David Adam Edelstein (davadam) Mon 24 Nov 08 13:52
We're very pleased to welcome WELL member Gary Greenberg to Inkwell. Gary Greenberg is a psychotherapist and freelance writer. His features and essays, most of them about science and medicine, and the way they make the world a weirder place, have appeared in The New Yorker, Harper's, and Rolling Stone, among other magazines. He's a contributing writer for Mother Jones, and his work has been chosen for Best American Science and Nature Writing. The Noble Lie is his second book. His first was The Self on the Shelf: Recovery Books and the Good Life (SUNY Press, 1994), and his third will be Manufacturing Depression: The Secret History of an American Disease, due out in early 2010 from Simon and Schuster. Leading the conversation with Gary is our own Steve Silberman. Steve Silberman is a senior writer for Wired magazine and a conference host on the WELL. Over the years, he has written about autism in Silicon Valley, antibiotic-resistant infections in Iraq war veterans, the neurologist Oliver Sacks, neuroplasticity and Buddhism, and the writers of the Beat Generation. His articles have appeared in Wired, the Shambhala Sun, GQ, Time, and many other national publications. He was also the co-author of "Skeleton Key: A Dictionary for Deadheads" in 1993 with David Shenk. Steve's homepage is stevesilberman.com. Welcome, Gary and Steve!
Steve Silberman (digaman) Tue 25 Nov 08 09:27
I'm honored to welcome Gary Greenberg to Inkwell to discuss The Noble Lie. It's not only a fascinating and very brave book, it's extremely well written and a real page-turner -- I couldn't put it down. Gary basically jumps right into some of the most knotty moral dilemmas of our time (is addiction a lifelong disease, as the 12-step folks claim? when is someone truly dead? is sexual orientation binary and genetically fixed? what good is immortality, even if it was scientifically feasible? what makes life worth living? is "depression" also a disease?), and instead of untying these knots with facile phony answers and opinionating, Greenberg acknowledges the complexities on all sides, and reveals even deeper knots beneath the surface. It's a brilliant, vivid, and often disconcerting book that strips away layers of unconsciousness about these issues in much the same way that a truly honest and probing therapist will keep pushing past zones of comfort in pursuit of authentic insight. One of the particularly weird and fascinating sections of the book talks about a correspondence that Gary developed with Unabomber Ted Kaczynski. More on that later! But Gary, one of the things you don't get into much in The Noble Lie is how and why you became a psychotherapist, what sorts of clients you see in daily practice, and how the work you do in therapy informs the concerns you bring to light in this book. Thank you for being here with us.
Steve Silberman (digaman) Tue 25 Nov 08 09:28
(Thank you also, Dana and David, for setting up this conversation).
(dana) Tue 25 Nov 08 10:52
My pleasure. (NOTE: Offsite readers with questions or comments may have them added to the conversation by emailing <firstname.lastname@example.org> -- please put the authorâs name in the subject line. Thank you!)
Steve Silberman (digaman) Wed 26 Nov 08 07:32
Gary, I know that PR materials are routinely hyperbolic, but the jacket copy on your book refers to you as a "notorious" journalist and a "controversial" science writer. I can see why challenging the disease notion of alcoholism or depression, or questioning the schizophrenic diagnosis of the Unabomber, would make waves, but can you tell us what piece of writing of yours has stirred the most controversy, and what it was like to get that kind of reaction? Was any of it unexpected?
Gary Greenberg (gberg) Wed 26 Nov 08 15:27
Hi, Steve, and thanks for that kind introduction. Your second question first. I more or less begged my editor not to go with notorious. But, as he reminded me, they do have to earn my advance back. As for controversial. Two chapters of the book stand out. The story about brain death, a shorter version of which appeared in the New Yorker, ruffled many feathers. People objected to two things--first, to my characterization of brain death as an invention for the sake of organ transplant, and second to the chilling effect that telling people that brain death was an invention would have on organ donation. These are both hot button issues. To understand why, you have to know that brain death is a concept which says that when your brain is totally and irreversibly destroyed, when there is absolutely no activity in the brain (measured by blood flow, EEG, and other clinical signs), you are dead--even if your heart is beating and you are breathing(with a respirator). Back in 1968 when the concept was originated, doctors knew that they could say that there were certain kinds of comas, the kind that brain-dead people had, which were irreversible and that those people could therefore be withdrawn from life support without forfeiting the meaningful possibility of recovery. But that would mean they were stll alive until they stopped breathing and their hearts stopped, by which time their organs would be ruined. But if you made brain death the criterion not of withdrawing support but of actually declaring someone dead, then you could keep the patient on the respirator-and his organs viable--until the moment of harvest. You could, in other words, take the organs out of a living body without committing either vivisection or murder. So doctors--a committee at Harvard-- decided to move the line between life and death, to redefine death as the cessation of cerebral activity. THey tried to find some biological rationale for this, but what they came up with was really weak. To say that a brain dead person was dead was to make a legal/philosophical claim, not a biological one. It was really a brilliant move. Now imagine trying to redefine life (and therefor death)in post Roe-v.-Wade America. Or, for that matter, what happens to organ transplant if people start pointing out that it is really not a scientific concept. We actually know what happens, at elast to some extent. IN recent years, countries that have tried to redefine death as the death of the brain have found it harder and harder to do so. It's not just the right-to=lifers who complain. It's anyone who worries about the coarsening of our attitude toward life. ANd then imagine what happens to organ transplant without brain death. Which is what the people who objected to my article were imagining. They would prefer that their spin on it,which even they acknowledge was fundamentally deceptive, go unchallenged.
Gary Greenberg (gberg) Wed 26 Nov 08 15:31
As for the depression chapter, that first appeared in Harper's and elicited spirited debates with Peter Kramer and other depression doctors on national radio and Canadian television, and some of the most hateful mail I've ever gotten in my life. You can't question the idea that depression is a disease that should be treated with antidepressants without people accusing you of wanting to deprive patients of their medicine, or of wishing suffering upon them. And because the arguments to be made about depression as a biological disease of epidemic proportion and about the drugs as effective cures are so weak, the arguments are nearly all ad hominem. The only thing they can do is challenge my integrity or intentions, because when we talk science, they don't have much to say.
Gary Greenberg (gberg) Wed 26 Nov 08 15:36
Sorry, by the way, for the delay. I was on KGO radio this morning, the Ronn HOward show. It was sort of like getting interviewed by Fred Flintstone--an affable, hairy, round guy. During the first commercial break, he said, "You know what the secret to a long marriage is?" I said no. He said, "Zoloft." Then he said, "In my family, we all sit down to dinner at the same time. It used to be that my wife would say at least two things that really pissed me off. But since the Zoloft, she says the same things, but it doesn't matter." I didn't ask if the wife's name was Wilma.
Linda Castellani (castle) Wed 26 Nov 08 16:09
This sounds like a fascinating book. I'm looking forward to this discussion, particularly the part about depression. Did Ronn say what those two things were?
Gary Greenberg (gberg) Wed 26 Nov 08 16:15
No. I got the impression it was a different two things every night.
Steve Silberman (digaman) Wed 26 Nov 08 16:16
Gary, it seems to me that one of the meta-themes of your book is what the poet John Keats called negative capability: "when man is capable of being in uncertainties, Mysteries, doubts without any irritable reaching after fact & reason." I've heard negative capability talked about as one of the hallmarks of maturity -- to be able even to hold two contradictory ideas in mind, while resisting the urge to either conveniently void the truth of one or boil the whole situation down to an oversimplification that does not do justice to the richness of the situation. Certainly, the Bush administration seemed to have almost declared war on negative capability, seeing doubt and nuance itself as suspect. It feels to me like America might be entering a new phase, of being able to embrace nuance as necessary for solving some of the hard problems we're facing as part of a global society. Forgive me if this is just drift, Gary, but while reading your book I thought a lot about your ability to hold contradictory ideas -- even about life and death -- in mind without "irritably reaching" for an easier (non)solution.
Steve Silberman (digaman) Wed 26 Nov 08 16:20
If you don't mind telling us, how did you first get interested in the case of the Unabomber, and what effect did your correspondence with him have on your life? And another, riskier question: Reading your chapter on him, one can't help but feel that you not only empathize with Kaczynkski, but even identify with him in some ways. Is that so? And how much of our labeling of people as "crazy" or "schizophrenic" or "monstrous" -- and he clearly did things that were monstrous -- do you think is to cut off this kind of empathy and identification?
Gary Greenberg (gberg) Wed 26 Nov 08 16:36
"The test of a first-rate intelligence is the ability to hold two opposing ideas in mind at the same time and still retain the ability to function. One should, for example, be able to see that things are hopeless yet be determined to make them otherwise."--F Scott Fitzgerald. YOur comment on negative capability is spot-on. And you have gotten to one of the reasons that I've been interested in this topic, which is that the disaster of the last eight years was set in motion and kept alive by a kind of singlemindedness, certainties piously held--the exact opposite of what Keats had in mind. It turns out that science, when it is an ideology as opposed to an epistemology or method, can easily be recruited to the side of the pious. As Gans would say, Who;s gonna save us from the saved? Especially when they can claim that science is on their side.
Steve Silberman (digaman) Wed 26 Nov 08 16:45
Indeed. I'm curious who your personal writing heroes are -- the folks who inspired you to tackle head-on such difficult, hot-button issues without flinching? (I also want to say that I just adored the writing in The Noble Lie, and laughed outloud at perhaps the most subtle Zen-inspired pun I've ever seen, when you mention "a finger pointing at the mood.")
Gary Greenberg (gberg) Wed 26 Nov 08 17:04
I;m gonna defer the Unabomber question. I'm about to get treated to a vinyl version of Patti Smith's Twelve, played on a really excellent stereo. As for writing heroes, my biggest is Stanley Elkin. The most fearless writer ever about illness. He never saw a taboo he didn't want to violate--not for mischief's sake, but because behind the taboo was always something deep and moving and disturbing.
Cogito, Ergo Dubito (robertflink) Wed 26 Nov 08 19:31
Gary and Steve, thanks for the discussion thus far. I'm looking forward to getting the book and more of the discussion. BTW, at our local "Socrates Cafes" I think we may be experiencing some of this "negative capability". Commonly, we investigate a selected question without any attempt to drive to an "answer" or consensus. This leaves us free to wonder about aspects of the question including embedded concepts, inherent assumption, internal contradictions, etc.. As we are not looking for answers there is little conflict to distract us as we explore questions arising from the question. A meeting is deemed a success it we leave with more questions than we started with.
Steve Silberman (digaman) Wed 26 Nov 08 19:39
Alas, I've never read Elkin. Thanks for the tip! Gary, while I was reading your book, I came across this New York Times article about parents of kids diagnosed with ADHD who encourage them to identify with Olympic swimmer Michael Phelps, who was also diagnosed: http://www.nytimes.com/2008/11/25/health/25well.html?_r=1 It seemed relevant to the parts of your book that talk about how certain behaviors have been turned into diseases, and beyond that (and more positively, in a sense), into _identities_. People don't just drink excessively, they're alcoholics; they don't just have sex with members of their own gender, they're homosexuals, following the dictates of genetically determined and binarily defined sexual orientation. As someone who is legally married to a same-sex partner -- at least until Proposition 8 really kicks in! -- I've thought a tremendous amount about the social construction of sexual orientation, and I really respect you for putting that under your microscope, even if you risk pissing off both the homophobes and the gay-rights forces who are pushing the notion that sexual orientation is genetically determined. To me personally, the flipside of claiming that sexual orientation is genetic is a kind of whiny "we can't help it, so don't bash us!" subtext. That's not to say I disagree with the genetic hypothesis, but I'm aware of the danger of pinning equality on a diagnosis, to say it perhaps overly bluntly. I thought your discussion of how homosexuality was deleted from the DSM as a disorder was fascinating, and I was absolutely chilled by your line, "although it is always possible that further research into sexual orientation, coupled with a shift in the political climate, could lead to re-diseasing [homosexuality]." There's plenty to discuss re: the gay stuff alone, but I wanted to talk about the larger issue of behaviors or symptoms becoming identities. Obviously, that's done a lot of good in the world: millions of people have extricated themselves from the hell of alcoholism by walking the 12 steps; some kids who would have been shut away as simply "retarded" in previous generations are now recognized as autistic with high intelligence, and can even take pride in being "non-neurotypical." But what are the dangers in turning behaviors into identities?
Steve Silberman (digaman) Wed 26 Nov 08 19:39
That's wonderful, Robert.
Kurt Sigmon (kdsigmon) Wed 26 Nov 08 21:30
Gary, your book subtitle is 'When scientists give the right answers for the wrong reasons'. Starting with the introduction, the examples focus on medicine. Is this actually a problem with science in general as it is practiced? Are you looking at other scientific arenas for future work?
Gary Greenberg (gberg) Wed 26 Nov 08 21:55
Here again, this was my publisher's idea, and while I was not crazy about it, I didn't go to the mat about it either. I think the book is about medicine, but to be fair, the problem it describes is not unique to medicine. The use of science as an ideology--scientism, let's call it--is just easiest to see when its power is exercised in the human domain, which is what medicine does. I haven't studied this closel, but I do think that some of the scientific evidence mustered in support of global warming as a man-made phenomenon is less definitive than it ought to be. Some of what we know about the way the climate could be accounted for by long-term climatic variation, but we don't hear much about that. In some respects, climate change is only the confirmation of something that many people (I'm probably one of them) have been feeling for a long time, certainly long before we ever heard the words "greenhouse effect": that there is something really wrong with the way technology reshapes the natural world and ourselves. It's nice to have science confirm your deepest beliefs, so nice that it's very tempting to make it your ally even when it's not quite.
Gary Greenberg (gberg) Wed 26 Nov 08 22:00
>But what are the dangers in turning behaviors into identities? Most immediately a disengagement from the process of creating an identity in favor of having already found one. That's why it's disturbing to me that according to the addiction model, you are always an addict: because for they rest of your life, that's who you are. And in the case of depression as a chronic disease, the danger is that you become dependent on the drug companies for the rest of your life. Which is not as unlike addiction as they would like you to believe. Finally, I'd mention that when your identity is based on some biochemical process gone wrong inside your body, you are that much less likely to look to your social and political world to account for yoru suffering, and to act on those worlds to relieve it.
Andrew Alden (alden) Wed 26 Nov 08 22:00
Scientists giving the right answers for the wrongs reasons is a powerful subtext in climate-change/global warming science today.
Steve Silberman (digaman) Wed 26 Nov 08 22:47
Gary, did you change your mind about anything big in the process of writing the book? Was there something that you thought was incontrovertibly true that you came to doubt?
Gary Greenberg (gberg) Thu 27 Nov 08 06:05
So many good questions, so few fingers. >Reading your chapter on him, one can't >help but feel that you not only empathize with Kaczynkski, but even >identify with him in some ways. Guilty as charged. What fascinated me about Kaczynski, or at least one thing that did, was how much sense he made. And that was really disturbing. I never thought that random murder was anything but evil, but on the other hand at least he was doing something. He hadn't just retreated into some kind of ironizing fog, the kind that most of us live in, in which, like him, we see that something is terribly wrong here but can't or don't do anything about it. He just couldn't muster the bad faith that the rest of us have cultivated. I was reminded of this a few months ago when I went to see Laurie Anderson's recent song cycle "Homeland." It's a beautiful, haunting piece about all that has unfolded since 9/11, all the ways in which we are all implicated in terror. She performed it in a beautiful theater in New York to an appreciative crowd. We laughed and clucked our tongues and nodded knowingly and clapped appreciatively as she narrated the ugliness of the last seven years. But then it occurred to me that we would all leave this beautiful theater and go back to our ironizing fog, that no one was going to trash the stupid shopping mall on the floors below the theater, no one was oging to heave a trash can through a window, no one was going to mass in the streets and demand that the horror end, that all our rage was being channeled into entertainment. She was playing the violin at that moment, and I wondered if this was our equivalent of Nero fiddling while Rome burned--not that she was a dictator, but that even protest had become a distraction. That's waht Kaczynski refused (or was incapable) of doing: distracting himself from the contradictions and atrocities of the society he lived in. And even after he separated himself from it, it continued to torment him. AN airplane flew overhead and he felt all the implications of the airplane--the environmental and political and social depredations that it embodied. ANd I knew that feeling, because I'd done the cabin-in-the-woods thing for a few years. I knew you just couldn't get far enough away. And I think many people feel that way. Which is why Kaczynski had to be "othered" so quickly by getting diagnosed as a schizophrenic. Which he definitely was not. Tjhe diagnosis attenuated the identification. It made his protest less disturbing. And it did one other thing. The diagnosis covered up the fact that Kaczynksi, whatever his motives, was evil. Evil is a very disturbing thing.
Gary Greenberg (gberg) Thu 27 Nov 08 06:10
Of course, the weird thing about the Kaczynski caper is that I first approached him because I wanted to write his biography. It was a frank attempt to capitalize on his celebrity. He ended up saying no, but the correspondence between us became the basis of a long article in McSweeney's. That article ran in the issue that came out juswt as Dave Eggers, the editor, was getting famous for his Heartbreaking Work of Staggering Genius. And it seemed that every time he got interviewed and asked about McSweeney's, he mentioned my article, which was the longest piece in that issue. Which for a moment raised my profile, at least enough so that the next thing I knew I wasw writing an article for the New Yorker. So I owe it all to Ted Kaczynski.
Gary Greenberg (gberg) Thu 27 Nov 08 06:19
Another inspiring writer--Francine Prose. Again, fearless and relentlessly articulate and deeply in love with language, just the sound of the written word whispering in your head. And not afraid to go where she shouldn't. Her novella Guided Tours of Hell, about a tourist trip to a concentration camp, is an excellent example of transgressive writing. It reminded me of Stanley Elkin's Magical Kingdom, which is about a group of terminally ill kids who go on a last wish trip to Disney World, and in which he never sentimentalizes their illnesses, never flinches from describing them, and insists on showing us how the sick children are just as confused and cruel and inhumane as everyone else, and then somehow spins the whole thing into a meditation on the politics of death and dying. And George Saunders. Oh my god. To write like George Saunders.
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