MAIA SZALAVITZ: There are people who are trying to promote brain surgery for addiction using electrical stimulation of that area and it doesn't work any better than methadone. And that's not to say that methadone isn't the most useful drug we currently have, but it does not involve invasive surgery. I should say methadone and buprenorphine, the opioid agonists, are the best treatments that we have for opioid addiction. And what they do is two things: The first thing is they cut the death rate by 50 percent, which is – this happens whether you continue using on top or not. So that's pure harm reduction and that's wonderful. If we can keep you alive long enough that you stabilize your life, that is a lot better than having you die. The other thing that they do is they allow people, who are ready, to stabilize their lives. So you couldn't tell right now if I was on a maintenance treatment or not because basically once you get a tolerance to these drugs you are not high or impaired, and you can drive and you can work and you can love and you can do all of these things, but we don't understand, we think, "Oh you've just substituted one addiction for another." No, what you've done is you've substituted compulsive behavior despite negative consequences, and now you just have a physical dependence. And that's not a real problem as long as you have a safe and legal supply.
I think the most important place to start is that addiction is a learning disorder; it's not a sign that you're a bad person. And if you want to have a safe and addiction-free, or at least lower level addiction, workplace or school, you want people to feel included and comfortable and safe and you don't want this to be an adversarial thing. The research shows that the best way to get people help is through compassion and empathy and support, and absolutely not tough love. There may be situations in which an employer has to fire somebody because their performance has just degraded so much that there's no other option, but they shouldn't think, "I'm doing them a favor by firing them, because that will make them hit bottom and it will help them." Sometimes that happens, but sometimes they just go on to a life of homelessness and then die. So you can't assume that creating extra-negative consequences is actually going to help a person with addiction. What you want to do is ally yourself with them and, presuming this is an employee that you want to keep, help them realize that this is not a sin. "I am not trying to control you. What I want to do is for you to be at your best – at work, at home. And you're not being at your best right now, so what can we do to help?"
Well, I think the important way to start that conversation is to first not assume that a problem that you think might be drugs is drugs. The person could be having any number of mental illnesses, the person could be having, you know, there's a million things that could look like oh you think they have a drug problem and there's something else going on. So if you approach the person with respect and not assuming that you're going to find a drug thing unless, obviously in some situations it's completely obvious, but in most situations it isn't. And so the best way, I think, is to say, "I've noticed XYZ. I'm worried about you. I'm concerned about you. I want to make sure that I can help you." So it comes from a place of not like, "I caught you!" you know, because there's so much advice that is just like, "Well, threaten to fire them if they don't change, and drug test them immediately," and all of this kind of stuff which destroys trust. So, that's not to say that if somebody is doing something dangerous or clearly inappropriate that that behavior doesn't need to be addressed, but it is to say that you can approach somebody in a confrontational degrading and sort of high-powered manner or you can approach them as an equal human being deserving of respect. And if you do the latter you will have much better results.
And I have to say, it's almost and never going to be easy because people, whether they have addiction or mental illness or anything else going on with them, often don't want to admit to themselves that there's a problem. In the addictions field there's been this whole thing 'we've got to break through denial' and everything like that. Well, people have denial for good reasons. If we didn't have denial everybody would be sitting around obsessing about death, or at least I would be. It's a defense mechanism because we need defending. So recognizing that can allow you to approach somebody not from an attacking stance; approach somebody from a befriending sort of stance. And that is hard to do and some people are going to get very defensive no matter what you do and it's not going to be a pleasant conversation most of the time. But you can minimize harm. I mean, this whole thing always comes down to like reducing harm, making things less unpleasant if you can't make them non-unpleasant or actually pleasant. But the main thing is to see them as a full human being.
And I think really important in getting people into any kind of treatment is that, and I always say this to parents or anybody who has an addicted loved one, the first step should always be a complete, thorough psychiatric evaluation by somebody who is not affiliated with any treatment organization so that you can know going in what the problems may be and what kind of services you should be seeking. There are some absolutely wonderful treatment providers who, if somebody shows up who is not appropriate for their services, they will send them away. There are also unfortunately many people who will just take that person to make a profit off of them and they will not help that person and they will not inform them of that, for example, if they stayed on maintenance they would have a 50 percent reduction in their death risk. They would just say, "We do abstinence; that's good for you." Blah. And so I think, again, this is a sort of "buyer beware" industry. In the rest of the medicine it's pretty easy to say, "Okay, here is PubMed, this is the treatment for this particular cancer that has the most evidence behind it, and here's the guy who designed the best treatment. Let's go find this person." In addiction, it's virtually all based on like reputation and advertising, and it is very difficult to actually find programs that provide evidence-based care.
This is also a problem in mental health more generally. But anyway, the point here is that in order to get care that is good for you, you need to advocate for yourself, and if you have an employer that's willing to advocate for you that's even better. The way I think that employers could do an enormous amount of good is by demanding that the treatment providers they work with, the treatment that they cover, is evidence-based, and is not restricted because of money but is restricted because stuff that doesn't work shouldn't be paid for.
- Addiction is a learning disorder; it's not a sign that someone is a bad person.
- Tough love doesn't help drug-addicted people. Research shows that the best way to get people help is through compassion, empathy and support. Approach them as an equal human being deserving of respect.
- As a first step to recovery, Maia Szalavitz recommends the family or friends of people with addiction get them a complete psychiatric evaluation by somebody who is not affiliated with any treatment organization. Unfortunately, warns Szalavitz, some people will try to make a profit off of an addicted person without informing them of their full options.
As he described it, “In my mind's eye I saw many, many things: children that I hadn't even had yet, friends that I had never seen but are now my friends. The thing that really stuck in my mind was playing an instrument". Then Tony landed on his head and lost consciousness.
When he came to at the hospital, he felt like a different person and didn't want to return to his previous life. Over the following weeks, the images kept flashing back into his mind. He felt that he was “being shown something" and that the images represented his future.
Later, Tony saw a picture of a saxophone and recognized it as the instrument he'd seen himself playing. He used his compensation money from the accident to buy one. Now, Tony Kofi is one of the UK's most successful jazz musicians, having won the BBC Jazz awards twice, in 2005 and 2008.
Though Tony's belief that he saw into his future is uncommon, it's by no means uncommon for people to report witnessing multiple scenes from their past during split-second emergency situations. After all, this is where the phrase “my life flashed before my eyes" comes from.
But what explains this phenomenon? Psychologists have proposed a number of explanations, but I'd argue the key to understanding Tony's experience lies in a different interpretation of time itself.
When life flashes before our eyes
The experience of life flashing before one's eyes has been reported for well over a century. In 1892, a Swiss geologist named Albert Heim fell from a precipice while mountain climbing. In his account of the fall, he wrote is was “as if on a distant stage, my whole past life [was] playing itself out in numerous scenes".
More recently, in July 2005, a young woman called Gill Hicks was sitting near one of the bombs that exploded on the London Underground. In the minutes after the accident, she hovered on the brink of death where, as she describes it: “my life was flashing before my eyes, flickering through every scene, every happy and sad moment, everything I have ever done, said, experienced".
In some cases, people don't see a review of their whole lives, but a series of past experiences and events that have special significance to them.
Explaining life reviews
Perhaps surprisingly, given how common it is, the “life review experience" has been studied very little. A handful of theories have been put forward, but they're understandably tentative and rather vague.
For example, a group of Israeli researchers suggested in 2017 that our life events may exist as a continuum in our minds, and may come to the forefront in extreme conditions of psychological and physiological stress.
Another theory is that, when we're close to death, our memories suddenly “unload" themselves, like the contents of a skip being dumped. This could be related to “cortical disinhibition" – a breaking down of the normal regulatory processes of the brain – in highly stressful or dangerous situations, causing a “cascade" of mental impressions.
But the life review is usually reported as a serene and ordered experience, completely unlike the kind of chaotic cascade of experiences associated with cortical disinhibition. And none of these theories explain how it's possible for such a vast amount of information – in many cases, all the events of a person's life – to manifest themselves in a period of a few seconds, and often far less.
Thinking in 'spatial' time
An alternative explanation is to think of time in a “spatial" sense. Our commonsense view of time is as an arrow that moves from the past through the present towards the future, in which we only have direct access to the present. But modern physics has cast doubt on this simple linear view of time.
Indeed, since Einstein's theory of relativity, some physicists have adopted a “spatial" view of time. They argue we live in a static “block universe" in which time is spread out in a kind of panorama where the past, the present and the future co-exist simultaneously.
The modern physicist Carlo Rovelli – author of the best-selling The Order of Time – also holds the view that linear time doesn't exist as a universal fact. This idea reflects the view of the philosopher Immanuel Kant, who argued that time is not an objectively real phenomenon, but a construct of the human mind.
This could explain why some people are able to review the events of their whole lives in an instant. A good deal of previous research – including my own – has suggested that our normal perception of time is simply a product of our normal state of consciousness.
In many altered states of consciousness, time slows down so dramatically that seconds seem to stretch out into minutes. This is a common feature of emergency situations, as well as states of deep meditation, experiences on psychedelic drugs and when athletes are “in the zone".
The limits of understanding
But what about Tony Kofi's apparent visions of his future? Did he really glimpse scenes from his future life? Did he see himself playing the saxophone because somehow his future as a musician was already established?
There are obviously some mundane interpretations of Tony's experience. Perhaps, for instance, he became a saxophone player simply because he saw himself playing it in his vision. But I don't think it's impossible that Tony did glimpse future events.
If time really does exist in a spatial sense – and if it's true that time is a construct of the human mind – then perhaps in some way future events may already be present, just as past events are still present.
Admittedly, this is very difficult to make sense of. But why should everything make sense to us? As I have suggested in a recent book, there must be some aspects of reality that are beyond our comprehension. After all, we're just animals, with a limited awareness of reality. And perhaps more than any other phenomenon, this is especially true of time.
Steve Taylor, Senior Lecturer in Psychology, Leeds Beckett University
This article is republished from The Conversation under a Creative Commons license. Read the original article.
A Florida student figured out a way to more accurately measure the size of one of the largest fish that ever lived – the extinct megalodon shark – and found that it was even larger than previously estimated.
The megalodon (officially named Otodus megalodon, which means "Big Tooth") lived between 3.6 and 23 million years ago and was thought to be about 34 feet long on average, reaching the maximum length of 60 feet. Now a new study puts that number at up to 65 feet (20 meters).
Homework assignment leads to a discovery
The study, published in Palaeontologia Electronica, used new equations extrapolated from the width of megalodon's teeth to make the improved estimates. The paper's lead author, Victor Perez, developed the revised methodology while he was a doctoral student at the Florida Museum of Natural History. He got the idea while teaching students, noticing a range of discrepancies in the results they were getting.
Students were supposed to calculate the size of megalodon based on the ancient fish's similarities to the modern great white shark. They utilized the commonly accepted method of linking the height of a shark's tooth to its total body length. As the press release from the Florida Museum of Natural History expounds, this method involves locating the anatomical position of a tooth in the shark's jaw, measuring the tooth "from the tip of the crown to the line where root and crown meet," and using that number in an appropriate equation.
But while carrying out calculations in this way, some of Perez's students thought the shark would have been just 40 feet long, while others were calculating 148 feet. Teeth located toward the back of the mouth were yielding the largest estimates.
"I was going around, checking, like, did you use the wrong equation? Did you forget to convert your units?" said Perez, currently the assistant curator of paleontology at the Calvert Marine Museum in Maryland. "But it very quickly became clear that it was not the students that had made the error. It was simply that the equations were not as accurate as we had predicted."
Found in North Carolina, these 46 fossils are the most complete set of megalodon teeth ever excavated.Credit: Jeff Gage/Florida Museum
The new approach
Perez's math exercise demonstrated that the equations in use since 2002 were generating different size estimates for the same shark based on which tooth was being measured. Because megalodon teeth are most often found as standalone fossils, Perez focused on a nearly complete set of teeth donated by a fossil collector to design a new approach.
Perez also had help from Teddy Badaut, an avocational paleontologist in France, who suggested using tooth width instead of height, which would be proportional to the length of its body. Another collaborator on the revised method was Ronny Maik Leder, then a postdoctoral researcher at the Florida Museum, who aided in the development of the new set of equations.
The research team analyzed the widths of fossil teeth that came from 11 individual sharks of five species, which included megalodon and modern great white sharks, and created a model that connects how wide a tooth was to the size of the jaw for each species.
"I was quite surprised that indeed no one had thought of this before," shared Leder, who is now director of the Natural History Museum in Leipzig, Germany. "The simple beauty of this method must have been too obvious to be seen. Our model was much more stable than previous approaches. This collaboration was a wonderful example of why working with amateur and hobby paleontologists is so important."
Why use teeth?
In general, almost nothing of the super-shark survived to this day, other than a few vertebrae and a large number of big teeth. The megalodon's skeleton was made of lightweight cartilage that decomposed after death. But teeth, with enamel that preserves very well, are "probably the most structurally stable thing in living organisms," Perez said. Considering that megalodons lost thousands of teeth during a lifetime, these are the best resources we have in trying to figure out information about these long-gone giants.
Researchers suggest megalodon's large jaws were very thick, made for grabbing prey and breaking its bones, exerting a bite force of up to 108,500 to 182,200 newtons.
Megalodon tooth compared to two great white shark teeth. Credit: Brocken Inaglory / Wikimedia.
Limitations of the new model
While the new model is better than previous methods, it's still far from perfect in precisely figuring out the sizes of animals which lived so long ago and left behind few if any full remains. Because individual sharks come in a variety of sizes, Perez warned that even their new estimates have an error range of about 10 feet when it comes to the largest animals.
Other ambiguities may affect the results, such as the width of the megalodon's jaw and the size of the gaps between its teeth, neither of which are accurately known. "There's still more that could be done, but that would probably require finding a complete skeleton at this point," Perez pointed out.
How did the megalodon go extinct?
Environmental changes that led to fluctuations in sea levels and disturbed ecosystems in the oceans likely led to the demise of these enormous ancient sharks. They were just too big to be sustained by diminishing food resources, says the ReefQuest Centre for Shark Research.
A 2018 study suggested that a supernova 2.6 million years ago hit Earth's atmosphere with so much cosmic energy that it resulted in climate change. The cosmic rays that included particles called muons might have caused a mass extinction of giant ocean animals ("the megafauna") that included the megalodon by causing mutations and cancer.
Scientists, led by Adrian Melott, professor emeritus of physics and astronomy at the University of Kansas, estimated that "the cancer rate would go up about 50 percent for something the size of a human — and the bigger you are, the worse it is. For an elephant or a whale, the radiation dose goes way up," as he explained in a press release.
