DANGEROUS BELIEFS

In “Fueling Extremes,” Stephen D. Reicher and S. Alexander Haslam repeatedly lay blame on the victims, as in, for instance: “counterterrorism efforts in many countries give little consideration to how our responses may be upping the ante.”

Unfortunately, pacifism will not work with the Islamic extremists who believe that it is their mission to establish a Muslim caliphate on earth and that all nonbelievers must be killed. All of the love and understanding that the authors would like us to bring to these folks will not deter them, for one moment, from committing horrific acts that they believe advance the caliphate.

Edward Graf 
Alexandria, Va.

I was disappointed that your three articles about terrorism focused only on the actions of groups such as ISIS and did not acknowledge the greater threat of other sources of terrorism. Overwhelmingly, those who have committed terrorist attacks in the U.S. and Europe are not Muslims. You should have mentioned all of the homegrown terrorists in the U.S.—for instance, the recent terrorist acts in Colorado Springs, in which a Planned Parenthood clinic was attacked.

You had the opportunity to make a more scientific statement about who the terrorists that really threaten us are, and instead you chose to reinforce the fear that is expressed in our national news media about Muslims.

Virginia McAfee 
Boulder County, Colorado

THE TROUBLE WITH SHAME

In “For Shame,” Diana Kwon mentions a teenager posting “raunchy photographs to the Web.” There is a lot of inherent bias in the choice of that adjective! Raunchy? Sexual or provocative, perhaps—and perhaps not at all a turn-on to countless people.

I have a Ph.D. in human sexuality, and I have lectured internationally on sex education and behaviors. Unfortunately, slut shaming, fat shaming and other slams are still rampant, even in our more accepting times. Raunchy—or was it artistic and beautiful? Is the self-awareness of the girl who knowingly posted her pictures simply not okay for the author?

Safe, sane and consensual sex is okay. It should not be the object of shame, guilt or someone else passing judgment.

Robert Berend 
Beverly Hills, Calif.

Kwon's article seems to confuse shame and humiliation. Shame is a basic and primary human emotion—we are born with it. Humiliation is what you feel when someone has “shamed” you, publicly, but it's a different emotion than basic shame or a version of shame with the added negative emotions of anger (at being disrespected) and/or fear (of social rejection).

In cases where shame leads to a positive outcome, it is because shame has arisen on its own after the person has had time alone to process and reflect. In situations where shame leads to defensive digging in, despair or even suicide, it is because someone else has tried to make the person feel shame.

 

Shame cannot be commanded or demanded—because then it is humiliation instead, and humiliation is toxic. Trying to control someone else's behavior by manipulating his or her emotions almost never leads to anything positive or constructive. An obvious analogy: I cannot make you love me. Most of us get that one. Well, I cannot make you feel shame either, and when I try, just like when I try to make you love me, it usually backfires and may actually result in the opposite of what I'm trying to make happen.

Publicly shaming someone is no different than bullying, harassment or other forms of interpersonal violence. Please make this distinction clear.

Rebecca Stanwyck 
Castro Valley and Pleasanton, Calif.

WHAT ABOUT COUNSELING?

I found Carol W. Berman's careful observations regarding her patient's symptoms and emotions in “The Black Spot” [Cases] to be interesting and educational, but I was dismayed by her stated chain of logic regarding treatment. As she acknowledged, cognitive-behavioral therapy (CBT) has proved to be effective for many people with obsessive-compulsive disorder (OCD), and this seems particularly true when provided in combination with some medications. And yet she apparently decided that she would only prescribe massive doses of Zoloft. Her reasoning was that “we needed to act quickly.” I don't consider 30 or more days to be quick, personally. Why not begin immediate psychological counseling in conjunction with drugs? At the very least, the man's anxiety may have been assuaged while awaiting the effectiveness of Berman's pending psychotropic cocktail. And at best, the pharmaceuticals may not have been needed at all, at least not in such massive dosages.

Terry A. Rogers 
Santa Cruz, Calif.

BERMAN REPLIES: If you read carefully, you'll notice at the beginning of the article that I'm engaged in a specific dialogue with my patient, which was psychotherapeutic in nature. Because psychopharmacology is my specialty in psychiatry, I naturally wanted to give him medication for his OCD. Although studies in the past have shown that CBT and pharmacotherapy may be considered equally effective for OCD, a recent article in the May 2016 issue of the American Journal of Psychiatry suggested otherwise. I personally have found medication to be highly effective.

KIDS AND ANTIDEPRESSANTS

In “The Hidden Harms of Antidepressants” [Head Lines], Diana Kwon highlights the efforts to suppress adverse effects of antidepressants in youths. Possibly more important is the dramatic lack of demonstrated advantage in using these drugs to “treat” our struggling children and teens.

The evidence base for this intervention rests on studies such as the 2004 Treatment of Adolescents with Depression Study. In this study of 439 youths, 109 were given fluoxetine (Prozac). Study conclusions reveal that in the short term, combined treatment of CBT and fluoxetine resulted in the greatest advantage, followed by fluoxetine alone. But after the conclusion of the study (at 36 weeks), a one-year naturalistic follow-up shows the advantage of medication disappeared: participants from all arms of treatment were in a virtual dead heat of progress on depression scores.

Even more stunning than this deteriorating benefit are the efforts in substantiating SNRI medications, such as duloxetine (Cymbalta) or venlafaxine (Effexor). In a primary duloxetine study reported in the Cymbalta package literature, researchers found that efficacy in treating major depression was not demonstrated in patients aged seven to 17: neither Cymbalta nor an SSRI was superior to a placebo. In a major study of Effexor, the drug failed to outperform a placebo in two placebo-controlled trials of a total of 766 youths.

Rather than subjecting the developing nervous system to these medications, clinicians should carefully reconsider their support for such interventions.

Robert Foltz 
Chicago School of Professional Psychology

I am 15 years old, I take antidepressants, and if I didn't take them, I would be a different person. Without them, I go into a downward spiral, with no end until I take my medication again. I have ADHD, I'm on the autism spectrum and I am depressed. Every day is a challenge. Antidepressants don't make me more aggressive and depressed—they help me stay regulated. I don't think that it is fair to say that doctors need to stop this trend of constantly prescribing these drugs without also including the experience of youth like me who benefit from them.

K. Marion 
via e-mail