Listening to (the headlines about) Prozac

A meta-study conducted by Hull University recently brought to light some unpleasant revelations about the most widely-used class of antidepressants. It’s an interesting study, though of course without the actual text of the paper it’s hard to say a lot. It’s a meta-study, which means that instead of going out and holding clinical trials, the researchers instead gathered the raw data used in a number of other studies and tried to draw inferences from that. How they divvied up and applied the data across particular drugs, etc., will have a lot to do with the final results.

The kicker here is the horrible job that the media has done of presenting the findings, at least as far as the headlines go. Here is one of the more in-depth articles on the topic. Essentially, according to the article, the study revealed:

1) Mildly depressed people improve when taking SSRI’s. So do people taking a placebo. People taking SSRI’s improve slightly more than placebo takers, but not by a lot.
2) Alternative therapies, like exercise, counseling, and cognitive behavior therapy can provide relief as well, and may be preferred as they carry no risks of side effects.
3) Severely depressed people respond more strongly to the SSRI than to the placebo.

The headline of this article, and almost every other on the subject:

“Antidepressant drugs don’t work”

Religion in the US: Surveying the Field

Two surveys out this week that cast some light on religious trends in the US: first the National Council of Churches Yearbook provides data reported by large denominations regarding changes in their membership and giving. Second, a new survey from the Pew Forum on Religion and Public Life provides some data on the rate at which people are moving from one denomination to another, and the retention rates and growth of various non-Christian denominations.

The big themes are to be expected: old mainline denominations like the Episcopal church continue to decline; Catholics are kept steady only by an influx of new members. Evangelical and charismatic churches, particularly smaller ones, continue to hold their own or grow.

Two interesting quotes:

“The American religious economy is like a marketplace — very dynamic, very competitive,” said Luis Lugo, director of the Pew Forum.

While the large denominations are struggling to retain members, many smaller, more innovative churches are continuing to grow- thus keeping overall attendance quite high among Christians in the US, even if membership and particular denominations are taking a hit. This is a perfect example of how markets are supposed to work. Contrast this situation in Europe, where widespread state churches have tended to hold a monopoly on Christianity, creating large centralized systems that gobble up tax dollars and respond to changes in society slowly if at all. It’s a prime example of free market competition outperforming a centrally planned market. Bad news for folks who think one particular organization has a monopoly religious truth, but an interesting case study in what is, in the US, a near-totally unregulated market.

The self-identified Buddhists — 0.7 percent of those surveyed — illustrate a core challenge to estimating religious affiliation: What does affiliation mean?

It’s unclear whether people who called themselves Buddhists did so because they practice yoga or meditation, for instance, or claim affiliation with a Buddhist institution.

Emphasis mine.

First of all, are we really to expect that someone who is casually performing a Hindu form of worship mostly shorn of its religious significance in the US is going to self-identify as Buddhist? Odder things have happened, but this seems like something of a stretch. But the article does raise a valid point: American notions of religious belonging are ill-equipped to quantify non-exclusive traditions like Buddhism, or people who mix their spiritual practices (which are increasingly likely to be Buddhist, Hindu, or new-age in origin) with a familial identity as a Christian or Jew. It’s similar to the frustration that Western demographers face when trying to come up with religious adherence counts for East Asia- by forcing someone to check a single box, you’re essentially forcing a narrowing of their religious identity. The resulting numbers don’t end up meaning a hill of beans.

Interesting implications as well for the prospect of making lasting religious communities in the West- these results would seem to imply that small, autonomous communities are going to enjoy more success than large groups with national or international organizational structures.

Enter the Nader

Certain amount of sturm und drang among Democrats today with the news that Ralph Nader is again running for President. Most of the commentary has been devoted to revisiting Nader’s spoiler effect in the 2000 election. Nader is much less of a threat to the Democrats in this go-round, however. The 04 election showed that many of his supporters in 2000 have trickled away from him. The Green Party won’t be providing him with backing or organizational support. Finally, Barack Obama has done a better job than either Gore or Kerry of motivating the young, progressive voters who might have been inclined to support a Nader election.

The final fact that will be working against the possibility of Nader playing the spoiler is the change in attitudes among progressives. What hurt Gore more than anything in 2000, with respect to the Nader vote, was the feeling among the electorate that there wasn’t a great deal of difference between Bush and Gore. Gore was an un-personable technocrat. Bush was a malapropism spouting unknown quantity, who claimed to be a “compassionate conservative”. Support for both of them ran lukewarm, as neither was able to capture a significant number of independents or crossover voters. The result was the 50-50 split that saw Bush take the presidency despite a lower popular vote, thanks to the peculiarities of the electoral college.

This year, there is a much stronger feeling among Democratic and independent voters that their vote is a significant choice- particularly with Obama as the Democratic nominee. While there’s still some frustration with the two main stream parties among some independents, an Obama-McCain general election would would result in the independent and crossover votes that might have once gone to Nader being apportioned between McCain and Obama- with Obama taking the lions share, thanks to his appeal to both the more liberal Republicans who might vote for McCain, and the young, liberal Democrats who might have previously been tempted by Nader on the Green Party ticket. Conservative Democrats might split their vote, but that effect will be mollified by Obama by the fact that some hard-core conservatives might not turn out for a McCain election.

Interestingly, I think Nader plays a much bigger potential role in a run-off between Clinton and McCain. Both could inspire some antipathy among their own party members (particularly if there are any convention shenanigans that result in Hillary taking the nomination) that could push supporters towards a third-party candidate. In such a scenario, though, it’s difficult to state with any confidence what would happen to the protest vote- you might see more write-in votes for Obama than votes for Nader.

Looking Past the Convention

The Democratic primary race is still in full swing. But by the end of August, one candidate will be setting their eyes on the November general election, and the other will have to decide how their political career continues. Both Clinton and Obama have a few years left in their Senate terms; if they want it, they have a ready-made platform to use as a launching point for another run at the White House in 2012. But what happens on November 5th, 2008, as the loosing Democratic nominee takes a look at the shape of things for the next four years?

The first scenario to tackle is the one that Democrats least want to consider: John McCain captures the general election. If McCain is elected, both Obama and Clinton might see 2012 as their time to strike. Even if McCain were to perform well in office, by 2012 he’ll be 76, and health issues could easily prevent him from seeking a second term. Any McCain win in 08 will likely be narrow, and the Democrats will see an opportunity for an opening at the end of his first term. Look for a repeat of the 08 election; neither Clinton nor Obama is likely to give up their shot at the White House in the meantime. Obama will need to worry about his ability to recapture the momentum and effervescence that has characterized his candidacy to date; Clinton will have to find a way to re-tool her image and message in order to take a decisive win in the primary race. In this scenario, being the nominee in this years election is more or a handicap than a benefit. Obama would need to spend the next four years taking visible leadership roles on Senate issues to put to rest doubts about his achievements and leadership. Clinton would face a much harder task, needing to create new momentum and check her hawkish image with voters- there’s no way that she, or any other Democrat, could out-hawk McCain’s “perpetual war” stance while still keeping hold of Democratic voters.

If Obama or Clinton take the White House, I look for their rival to sit out the 2012 election. With a Democrat in the Oval Office, it will be much less appealing to either of them to join the field. A good performance by the Democratic president would cinch the nomination almost automatically. Poor performance would mean that a Republican would be more likely to take office, no matter who is running from the other side of the aisle. Both Obama and Clinton are savvy enough to avoid such a trap, and would focus instead on retaining their senate positions and rebuilding their campaigns for another run in 2o16.

What happens if Hillary Clinton takes the White House? One appealing prospect for Obama- and perhaps for Clinton as well- would be a cabinet position. Four or eight years removed from re-election concerns, and safely away from the Senate compromise votes that haunted John Kerry, a promised cabinet position would be an excellent way to bring together a Democratic party split over the nomination battle. Several years in the cabinet could put to rest for Obama any concerns about his age or experience. Having a dynamic future candidate in the cabinet could allow Clinton to name an older or less electable vice president without the need to worry about the party’s future in 2016.

Clinton, I think, would be less likely to accept such a deal; for her, a loss in August most likely means one thing only: the beginning of the next campaign. She’ll skip the 2012 presidential season and opt instead to retain her senate seat, and look towards 2016. In the meantime, she’ll work with the Democratic party to try and strengthen the party’s structure and organization to provide better support for the eventual nominee in 2016.

Obama was quick to realize after the previous convention that he was the man of the moment, and will be unwilling to turn loose of that momentum, no matter what the result in 2008. Meanwhile, Clinton is unlikely to waver in her ambition to become the first female president. Win or loose in August, look for both candidates to be back with gusto in 2012 or 2016.

Building Buddhist Communities

This article at Salon is broadly similar to a number of others that have appeared in Tricycle and other publications, discussing the creation of Buddhist-themed study groups and practice groups geared specifically at Gen-Xers and their ilk. Lurking in the background of a number of these pieces is the specter of the dharma groups and practice centers created in the 60’s and 70’s, institutions that have, in most cases, failed to attract and sustain the attention of the next generation.

I wrote a bit about this on Salon’s editorial page, but it’s an idea that’s been kicking around in my head for a while. The Buddhist centers created by the first generation of Western converts have, somehow, failed in many cases to make the transition into complete religious communities- specifically, multi-generational communities that will be able to endure turnover in their membership, and particularly the graying and eventual departure of their senior leaders and organizers. Why did this happen? A few reasons:

  • Pruning Buddhism: Many practice centers, in a quest to keep new members from feeling “uncomfortable”, have shorn Buddhism of any of its ritual or cultural trappings. However, ritual gives familiarity and structure, and helps bind a community together by giving order to important stages of life. There are many Western Buddhist practice centers; there are few Western Buddhist weddings, funerals, or coming-of-age ceremonies.
  • Mono-generaltionalism: A made up word used to describe the way that Western practice centers have tended to crystallize around a relatively small cohort of people of the same general age and background, and then age with them. Groups that started in the 60’s have tended to morph into “Buddhism for Baby Boomers” centers, with few attempts to incorporate older or younger members. The modern “Dharma Punx” groups seem to be simply an updated form of the same phenomenon, creating groups tightly focused on the desires of a particular demographic without building ties to the wider community.
  • Leadership stagnation: Centers that started in the 60’s and 70’s immediately put the young people who started them into leadership roles, despite, in many cases, a relative paucity of experience as teachers, meditators, organizers, etc. Today, those roles are often still filled by the same people, as the group has aged together. 20-somethings in the 1960’s and 70’s were the leaders of their community; today, they’re implicitly being told that it will be 20-30 years before they have a strong voice in guiding their community.
  • Boring as Hell for Kids: An extension of the reduced role for ritual and culture is the tendency for Western Buddhist groups to become either cerebral or therapeutic. Neither discussions about the Abhidharma nor how meditation brings out your issues about your father well-serve the cause of integrating families into a community.
  • No challenge, no change: Buddhist groups in the West often go out of their way to avoid offending or discomforting their membership. It’s an admirable goal, in some ways: the intention is to make Buddhism available to as many people as possible. But in removing some of the thorns from the rose- particularly teachings on morality and right behavior, ritual practices that encourage respect for teachers and the teaching, and teachings that touch upon the supernatural- Western interpretors sometimes remove those aspects of the teaching that challenge the practitioner to live their life in a better way. I’m OK-you’re OK interpretations of Buddhism can encourage a self-satisfied complacency, ultimately doing a disservice to the student.

The Buddhist institutions created in the West by the converts of the 60’s and 70’s were, in many cases, the work of individuals in rebellion against the religious institutions of their era. The virtues and flaws of that rebellion persist to this day: on the one hand, Western Dharma centers and practice groups are non-judgmental, frequently loosely-structured places that ask little of their members. On the other hand, they are also in many cases guilty of neglecting the wisdom regarding building religious institutions that will persist for multiple generations that the churches and synagogues of the US long since acquired.

So what do these Western centers have to learn, if they intend to outlive the Baby Boomers?

  • Rituals give structure to life and community. Buddhist groups can’t be so afraid of their ritual heritage- which has developed in a variety of loosely related cultures over thousands of years- that they dump the entire lot in order to avoid offending the supposedly fragile sensibilities of their members. Has anyone who went to a Buddhist temple or gathering really been offended or made uncomfortable by statues of the Buddha, bowing, or chanting? If so, is it really reasonable to cater to that demographic exclusively? Would you be offended if you went to a mosque, and someone read from the Koran? An invocation of Jesus at a Catholic church? Of course not. It’s simply ridiculous to claim to be drawing from an ancient tradition, and then bend over backwards to avoid acknowledging it.
  • Make a place for many age groups. But don’t let them stay there. Clearly, the needs of children aren’t the same as those of teenagers, adults, and senior citizens. These groups need their own space- Dharma Sunday schools, youth groups, singles and family groups, etc.- in which to explore how the teachings of the Buddha impact the challenges of their particular stage of life. At the same time, strict segregation by age results in a variety of dissociated semi-communities, instead of a coherent whole. Protestant churches figured this out more than a generation ago. Services can begin with a period of collective worship- simple songs, devotional readings, short meditations, offerings, etc. The group then breaks into individual classes for study at age-appropriate levels: kids get digestible teachings that hold their attention, and their parents and grandparents are free to explore more (or less) intellectual pursuits for a while. The entire body then reconvenes before the end of the service. Additional, not strictly religious activities- pot-luck meals, social gatherings for particular age groups, outings for single people, rotating dinner groups- create a sense that this is a community that extends beyond the walls of the temple or church. Community members are encouraged to look to each other for social supports that extend around the family.
  • Create leadership roles for younger members. No one needs to be running a Dharma center for forty years. There needs to be a structured path in place to encourage young members to take leadership roles- first among their peers, and , ultimately, among the group as a whole. Mentoring and “young leaders” programs can help with this- as can term limits for institutional offices.
  • Teachers can’t back down from challenging their students. Buddhism does have particular things to say about what is and isn’t skillful behavior, and what behaviors lead to good and bad outcomes for people. To neglect these teachings does favors for no one. The sutras teach that ethical behavior is the foundation for everything else- all this business about counting breaths and noticing moments can only do so much to reduce your suffering if you’re constantly adding to the total with unskillful actions. Asking little or nothing of a devotee doesn’t necessarily mean that they will remain engaged. While attitudes of excessive condemnation and guilt-tripping drive people off, we all know what happens to the kids of parents who refuse to set boundaries.

Part of the problem, no doubt, is one of resources and size. The plurality of Buddhist traditions represented in the West, and the confusion that surrounds the differences between them, has resulted in a variety of small autonomous communities, many without sufficient resources to do much more than keep the lights on. On the other hand, in many urban areas there are significant pockets of interest, and communities that could grow beyond their traditional limits if they were willing to make a concerted effort to broaden their own identity. This leaves out, of course, the issue of the so-called “ethic” communities- immigrant Buddhist communities that tend to organize on national lines. They have their own challenges, and it’s likely that both groups- converts and traditional ethnic Buddhists- have things to learn from each other about how to hold a community together, and how to hold the attention of their members in the uniquely American environment. But that’s another post.

Not Without My (Rotting) Spleen

British PM Gordon Brown floated the idea on Sunday that Britain should convert to an “implied consent” system of organ donation. If cranky Internet comments are any indication, Brown is taking a lot of flack for the idea- and British papers seem to be in the act too, choosing to represent Brown’s plan with the quaint headline “Organs to be Taken Without Consent“.

For those not familiar with the implied consent system- which is already used successfully in Spain- here’s how things work. In the system currently used in Britain and the United States, the blanket assumption is that people do not want their organs donated. You must explicitly opt in in order to be considered as an organ donor. Here’s the problem: these opt-ins are often ignored or forgotten, even though most people claim to support organ donation, and only a comparatively small portion of the population has religious or other beliefs that lead them to explicitly reject organ donation.

Implied consent turns the assumption around. Everyone is assumed to consent to donating their organs in the event of their death, unless they opt out. You can opt out of the system for any reason: religious beliefs, irrational fears about EMTs smothering you with a pillow so they can gather your precious corneas, selfishness, or elective conformance with ancient Egyptian burial practices. Whatever. If, for any reason, you want your organs to rot in the ground, be burnt, or pickled in formaldehyde, that’s your right. You just have to care enough to fill out a form or sign your driver’s license, click on a link on the Internet, etc.

The net effect of such a plan is that anyone who actually cares enough to take a token action will still not have their organs donated- thus preserving the religious conformance of those whose beliefs dictate a need to keep their organs around after death- whereas people who never cared enough to have an opinion may have their organs used to save lives.

The notion that this will result in organs being taken “without consent” seems like a red herring. Anyone who cares even slightly about retaining their organs can easily make their wishes known through a registry. Everyone retains the exact same rights over the disposal of their corpse that they know have; Brown is just proposing that we change the default option in a way that will benefit many, many people.

If someone has an organ removed from their dead body because of laziness or indifference, it’s little enough tragedy. Not so with someone dying for the same reason.

Reading Iowa’s Entrails

The dust is settling in the Iowa Caucus, and it appears that Barack Obama has pulled off a win, dealing an early black eye to Hillary Clinton’s campaign in particular. While it’s too early to read a lot from the win, the most interesting thing about Iowa may not be which Democratic candidate won, but how he won. Clinton’s appeal, according to pundits, is to older voters and particularly women. She is supposed to be the Democrat capable of appealing to the rightmost edge of the party, voters who will supposedly be swayed by her credentials as a Democratic hawk and experienced political operator. The numbers in Iowa may reveal an on-the-ground weakness in the Clinton campaign not previously perceived; if any of Hillary’s key demographics (females, older voters, conservative Dems) are breaking more in Obama’s favor, Iowa could reveal what ultimately proves to be the unraveling of Hillary’s White House bid. It’s not necessary that Obama necessarily take a majority of any of those groups; he needs only to take more of Hillary’s thunder then was expected. Simply defying expectations in Iowa may be enough to put big cracks in the media narrative of Hillary as the “safe” candidate who appeals to the middle of the road.