the response of other authors whose stance is seen as more balanced by mental health professionals such as myself.

Paul W. Schenk
Tucker, Ga.

LAMBERT AND LILIENFELD REPLY: Richardson and Schenk raise several intriguing issues but confuse the question of whether some recovered memories may be genuine (which was not the focus of our article and remains scientifically unresolved) with the question of whether suggestive therapeutic procedures can induce false memories and false identities in certain clients (which was the focus of our article and should, in our view, no longer be in scientific dispute). Moreover, in scientific terms, “balance” does not imply that the truth invariably lies between two extremes—the fact that some people believe the earth is round and others believe it is flat does not imply that the earth is oblong. Indeed, Harvard University psychologist Richard J. McNally and others who have carefully investigated widespread claims for the existence of recovered memories have found most of these claims wanting. Knowing that recovered memory therapies are potentially devastating, as in Sheri J. Storm’s case, it is incumbent on mental professionals to exercise extreme caution.

CONTRADICTING ADVICE
I was confused by your October/November issue. In Nikolas Westerhoff’s article “Fantasy Therapy” I read that psychologists “treated male disaster workers traumatized by the World Trade Center attacks of September 11 by exposing them to realistic renditions of planes flying over virtual twin towers....” But then in “Brain Stains” I read, “For example, research ... has shown that reliving traumatic memories shortly after a terrifying event—performed in a popular therapeutic technique called crisis debriefing—may cause unnecessary stress and impede recovery.”

Are some traumas so damaging that once they have occurred there is not much therapy can do?

Chuck Kollars
Ipswich, Mass.

LAMBERT AND LILIENFELD REPLY: Regarding the question of when, if ever, therapeutic exposure to traumatic experiences is helpful, both learning theory and scientific evidence offer guidance. Exposure can be helpful, but only when it is sufficiently prolonged to permit clients’ anxiety to dissipate. One of the key shortcomings of crisis debriefing is that it is typically conducted in an uncontrolled fashion—some clients may leave sessions less anxious than when they entered, whereas others may leave sessions more anxious. For the latter individuals, crisis debriefing may be harmful.

MOOD MEDS VS. PLACEBOS
The Best Medicine?” [Facts and Fictions in Mental Health], by Hal Arkowitz and Scott O. Lilienfeld, is a valuable article on the advantages of cognitive-behavior therapy over antidepressants. But the authors err in repeating the highly inflated claim of 67 percent effectiveness for antidepressants in the study by psychiatrist A. John Rush and his colleagues, which offered patients a four-step sequence of different antidepressant medications. Ifpatients did not attain remission at one stage, they could then try a different antidepressant.

It is important to note that this study included no placebo control groups. Published studies that do include such controls typically find a 25 to 30 percent success rate with placebo. Only one drug in Rush’s study achieved even that rate of remission—all other drugs and drug combinations did worse. Rush’s 67 percent figure came from cumulating across trials without taking into account the placebo effects operating within each trial.

Moreover, supporting the explanation that antidepressants provide primarily a placebo effect, patients showed very high relapse rates consistent with the time-limited value of placebos.
The widely quoted 67 percent figure is bogus. I am the second author of an article soon to be submitted for publication that provides a critique of this study, citing the placebo problem as well as other issues.

Allan M. Leventhal
Silver Spring, Md.

ARKOWITZ AND LILIENFELD REPLY: Leventhal raises two different but related questions about Rush’s study. The first is, How effective was the treatment sequence used in this study (regardless of what was responsible for its effectiveness)? We disagree that the 67 percent finding is “bogus.” Irrespective of what caused this outcome (active medication or placebo effect), it is true that 67 percent of the patients were in remission by the end of the study.

The second question relates to the degree to which the outcomes could be attributed purely to the active effects of the medications. Leventhal correctly points out that the absence of placebo control groups in the study makes it unclear whether the outcomes were the result of the drugs or placebo factors such as expectations of change and supportive contact with the research staff. This issue becomes even more significant in light of the fact that most studies comparing antidepressants with placebos usually show only a small advantage for the medications.

We thank Leventhal for clarifying an important issue. As he correctly notes, it is likely that the contribution of medications to the outcomes was considerably less than the widely reported 67 percent remission statistic would indicate.