On "Pasta"

My systems and theories class was rather... interesting. I had a number of difficulties with the class, not the least of which involved the professor. That said, one of the ongoing assignments was worthy of note.

For many of the "theories" we covered, we were expected to write a little summary, answering a series of ten questions. I've already posted one set of my answers to these here. At the end of the class, however, we were expected to answer these questions for ourselves. The professor called this "making pasta". I call the process of "making pasta" from assorted theories along the lines which he suggested "highly unethical", "academically dishonest", or "bullshitting" -- depending on what, exactly, you intend to do with this "pasta" after you "make" it.

That said, I did answer the questions anyway. I just didn't pick up elements willy-nilly from assorted "theories" based on their personal and ideological appeal.

It occurs to me that these answers may be of interest to assorted and sundry readers of this blog. So, without further ado...

1-How does the theory conceptualize the basic beliefs about people? Does the theory see people as "good", "bad", neutral, capable of growth, proactive or reactive to the environment?

Theories and theoretical positions are valid within a clinical environment to the extent that they either are supported by the available empirical evidence ("are accurate") and/or have been demonstrated to improve client outcomes ("are useful"). Theories which possess accuracy but have yet to demonstrate utility can be justified on the grounds of improving understanding; theories which have demonstrated utility but lack accuracy can be justified on the grounds of the ethical principle of benevolence. Theories that have neither property have no business anywhere near clients in a clinical environment.

While some basic propositions about humanity are answerable by the currently available evidence (e.g. the available research on education, development, and cultural differences strongly supports the idea that people are capable of learning), others are not. By definition, answers to such questions are speculation or assumptions; representing them as other than this, if done for financial or academic gain, constitutes fraud.



2-How does the theory describe the function of personality? What is the purpose of our "personality"; what needs does the personality meet?

Assumptions about human nature are dangerous for counselors and their clients. They should be avoided whenever possible. At the moment, the available empirical evidence does not even begin to answer this question. No clinical technique should be predicated on answers which do not exist.


3-How does the theory describe the "structure" of personality? What IS our personality? What does it consist of?

The current state of knowledge about personality and individual differences are such that we can say things about it (e.g. that extroversion typically remains fairly constant over time; that people who report that they prefer showers over baths statistically tend to be more extroverted than those who do not) but cannot say much beyond that. Again, assumptions hurt clients and should be avoided where possible.


4-How does the theory describe how we develop into a "normal person"?

While developmental psychologists have done a fairly good job of mapping out the general bounds of the developmental path which a statistical majority of people follow from the context of Piagetian constructionism, assumptions such as the belief that deviation from this path must necessarily be harmful are, by their nature, both biased and bigoted.

Generally speaking, mental health isn't – in the sense that it is impossible to define "mental health" except as an absence of and lack of vulnerability to problems. This same problem is why medicine is defined as the science and practice of treating and preventing disease rather than as the promotion of good health.

Assumptions such as the regularly-made assumption that an individual must conform to some preconceived notion of "functioning" to be "healthy" have no place in clinical practice.


5-How does the theory describe how we develop into "abnormal" people?

Problems with psychological components can arise from a variety of sources.
These can be environmental in nature (e.g. exogenic depression induced by parental mortality), biological in nature (e.g. forgetfulness induced by traumatic brain injury), social in nature (e.g. lack of assertiveness and ability to self-advocate induced by pervasive prejudice and paternalism), historical in nature (e.g. emotional scars left by traumatic experiences), or have a completely different nature which I couldn't think of when writing this. Assumptions in this regard have a distinct tendency to harm clients (i.e. assumptions on the cause of a specific problem can be and often are wrong, and treatment methods selected based on incorrect assumptions tend to be unnecessarily ineffective and/or harmful).



6-How does the theory conceptualize the process of counseling? How does it work, in general?

Counseling is defined (Merriam-Webster) as "professional guidance of the individual by utilizing psychological methods especially in collecting case history data, using various techniques of the personal interview, and testing interests and aptitudes".

Or, in other words, counseling someone means finding out what the problem is and helping them decide on a course of action to take about it. In common use, assisting or guiding the person in implementing the course decided on is also considered part of the counseling process.


7-How does the theory conceptualize the specific techniques of counseling?

Evaluation procedures, regardless of their theoretical origins, are acceptable to the extent that they have been shown to produce valid data. Therapies are acceptable to the extent that they have been shown to improve client outcomes. Tests and therapies which are not supported by the available empirical evidence should be considered inaccurate and/or harmful by default and have no business being practiced in practice outside of an IRB-approved research protocol.


8-How does the theory conceptualize the roles/responsibilities of the counselor?

The counselor's role is, by definition, to help the client arrive at a solution to the presenting problem.


9-How does the theory conceptualize the roles/responsibilities of the client?

The client's responsibility is to arrive at a solution to the presenting problem.



10-What is the utility of the theory -- strengths, weaknesses, limitation, applicability?

Theories are valid to the extent to which they explain existing data and predict future data. Good theories possess two properties which most of those we've studied have lacked: domain-specificity and falsifiability. A theory which possesses domain-specificity attempts to explain only a limited set of information; grand, over-arching theories of everything tend to be wrong more often than not. A theory which is falsifiable is testable and does not attempt to explain away data which does not fit its predictions. Good theories are typically constructed to fit the data they are attempting to explain rather than according to the author's ideological prejudices.

When evaluated by this standard, which is considered incredibly basic in the field of detecting pseudoscience and health fraud, the vast majority of the theories we've studied in this class come out extremely poorly. In the absence of good theories, the best option is generally to practice as atheoretically as possible.

There are some things which I'd change if I were writing this today. There are many more things which I wouldn't. In any case, there are many little nuggets of interest in here...

And Then There's These... People

When you work with one of the most vulnerable populations in America, you quickly start to realize just how nasty the human race can be. While I don't know who said it, there's a rather famous quote which about sums it up: "There is no such thing as an inhuman act, for there is no act so vile that you cannot find a human willing, even eager, to commit it."

Some of the things I have seen defy description. The things I've seen news coverage of are worse. This was rather spectacularly demonstrated yesterday, with an article from the LA Times that highlights this in a truly awful fashion.

I've tried to write out the story several times. I can't, as hard as I try. As such, I'll just quote the article -- which really does speak for itself.

The package mysteriously left at Los Angeles County Sheriff's headquarters shocked even some of the department's most grizzled detectives: A hundred hours of video footage showing severely disabled women, many in diapers, being sexually assaulted by anonymous men.

The attacks appeared to have taken place at residential care centers, authorities said, and most of the attackers are believed to be employees. One suspect appears to be a paraplegic patient, hoisting himself off his wheelchair, before removing his diaper and that of his victim's, and beginning his assault.

The footage, dropped off in March, has left detectives with few leads. Though authorities are confident the scenes were shot in residential care facilities, it's unclear if they are located in Los Angeles County. Much of the footage is so grainy that only the faces of four of the estimated 10 men could be made out.

Authorities Thursday asked for the public's help in identifying the men, releasing screenshots and composite drawings of the attackers.

"Maybe they can identify these people," said Sgt. Dan Scott. "Maybe they can identify the room."

Detectives are also hoping the tipster who dropped off the package will come forward. The footage left at sheriff's headquarters in Monterey Park came with a note explaining how he discovered the video. He had been commissioned by a man to scrub a computer hard drive, but before he did, he burned 100 hours of video files onto DVDs.

Detectives said the women in the videos appear to be between 20 and 40 years old, some appearing almost entirely unresponsive. The men appear to also be between 20 and 40. The footage, detectives said, appears to be a collection, with some men appearing in more than one scene. Some of the footage was shot with a handheld camera, with the rest appearing to be captured by a security camera, detectives said.

Enhancing and analyzing the video took several months, authorities said. Detectives have not contacted local residential care centers yet, an official said.

Anyone with information is asked to call Special Victims Bureau detectives at (866) 247-5877. Anonymous tipsters can call (800) 222-TIPS.

As I said, the story speaks for itself. The photos can be found here.

On Wakefield and Fraud

On his blog, the rather well-known blogger and commenter, Harold Doherty, writes:

I was aware that a medical society tribunal in the UK had found problems with the MMR study but I was unaware that a court of law, or governing medical society tribunal, had found Wakefield guilty of the serious offence of fraud.

If anyone knows which court of law, or governing medical society tribunal, found Dr. Wakefield guilty of fraud could you post a link to this site please?

The "medical society tribunal" Doherty refers to was the British General Medical Council, (or "GMC"; see their website here). They are hardly a mere "medical society tribunal" -- they're a governing body established by legislative action. They have a direct government mandate... and the legal authority to control who can and cannot practice medicine in the UK.

I suppose you could call them a "governing medical society tribunal", per Mr. Doherty's instructions. I would not: they're a regulatory body tasked with a judicial function. They are not part of any medical society (although the memberships certainly overlap!).

In its sanction against Dr. Wakefield, the GMC found (among other things):

The children described in the Lancet paper were admitted for research purposes under a programme of investigations for Project 172-96 and the purpose of the project was to investigate the postulated new syndrome following vaccination. In the paper, Dr Wakefield failed to state that this was the case and the Panel concluded that this was dishonest, in that his failure was intentional and that it was irresponsible. His conduct resulted in a misleading description of the patient population. This was a matter which was fundamental to the understanding of the study and the terms under which it was conducted.

In addition to the failure to state that the children were part of a project to investigate the new syndrome, the Lancet paper also stated that the children had been consecutively referred to the Department of Paediatric Gastroenterology with a history of a pervasive developmental disorder and intestinal symptoms. This description implied that the children had been referred to the gastroenterology department with gastrointestinal symptoms and that the investigators had played no active part in that referral process. In fact, the Panel has found that some of the children were not routine referrals to the gastroenterology department in that either they lacked a reported history of gastrointestinal symptoms and/or that Dr Wakefield had been actively involved in the process of referral. In those circumstances the Panel concluded that the description of the referral process was irresponsible, misleading and in breach of Dr Wakefield’s duty as a senior author.

The statement in the Lancet paper that investigations reported in it were approved by the Royal Free Hospital Ethics Committee when they were not, was irresponsible.

In other words, the GMC found that Wakefield lied repeatedly in the Lancet paper. Moreover, he concealed financial interests in the results being what they were:

Regarding the issues of conflicts of interest, Dr Wakefield did not disclose matters which could legitimately give rise to a perception of a conflict of interest. He failed to disclose to the Ethics Committee and to the Editor of the Lancet his involvement in the MMR litigation and his receipt of funding from the Legal Aid Board. He also failed to disclose to the Editor of the Lancet his involvement as the inventor of a patent relating to a new vaccine for the elimination of the measles virus (Transfer Factor) which he also claimed in the patent application, would be a treatment for inflammatory bowel disease (IBD).

In summary of their findings, the GMC wrote:

The Panel made findings of transgressions in many aspects of Dr Wakefield’s research. It made findings of dishonesty in regard to his writing of a scientific paper that had major implications for public health, and with regard to his subsequent representations to a scientific body and to colleagues. He was dishonest in respect of the LAB funds secured for research as well as being misleading. Furthermore he was in breach of his duty to manage finances as well as to account for funds that he did not need to the donor of those funds. In causing blood samples to be taken from children at a birthday party, he callously disregarded the pain and distress young children might suffer and behaved in a way which brought the profession into disrepute.

As such (among other things):

The Panel concluded that Dr Wakefield’s shortcomings and the aggravating factors in this case including in broad terms the wide-ranging transgressions relating to every aspect of his research; his disregard for the clinical interests of vulnerable patients; his failure to heed the warnings he received in relation to the potential conflicts of interest associated with his Legal Aid Board funding; his failure to disclose the patent; his dishonesty and the compounding of that dishonesty in relation to the drafting of the Lancet paper; and his subsequent representations about it, all played out against a background of research involving such major public health implications, could not be addressed by any conditions on his registration.

In short, Wakefield was found to be a dirty, rotten liar who faked data for publication in The Lancet. In common scientific parlance, they found that the paper was a classic example of academic fraud.

Edit: Kev of LBRB does an excellent analysis of the issue here, focusing less on the legal findings and more on illustrating the fact that Wakefield's paper was fraudulent.

A Year In Review

Today is the last day of the year 2010. It is something of a tradition on this day to spend some time looking back on the year that has gone by, thinking and reflecting on the events which have occurred.

Normally, I do so privately. This year, I am doing a portion of it publicly -- on this blog.

For me, the year started off with the Zakh Price case. There are some situations that you just can't leave alone; for me, that was one of them. I won't discuss what my role in the whole matter was, but I did play one. I don't know if I, personally, made a difference... but I don't really care. As of the last I heard from the family (which was late summer or early fall), Zakh was doing quite well... and the situation had been resolved in a favorable fashion. In my honest opinion, that's all that really matters.

In other news, Andy Wakefield lost his medical license that month, and I very much enjoyed the 2010 CARD conference (although it was marred by one highly bigoted pseudo-scientist pretending at a neurology presentation). I was actually at the conference (or, more accurately, in my room at the conference hotel) when I found out about Wakefield, and it was all I could do to avoid waking my neighbors with a whoop of joy.

Then I got back and immediately (i.e. the very next day) went in for a much-needed knee surgery. I was on crutches for more than two months.

I discovered that the James Randi Educational Foundation is physically located not that far from my house... down the street from a psychic and across the street from a chiropractor. I've very much enjoyed their periodic open houses... and Randi himself is quite entertaining (and a breath of fresh air).

On the advocacy front, the Geiers moved into my metaphorical backyard and started peddling the "wonders" of chemical castration to the parents of local autistic children, shielded by a number of highly-influential political figures and using a local radiologist as their local patsy. I've been trying to "deal with" them ever since.

I got into a long and protracted series of misunderstandings that I still can't figure out a way to rectify (and that is still bothering me). Actually, that technically started last year... but it continued (and got a great deal worse) this year.

I resumed the MS Counseling program at Nova Southeastern University... and promptly had my first major issue with a postgraduate professor. It says something when it takes a flat-out written statement of intent to discriminate (in the form of deducting points for autistic literalism) for me to consider something a "major issue". I also got my first postgraduate B... in his class. Had it been any lower, I'd have challenged it; as is, I have the written notice available and thoroughly documented to show anyone who questions me about it.

Honestly, what sort of professor does something like that in writing? Seriously!

In a bit of irony, it was actually a bit worse: I received that written statement literally the week before I was scheduled to speak at Autreat. I'll get back to that in a bit, but the sheer hilarity of the timing has lead to a number of jokes since... especially since the professor was aware of both my diagnosis and my presentation.

I also did a brief internship at a small local school for individuals with severe developmental and intellectual disabilities. The kids there were very interesting (and very different from any population I'd previously worked with). Incidentally, for any parent from here on who tells me that I don't know what kids like theirs are like (to insinuate that their child is more severely disabled than any I've worked with)... yes, I do. Working with that population can be a serious mind-fuck, and I do not shy away from the use of that particular vulgarity in this case.

Then my internship ended (with the end of the academic year) and I started working for a behavior services company in Dade County. I've been doing part-time human resources work for them... which does, at least, help pay my expenses.

And, of course, I gave my first conference presentation: a presentation on pseudoscientific medicine in the field of autism. I've done related blog posts here and here, and I posted the PowerPoint slides to the Autreatinfo Yahoo group. I've also uploaded the slides here, if anyone wants to take a look. (Note that I verbally departed from them at several points. I'd be more than happy to explain in more detail if anyone asks in the comments.)

The presentation was two hours long, involved one hundred and fifty-five PowerPoint slides (of which five were references and suggested further reading), and contained thirty reference citations (not counting duplicates). During the preparation, I read far more than this -- my lit review for the thing involved over two hundred peer-reviewed articles and five books... of which, two were med-school textbooks.

Thinking back to that time, I am astounded that I managed to keep my sanity. I was, for a while, not only recovering from knee surgery (on crutches), but doing that internship, preparing that presentation, continuing my advocacy work, and taking a course load and a half of postgraduate classes. Yes, I took 150% of a semester's postgraduate coursework over the summer... on top of everything else. It was not particularly smart of me, and I really haven't quite fully recovered from all of that. The fact that most of my "recovery" time was spent working part time while taking a full course load (not, fortunately, the extra-full course load I took on over the summer) of classes while working part time certainly didn't help. My active participation in various student organizations and continuation of my advocacy work didn't help, either.

Fall, by contrast, was fairly... routine. There were a couple of crises which I can't really talk about, and work has been rather frustrating for reasons that I also can't talk about here, but I tried to use the time to recover. I failed.

I also grew pretty thoroughly sick of the MS Counseling program for a variety of reasons, most of which focus on the high bullshit content of many of the courses. I will be reviewing my "diversity studies" textbook later, but I've already reviewed my so-called "ethics" text. Of the two, the "ethics" book was the better one.

As the year pulls to a close, though, I'm filled with some degree of renewed optimism. For one thing, I've switched programs as of the upcoming semester (and I sincerely hope that the MS General Psychology program will actually involve considerations of evidence!). For another, my new program is a thesis program... which means actual research as part of my graduation requirements!

I suspect that several of my regular readers will find my thesis of interest... and yes, I do already know exactly what I'm going to be doing for my thesis. I will comment more on it after I've actually started doing it... but I suspect that one reader of this blog will find it very interesting: it falls under the category of behavioral sciences meta-research and was actually inspired by some of her comments.

The change won't delay my graduation too much... but my new classes are ones which I can hopefully actually enjoy. I am very much looking forward to them.

Hopefully I'll be able to catch up on my accumulated e-mails sometime next year. I'm something like three thousand behind...

So, in conclusion... for everyone reading this, happy new year!

Edit: Corrected a really embarrassing typo.

Demon-Haunted Inevitability

A very long time ago, I read a very good book entitled The Demon-Haunted World. As part of my efforts to help me put words to some of my thoughts, I started rereading it... and found it even better than I half-remembered. It is a touching, inspiring, and truly excellent tribute to the power, importance, and sheer beauty of science.

I am not, however, writing this blog entry in order to praise the glories of Sagan. I am discussing the book in order to explain where this blog entry is coming from. Specifically, it's coming from one quote (which is on p. 26 of the paperback edition I'm reading):

We've arranged a global civilization in which most crucial elements -- transportation, communications, and all other industries; agriculture, medicine, education, entertainment, protecting the environment; and even the key democratic institution of voting -- profoundly depend on science and technology. We have also arranged things so that almost no one understands science and technology. This is a prescription for disaster. We might get away with it for a while, but sooner or later this combustible mixture of ignorance and power is going to blow up in our faces.

Moreover, it isn't just science and technology that this dilemma applies to. A similar (and highly interconnected) mixture exists within medicine -- just as the populace depends on science and yet remains profoundly ignorant of it, the populace depends on medicine and yet remains equally clueless about it. Where this volatile mixture intersects with desperation, the consequences are entirely predictable.

This is especially true to anyone who's truly studied the history of medicine. Unlike the popular perception, the history of medicine is not one of straightforward progress, the history of medicine is one of delusion, stonewalling, and delay; of rampant bias and harmful treatments; and of quackery and pseudoscience. The history of medicine is a graveyard of harmful treatments which doctors once thought helpful. It is a history of failure upon failure... and of the occasional (and rare) gem hidden amongst the countless clods of fecal matter. It is a history of countless "diseases" that turned out to be benign... and countless "benign" phenomena which turned out to be diseases.

For instance, haemorrhoids, nosebleeds, and women's periods were once viewed by the medical establishment as benign forms of natural prophylaxis... and, moreover, the absence of these was viewed as dangerous and needing treatment. (1)

An absence of periods from a woman of child-bearing age was viewed as especially serious, and even dangerous (unless, of course, that woman was pregnant). While I won't deny that amenorrhea can be a sign of a number of problematic underlying issues, I do think that most of us would agree that "treating" it by placing leaches on the cervix is a bad idea... and I emphatically will deny that amenorrhea causes insanity or epilepsy (depression, however, may actually arise, especially if the woman in question is actively trying to have children). Heck -- in recent years, at least two people have actually suggested that deliberately suppressing menstration -- inducing amenorrhoea -- would be a good idea for many women (2).

Then there's our attitude towards "chemicals", the way we constantly fail to understand the meaning of the medical axiom that "the dose makes the poison", the way that the media is constantly trying to divide our foodstuffs into things which cause cancer and things that help prevent it... and even the way that many Americans' critical thinking skills are so incredibly atrophied that they are actually impressed by this lady (3) or by the "coverage" of medical issues provided by the Huffington Post.


We live in a culture of misinformation, where information is often passed on without regards to its veracity. Myths often take on the status of fact; people freely panic over things that later turn out to be false alarms. People believe in all sorts of "New Age" nonsense, and all sorts of woo -- from psychics and astrologers to countless books on the nonexistent continent of Lemuria -- are available freely at many major bookstores. The "Raw Food" movement is picking up steam, major pharmacies are selling homeopathic products, and there are even people who take this guy seriously as an information source (4).

There's very little new about this. Aristotle wrote about logical fallacies in the Organon -- and that was well over two thousand years ago. History reveals countless examples of mass hysterias, moral panics, scaremongering, health fraud, sensationalism, superstitions, and other problems of this nature. The basic thrust towards these tendencies is a consequence of countless aspects of human nature. It should be unsurprising that they show up in the world of autism.

Parents of autistic children aren't that different from anyone else (or, more accurately, any other parents) before they notice signs that their child is autistic... or they get the diagnosis -- whichever comes first. They are not particularly educated, not particularly rich, and very much not particularly skeptical. What they are, especially at first, is particularly desperate.

The fact that the metaphorical vultures are able to exploit this should hardly be surprising. Many, many parallels can be found elsewhere. The consequences may be tragic, but the problems themselves are hardly unexpected.

I just wish I could figure out a better way to deal with them.

(1) No, I'm not joking. They really believed this. It wasn't until relatively recently that this attitude changed. If you want an account of how and why, there are a number of possible sources... but I reccommend Wootton's Bad Medicine.

Incidentally -- doctors' treatments for the "problem" of an adult man's butt not bleeding? Well, since he weren't getting rid of that excess blood the "natural" way, a doctor had to resort to artificial means... or, in other words, bloodletting.

(2) I don't find their arguments particularly convincing, but that's just me.

(3) Yes, she really did say what you think she said.

(4) Yes, I munged that URL. I'm emphatically not raising his Google rank any more than I have to.

The Worst Clinical Ethics Textbook Ever?

This post is going to be a great deal more vulgar than my usual fare. I apologize, but I've been having a great deal of difficulty in restraining myself over this matter, and I really need to vent.

Moreover, I literally lack the words to adequately express my revulsion. Sometimes, "Ugh" doesn't cut it.

You see, I'm taking my program's clinical ethics class this semester. Our textbook is Corey, Corey, & Callanan's Issues and Ethics in the Helping Professions, eighth edition. In other words, this book.

As the title of this blog entry suggests, I don't like it very much. It's just... incredibly bad. To be honest, "bad" doesn't really cut it here. I mean, the book even says that I'm not human.

No, I'm not joking. The relevant quote is at the bottom of Page 93:

Spirituality is an essential quality of being human, and Allen Weber believes it must be addressed in whatever form is appropriate in counseling [Emphasis added].

An "essential quality" is a defining quality. Something without an essential quality of X isn't X -- and something which has all of the essential qualities of X is X. To say that spirituality is an essential quality of being human is to say that anyone or anything lacking spirituality is not human.

It would be far less offensive if the authors had written that spirituality is an essentially human quality (i.e. that only humans are spiritual), but the context makes it abundantly clear that this is not what they mean: in Corey et al.'s view, apparently, atheists aren't human.

No, I'm not an atheist (at least by the most common definitions), but I share an atheistic lack of spirituality (and, in fact, go a great deal further than many, as an upcoming Symphony of Science video helps illustrate). As such, I'm apparently not human.

I regard this sort of statement as blatantly unethical conduct in the writing of a clinical ethics textbook. How the hell did this get past the editors?

Of course, this is just one line in a 587-page book. If this was just an isolated problem, I wouldn't be nearly so frustrated. Unfortunately, however, it's not. The problems start far earlier... with the book's very definition of ethics.

"Ethics" is defined on Page 14. There are three statements which can be considered defining:

... ethics pertains to the beliefs we hold about what constitutes right
conduct.

Ethics are moral principles adopted by an individual or group to provide rules
for right conduct.

And, finally:

Ethics represents aspirational goals, or the maximum or ideal standards set by the profession, and they are enforced by professional associations, national certification boards, and government board that regulate professions. Codes of ethics are conceptually broad in nature and generally subject to interpretation by practitioners. Although these minimum and maximum standards may differ, they are not necessarily in conflict.

I've shown these quotes to several actual ethics professors. "What the fuck?" was the most common response.

You see, that's not what ethics is. Ethics is the branch of philosophy concerned with the evaluation of human conduct. Ethics is the study of what is right and wrong, the study of how we should act and how we should treat our fellow human beings.

By contrast, this book defines "ethics" as "following the rules set by your profession". What the Hell?

I could go on and on about the flaws in this book. These include its "discussion" of the issues surrounding proxy consent (it doesn't exist), its discussion of the issues surrounding involuntary committment (which boils down to, "consult with your colleagues and follow the law"), and many, many others. I just wouldn't be able to post this review in a reasonable timeframe if I did.

All of this raises a very important overarching issue, however: this book is being used to educate clinical professionals (who often likely never get much education beyond what's in the book). A substandard clinical ethics textbook promotes substandard and unethical treatment of clients -- meaning that it hurts and even kills people. As such, I have to conclude that both the publication and use of this textbook (qua textbook) is highly unethical.

In conclusion, however, I suppose I should revisit the headline of this post and ask the inevitable question: is this the worst clinical ethics textbook ever?

I don't know. I sincerely hope I am never in a position to test that hypothesis.

Edit: Corrected a couple of typos.

An Open Letter to Buzz Aldrin

Today is Autistics Speaking Day. For those of you who are unfamiliar with the event, it's an autistic reaction to the highly-misguided "Communication Shutdown Day", a day in which we autistic people make as much online "noise" as possible... on the day in which hordes of people are voluntarily abstaining from our preferred means of communication.

I won't discuss why the whole idea is a bad one. Others have already done so -- far better than I ever could. Instead, I'm going to post an open letter to one of the major participants in this farce.

Dear Mr. Aldrin,

When I was a child, the Apollo missions were a great inspiration to me. They truly stand out among the achievements of mankind as a spectacular triumph of science and a shining example of what man is capable of if we truly try. You, along with the other Apollo astronauts, were my childhood heroes. Your triumphs fanned the flames of my love of science, helping raise it from the bare embers of a childhood interest into a lifelong passion. Your successes comforted me when things seemed hopeless, helping to reassure me that even the seemingly impossible was often within reach.

Today, I am a graduate student in Nova Southeastern University's M.S. Counseling program and working towards board certification as a behavior analyst. My dream is to go into psychological research and to help raise the standards of the discipline to the point where psychology and the other "soft" sciences can be legitimately compared to the "hard" sciences in terms of methodological rigor... and to come, bit by bit, closer to the countless truths I seek. This is not to say, however, that I do not face substantial challenges in reaching my goal.

The worst of these challenges are prejudice and fear. You see, I have a disability. One of my professors flat-out told me (in writing, no less) that having it was unprofessional... in a course where a third of the course grade was participation and professionalism. My clinical ethics textbook states that I am not human. Fear-driven efforts to create a world without people like me in it have already claimed countless lives throughout the world, including at least ten innocent babies in California... this year alone. There's even a clinic within easy driving distance of my house dedicated to chemically castrating people like me.

My disability is most commonly called "autism".

This is why it hurt me so incredibly much to hear that you, one of my childhood heroes, has been raising money for a fear-mongering antivaccine group dedicated to the goals I mention above. I can only hope that you did this out of ignorance; the thought of you having done so knowingly just hurts far too much.

As you may or may not know, the proceeds from Communication Shutout Day go to the program's "global partners". In America (outside Colorado), this means Giant Steps, the Hollyrod Foundation, and the National Autism Association. It's this last which is the most concerning.

The National Autism Association is an anti-vaccine group dedicated to promoting untested, unproven, and often dangerous "treatments" for autism. They praise intravenous chelation (which risks death and brain damage, and, more importantly, involves pumping an irritant into a child's veins for at least two hours at a time). Their 2009 conference, which was held within walking distance of my house, featured a keynote presentation by Andrew Wakefield (whose unethical conduct and Mengele-like "experiments" were largely responsible for major measles outbreaks throughout Europe), a presentation blaming my neurology on MSG in vaccines, and a presentation on why my neurology should be considered a disease (among countless other things). One of their past conferences even involved a keynote from an infamous quack who makes his living chemically castrating autistic children (and who is responsible for the clinic near my home). They recently were involved in a concentrated effort to effect legislation here in Florida which would have effectively banned the flu vaccine. I am perfectly willing to provide references and further information on any of these assertions on request.

Mr. Aldrin, you are old enough to remember many of the diseases which vaccines prevent. For instance, with polio alone... the iron lungs, the countless children who were crippled for life... to groups such as the NAA, bringing back these things is worth it if it means not having people like me or my friends around. You should also remember Jonas Salk and his heroic dedication to the welfare of the children of the world. To groups such as the NAA, Jonas Salk and countless others like him are villains. I find it difficult to express the sheer perversity of this.

I will admit that the NAA has also campaigned against the more "classic" abuse of children with disabilities in the forms of seclusion and restraint. This, however, mainly serves to help legitimatize them and to help them lend support to other, wackier anti-vaccine organizations such as Generation Rescue, SafeMinds, and the National Vaccine Information Center. In a recent conference presentation on the NAA, I referred to them as a "gateway organization" because of their function in such groups' recruitment tactics.

I won't pretend that this is the only thing wrong with Communication Shutout Day. I strongly encourage you to read what Ari Ne'eman of the Autistic Self-Advocacy Network has written about the matter ( http://www.autisticadvocacy.org/modules/smartsection/item.php?itemid=122 ) and to peruse the various online writings relating to Autistics Speaking Day and the reasons for it.

In the meantime, however, I have to go to bed tonight knowing that one of my childhood heroes has chosen to raise funds for a group whose dedication to creating a world without people like me in it is so strong that they are perfectly willing to sacrifice the lives of countless innocents to create it.

Sincerely,

Alexander Cheezem