Inkwell: Authors and Artists

    
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!
  

    
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.
  

    
(Thank you also, Dana and David, for setting up this conversation).
  

    
My pleasure.

(NOTE: Offsite readers with questions or comments may have them
 added to the conversation by emailing <inkwell@well.com> -- please
 put the author’s name in the subject line. Thank you!)
  

    
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?
  

    
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.
  

    
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.
  

    
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.
  

    

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?
  

    
No. I got the impression it was a different two things every night.
  

    
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.
  

    
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?
  

    
"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.
  

    
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.")
  

    
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. 
  

    
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.  
  

    
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?
  

    
That's wonderful, Robert.
  

    
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?
  

    
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.
  

    
>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.
  

    
Scientists giving the right answers for the wrongs reasons is a powerful
subtext in climate-change/global warming science today.
  

    
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?
  

    
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.
  

    
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. 
  

    
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.