Psyche, Science, and Society

Did drug money save the banking system?

A UN official claims that money from the illegal drug trade saved the banking system during the height of the economic crisis:

Drug money saved banks in global crisis, claims UN advisor

Drugs and crime chief says $352bn in criminal proceeds was effectively laundered by financial institutions

By Rajeev Syal

Drugs money worth billions of dollars kept the financial system afloat at the height of the global crisis, the United Nations’ drugs and crime tsar has told the Observer.

Antonio Maria Costa, head of the UN Office on Drugs and Crime, said he has seen evidence that the proceeds of organised crime were “the only liquid investment capital” available to some banks on the brink of collapse last year. He said that a majority of the $352bn (£216bn) of drugs profits was absorbed into the economic system as a result.

This will raise questions about crime’s influence on the economic system at times of crisis. It will also prompt further examination of the banking sector as world leaders, including Barack Obama and Gordon Brown, call for new International Monetary Fund regulations. Speaking from his office in Vienna, Costa said evidence that illegal money was being absorbed into the financial system was first drawn to his attention by intelligence agencies and prosecutors around 18 months ago. “In many instances, the money from drugs was the only liquid investment capital. In the second half of 2008, liquidity was the banking system’s main problem and hence liquid capital became an important factor,” he said.

Some of the evidence put before his office indicated that gang money was used to save some banks from collapse when lending seized up, he said.

“Inter-bank loans were funded by money that originated from the drugs trade and other illegal activities… There were signs that some banks were rescued that way.” Costa declined to identify countries or banks that may have received any drugs money, saying that would be inappropriate because his office is supposed to address the problem, not apportion blame. But he said the money is now a part of the official system and had been effectively laundered.

“That was the moment [last year] when the system was basically paralysed because of the unwillingness of banks to lend money to one another. The progressive liquidisation to the system and the progressive improvement by some banks of their share values [has meant that] the problem [of illegal money] has become much less serious than it was,” he said.

The IMF estimated that large US and European banks lost more than $1tn on toxic assets and from bad loans from January 2007 to September 2009 and more than 200 mortgage lenders went bankrupt. Many major institutions either failed, were acquired under duress, or were subject to government takeover.

Gangs are now believed to make most of their profits from the drugs trade and are estimated to be worth £352bn, the UN says. They have traditionally kept proceeds in cash or moved it offshore to hide it from the authorities. It is understood that evidence that drug money has flowed into banks came from officials in Britain, Switzerland, Italy and the US.

British bankers would want to see any evidence that Costa has to back his claims. A British Bankers’ Association spokesman said: “We have not been party to any regulatory dialogue that would support a theory of this kind. There was clearly a lack of liquidity in the system and to a large degree this was filled by the intervention of central banks.”

December 13th, 2009

Psychiatry fights over DSM

While psychology is riven with conflicts over the profession’s role in interrogations, torture, and detainee abuse, and anthropology is fighting over military (mis)use of Human Terrain Systems counterinsurgency efforts, psychiatry, too, has its civil war. In the case of psychiatry, the battle is over the revision of the American Psychiatric Association’s Diagnostic and Statistical Manual of Mental Disorders (DSM), now in edition IV. The lead psychiatrists for the third and fourth editions are among the fiercest critics of the process for developing the fifth edition.

While the controversy may seem arcane, it has major real world consequences. If, as expected, the DSM radically expands the number and scope of “mental disorders,” it will likely lead to a major increase in the number of people receiving psychotropic medications. For DSM is not really about understanding mental or emotional problems so much as it is about identifying target conditions for medications. While medications have their uses in treatment of mental or emotional problems, they are far from the only, and should often not be the primary approach to treatment.

While the National Institutes of Health usually requires psychotherapy researchers to study therapy for identifiable DSM conditions, there is really little evidence that the DSM way of carving up emotional problems is relevant to psychosocial treatments. For psychotherapies deal with emotional or interpersonal conflicts, (maladaptive” thoughts, problematic coping strategies, or dysfunctional behavior patterns and the like. None of these therapy targets map onto DSM categories in any systematic way. Yet, therapists are often required to assign DSM diagnoses to their patients.

Thus, the DSM is part of an imperial effort by psychiatry to make medication the dominant treatment modality for anyone experiencing problems in living. Unfortunately, the American Psychological Association, which might be expected to lead the opposition to this medicalization of human problems is more interested in helping their members get a share of this lucrative business. The psychological association has made getting psychologists the right to prescribe psychotropic drugs their #1 legislative priority. If the succeed, it is likely that psychologists, like psychiatrists, will find prescribing medications much more lucrative than listening to patients, and psychosocial approaches will be further marginalized.

New Scientist covers the controversy in a new article and recomends doing away with the lucrative DSM books altogether in an accompanying editorial:

Psychiatry’s civil war

By Peter Aldhous

Since this article was first posted, the American Psychiatric Association has announced that the publication of DSM-V will be delayed until May 2013. “Extending the timeline will allow more time for public review, field trials and revisions,” says APA president Alan Schatzberg.

When doctors disagree with each other, they usually couch their criticisms in careful, measured language. In the past few months, however, open conflict has broken out among the upper echelons of US psychiatry. The focus of discord is a volume called the Diagnostic and Statistical Manual of Mental Disorders, or DSM, which psychiatrists turn to when diagnosing the distressed individuals who turn up at their offices seeking help. Regularly referred to as the profession’s bible, the DSM is in the midst of a major rewrite, and feelings are running high.

Two eminent retired psychiatrists are warning that the revision process is fatally flawed. They say the new manual, to be known as DSM-V, will extend definitions of mental illnesses so broadly that tens of millions of people will be given unnecessary and risky drugs. Leaders of the American Psychiatric Association (APA), which publishes the manual, have shot back, accusing the pair of being motivated by their own financial interests – a charge they deny. The row is set to come to a head next month when the proposed changes will be published online. For a profession that exists to soothe human troubles, it’s incendiary stuff.

Psychiatry suffers in comparison with other areas of medicine, as diseases of the mind are on the whole less well understood than those of the body. We have, as yet, only glimpses into the fundamental causes of the common mental illnesses, and there are no biological tests to diagnose them. This means conditions such as depression, schizophrenia and personality disorders remain difficult to diagnose with precision. Doctors can only question people about their state of mind and observe their behaviour, classifying illness according to the most obvious symptoms.

First published in 1952, the DSM has its origins in a book used by the US military to determine if recruits were mentally fit for combat. The difficulty of separating mental disorders from normal variation in behaviour made it controversial from the start. Over the years, the book’s influence has grown, and today it is used by doctors across the globe.

The wording used in the DSM has a significance that goes far beyond questions of semantics. The diagnoses it enshrines affect what treatments people receive, and whether health insurers will fund them. They can also exacerbate social stigmas and may even be used to deem an individual such a grave danger to society that they are locked up.

Some of the most acrimonious arguments stem from worries about the pharmaceutical industry’s influence over psychiatry. This has led to the spotlight being turned on the financial ties of those in charge of revising the manual, and has made any diagnostic changes that could expand the use of drugs especially controversial. “I think the DSM represents a lightning rod for all kinds of groups,” says David Kupfer of the University of Pittsburgh, Pennsylvania, who heads the task force appointed by the APA to produce the revised manual.

Few would claim that the DSM‘s current version is perfect. With each revision, the number of conditions it defines has swelled, many surrounded by bewildering lists of symptoms that must be checked to assign a diagnosis. Using current DSM checklists, for example, 114 different combinations of symptoms can lead to a diagnosis of schizophrenia. At the same time, many patients prove hard to fit into the framework.

One aim of the work groups compiling DSM-V is to cut through this chaos. They are streamlining diagnoses by removing various subtypes of schizophrenia, for example, and intend to address the confusion created by the fact that many people with one condition meet criteria for other disorders as well. The DSM-V task force is expected to propose a series of “dimensions” to be considered with a patient’s main diagnosis. So as well as deciding whether someone has, say, bipolar disorder, doctors would determine whether they are suffering from problems such as anxiety and sleeping disturbances, and assess them on a simple scale of severity.

Grandiose claims

This is widely seen as a first step towards a future in which psychiatric diagnosis has a more scientific base, where sprawling checklists of symptoms are replaced by sliding-scale measurements of the underlying determinants of mental health. Yet critics worry that even a limited embrace of this “dimensional” approach is running ahead of the science. Until we understand more about the biological basis of psychiatric disease, this approach will not be helpful, they say.

Some of the harshest criticisms have come from those who led previous revisions of the DSM, in 1980 and 1994. In July, Robert Spitzer and Allen Frances, both now retired, wrote a stinging letter to the APA, accusing it of planning unworkable changes and making grandiose claims. In a separate editorial in the magazine Psychiatric Times, Frances complained that most of the authors are university-based researchers who are cut off from typical doctors and patients.

Spitzer and Frances also criticise the fact that members of the various DSM-V work groups have had to sign confidentiality agreements. “The main problem is that we don’t know what they’re doing,” says Spitzer. The APA says the confidentiality agreements are to stop the manual’s authors writing their own diagnostic handbooks alongside the official manual. Kupfer points out that discussion does go on: work groups proposing major changes debate their ideas in papers and at meetings. “We’ve done everything we can to encourage it,” he says.

Another focus for Spitzer and Frances’s concern is the suggestion that DSM-V could include new categories to capture milder forms of illnesses such as schizophrenia, depression and dementia. “The result would be a wholesale… medicalization of normality that will lead to a deluge of unneeded medication,” Frances said in his editorial.

For example, one work group is considering whether it is possible to catch people in the early stages of schizophrenia or other psychotic illnesses before they have their first full-blown psychotic episode (Schizophrenia Bulletin, vol 35, p 841). Some doctors prescribe antipsychotic drugs at this early stage in the hope of stopping the illness from progressing.

Libido loss

These medicines can have serious side effects, such as loss of libido, weight gain and distressing tremors and spasms, so no one would want to take them without good reason. Yet it’s hard to separate distressed people who will go on to develop a psychotic disorder from the “false positives” – those who will recover or develop a different illness. The available evidence suggests that only about 30 per cent of people identified as being at risk of psychosis will go on to develop it within two years.

Nevertheless, William Carpenter, a psychiatrist at the University of Maryland in Baltimore who chairs the DSM-V work group on psychosis, believes the needs of the “true positives” are so great that adding a diagnostic category to cover “psychosis risk” would, on balance, be a good thing. Frances brands this proposed diagnosis as “the most worrisome suggestion entertained”.

Given the controversy, psychosis risk may not make it into the DSM proper, and may instead appear in the appendix, as a condition needing more research. But even that designation might boost prescribing.

Frances and Spitzer are not the only ones with concerns, and there are other flashpoints (see “Hebephilia”, “Transgendered” and “Bereavement”). In March, Jane Costello of Duke University in Durham, North Carolina, resigned from the work group on disorders in childhood and adolescence, worried about what she saw as a lack of scientific rigour across the whole DSM revision. “I felt that there was not enough empirical work being achieved or planned,” she says.

The disputes are getting ugly. Senior APA figures have even suggested that Spitzer and Frances are motivated by a desire to safeguard their flow of royalties from clinical guides linked to the current DSM. “The fact that Dr. Frances was informed… that subsequent editions of his DSM-IV associated products would cease when the new edition is finalized, should be considered when evaluating his critique,” leading APA figures said in a response to Frances’s editorial.

Spitzer and Frances reject this charge. “To suggest that I have no concern other than the royalties is a little absurd,” says Spitzer. “My annual royalties from DSM-IV related books are $10,000 per year,” notes Frances. “These have nothing to do with concerns I expressed.”

Attention has also turned to the financial interests of those working on DSM-V. The APA has ruled that members of the task force and work groups may not receive more than $10,000 per year from industry while working on DSM-V, and must keep their stock holdings below $50,000. This doesn’t satisfy Lisa Cosgrove of the University of Massachusetts, Boston, who studies financial conflicts in psychiatry (New Scientist, 29 April 2006, p 14). She notes that the APA’s ruling places no limit on industry research grants, and has found that the proportion of DSM-V panel members who have industry links is exactly the same as it was for DSM-IV, at 56 per cent (The New England Journal of Medicine, vol 360, p 2035).

The final version of DSM-V is scheduled to be published in 2012, but given the level of controversy and the need to test whether psychiatrists can reliably use the proposed diagnoses, that date seems certain to slip.

For now, there is an uneasy ceasefire, but next month the work groups will post their proposed changes on the APA’s website. Stand by for renewed hostilities.

December 13th, 2009

Anthopologists oppose counterinsurgency use of knowledge

TIME covers the controversy in anthropology around the military’s use of social scientists in its Human Terrain Systems program. Unlike the situation in psychology, where the American Psychological Association is totally in bed with the military-intelligence establishment, anthropologists have taken an ethical stand. Interestingly, the authors of the American Anthropological Association report condemning the HTS program includes several anthropologists who work with the military. [The AAA has links to additional press accounts of this issue on their web page announcing the report's release.]:

Social Science vs. The Pentagon: Should Anthropologists Go to War?

By Christopher Shay

Anthropologists have traditionally had a pretty wonkish reputation, earnestly taking field notes while interviewing a tribal chief, or lecturing in some college classroom about the intricacies of indigenous clan-systems. If the Pentagon has its way, though, more anthropologists will exchange their tweed for military fatigues and leave the halls of academe for the frontlines. For the last two years, the U.S. military has embedded anthropologists and other social scientists with American troops in order to improve the army’s cultural IQ. But last week, the American Anthropological Association (AAA) released a report coming out strongly against the program, saying that both in concept and application, it “can no longer be considered a legitimate professional exercise of anthropology.”

Since 2007, the Pentagon’s Human Terrain System has been placing social scientists in every army combat brigade, regiment and Marine Corps regimental combat team. There are now more than 500 people employed by HTS, a number that is increasing rapidly. On the ground in Iraq and Afghanistan, their job is to gather information and provide commanders with a greater understanding of the local population, reducing the need for lethal force by helping the army determine the needs of the community, according to Steve Fondacaro the project manager at HTS. Secretary of State Robert Gates has publicly praised the project, and one army colonel told Congress that one Human Terrain team reduced violent clashes encountered by his brigade in Afghanistan by 60-70%. As President Barack Obama revamps his Afghanistan strategy, getting ready to send 30,000 more soldiers, HTS is poised to become a major part of America’s war, helping troops navigate in a foreign land. “We’re pleased to find ourselves fully aligned with the goals [of the Obama administration],” says Fondacaro.

But if the military’s program is to continue its expansion in Afghanistan with the nation’s top scholars, it may be facing an uphill battle. The AAA says the program violates its code of ethics — a sort of Hippocratic Oath in which anthropologists vow to do no harm. Two years ago, the AAA condemned the HTS program, but this month’s 72-page report goes into much greater detail about the potential for the military to misuse information that social scientists gather; some anthropologists involved in the report say it’s already happening. David Price, a professor of anthropology at St. Martins University in Washington and one of the co-authors of the AAA report, says the army appears to be using the anthropological information to better target the enemy, which, if true, would be a gross violation of the anthropological code. One Human Terrain anthropologist told the Dallas Morning News that she wasn’t worried if the information she provided was used to kill or capture an insurgent. “The reality is there are people out there who are looking for bad guys to kill,” she said. “I’d rather they did not operate in a vacuum.” Price and other critics see this as proof that the anthropologists don’t have full control over the information they gather and that commanders can use it to kill. “The real fault with Human Terrain is that it doesn’t even try to protect the people being studied,” says Price. “I don’t think it’s accidental that [the Pentagon] didn’t come up with ethical guidelines.”

HTS adamantly denies that its program is designed to help the army improve its targeting, saying on its website that the role of the program “is neither to directly assist in lethal targeting of insurgents nor the collection of actionable military intelligence.” But Ben Wintersteen, who recently finished the nearly five-month HTS training program and has a masters in anthropology, says oversight is lacking. Once on the battlefield, “there’s definitely an intense pressure on the brigade staff to encourage anthropologists to give up the subject,” Wintersteen says. “There’s no way to know when people are violating ethical guidelines on the field.”

Still, Wintersteen, who is waiting to be sent to Iraq through HTS, says the AAA’s decision to attack the program will ultimately put more lives in danger by undermining the organization’s ability to provide guidance and dissuading top talent from joining. So far, HTS has struggled to bring in topflight social scientists with regional knowledge. “It hurts HTS and the people downrange like the American soldiers and the locals who depend on the rational analysis that anthropology brings,” Wintersteen says. In his training class of about 50 people, there were only about 13 social scientists, five with Ph.Ds — many of the others came from a military background. Because of the AAA, “there are a lot of highly motivated, ethical, critical anthropologists who are being discouraged from helping the program.” HTS project manager Fondacaro admits that finding recruits with regional expertise is “very rare,” but, he argues, HTS is creating a population of social scientists with firsthand experience in Iraq and Afghanistan where none existed before.

HTS is not the first time anthropologists have become involved with war efforts. Before the First World War, the field techniques of the discipline were used by the British to administrate and subdue the different cultural groups at the edges of its empire. Later in World War II, anthropologist Ruth Benedict played a key role in President Franklin Roosevelt’s decision to allow the Japanese Emperor’s reign to continue as part of Japan’s surrender to the U.S. According to Price, who has written a book on the use of anthropology during World War II, the majority of American anthropologists were actively involved the Allied war effort. One British anthropologist, Edmund Leach, even led a team of ruthless Kachin fighers — the indigenous group he was studying in Burma — against the nation’s Japanese occupiers.

But the relationship between the military and anthropology soured during the ’60s and early ’70s. In 1964, the U.S. army recruited scholars for Project Camelot, a program whose goals included helping the U.S. army “assist friendly governments in dealing with active insurgency problems” such as in Chile, the project’s test case. The project never moved out of Chile, however; in 1965, once the public got wind of it, Project Camelot was canceled. Later, in 1970, documents stolen from a U.S. anthropologist’s office implicated a number of social scientists in clandestine counterinsurgency efforts in Thailand. These two scandals created an uproar at the AAA, and many anthropologists grew wary of military funded programs. Over the last 30 years, according to an article by Montgomery McFate, the senior social scientist at HTS and a trained anthropologist, “the discipline has become hermetically sealed within its Ivory Tower.”

AAA policy is not against anthropologists helping the military — a few of the co-authors of the AAA report, in fact, work closely with the military. But McFate’s larger point stands: For the last few decades, anthropologists have had little influence in military or foreign policy circles. As American troops adopt a counterinsurgency strategy, cultural knowledge has become a foremost Pentagon concern. They know historically the record for winning a short-term counterinsurgency is not good, so they’ve once again sought out cultural expertise. The discipline’s checkered history, however, has made many anthropologists sensitive to the parallels between HTS and the colonial era. “Anthropology was used in much the same way to help colonial militaries and colonial occupation,” says David Vine, an anthropology professor at American University.

Of course, this hasn’t stopped the military from asking for their help. “What’s been missing is the insight and the experiences that social scientists bring to these kinds of conflicts,” Fondacaro says. The traditional army, he says, is good at treating “the symptoms of insurgency” — fighting armed violent groups or reducing the number of IEDs, for instance — but “what HTS is focused on is the disease. There’s a reason why the population tolerates and sometimes actively supports groups that advocate violence.” That, says Fondacaro, is what HTS is trying to diagnose and ultimately cure.

When it comes down to it, the AAA has no sanctioning power, and the decision whether or not to join HTS comes down to the individual. For now at least, the Pentagon wants to leverage the cultural insights of academics to succeed in Iraq and Afghanistan, but whether HTS has brought more top scholars into the military fold or only widened the schism between academia and the military remains unclear. James Der Derian, a professor of political science at Brown University who recently finished a documentary on HTS, and whose friend and colleague Michael Bhatia was killed in Afghanistan, one of three HTS social scientists to die on duty, says “the emphasis in previous wars has been more about how you defeat the enemy by controlling territory,” but now, “the center of gravity shifted to a psychological territory.” HTS is a clear indication that the Pentagon has realized in order to win the wars of the 21st century, cultural knowledge will need to be integrated into combat operations. And how do we do that exactly? Says Der Derian: “We’re still trying to figure that out.”

December 13th, 2009