Broad Use of Brain Boosters?

Use of drugs to enhance memory and concentration should be permitted, experts say.

By Emily Singer

Off-label use of stimulants, such as Ritalin, is on the rise among college students. Studies show that 5 percent to 15 percent of students use prescription drugs as study aids, and surveys suggest the practice may be common among academics as well. The trend has sparked debates over how and when these cognitive enhancers should be used. Military personnel routinely use stimulants while on active duty, but should that practice also be permitted among surgeons working long shifts? What about scientists working late nights in the lab? Or students taking exams?

A commentary appearing today online in the journal Nature advocates for broad access to brain-boosting drugs. According to the piece, written by a group of ethicists, psychologists, and cognitive neuroscientists, "cognitive enhancement, unlike enhancement for sports competitions, could lead to substantive improvements in the world." While opponents have argued that the use of performance-enhancing drugs is unfair and could undermine the value of hard work, the authors say that these drugs fall into the same category as more common efforts to increase brain function, such as drinking a cup of coffee, or getting a good night's sleep, and thus should be regulated accordingly.

One of the biggest concerns associated with broad access to these drugs is that people will feel pressured to take them to get ahead, or just to keep up. An informal survey conducted by Nature last year of 1,400 people from 60 countries found that 20 percent of respondents engaged in off-label use of drugs to enhance concentration and memory. Ritalin was the most popular, followed by Adderall. Both are prescribed for ADHD. The survey confirmed the potential for peer pressure; while 85 percent of respondents said that the use of these drugs by children under the age of 16 should be restricted, a third said they would feel pressure to give them to their children if others were using them.

The authors of the commentary also note that if cognitive enhancers are to be used more broadly, more extensive study of the risks and benefits of the drugs is sorely needed. The side effects of long-term stimulant use, especially in children, are not yet known. And the potential for dependence and abuse has not been well documented.

They killed their neighbors: genocide's foot soldiers

By Courtney Yager
CNN

Adolf Hitler, Pol Pot, Slobodan Milosevic. They are household names, infamous for masterminding genocide. But who were the foot soldiers who did the dirty work?

In many cases they were equally notorious in their communities because they were the friends, neighbors and co-workers of those they raped, slaughtered and buried alive.

Nusreta Sivac watched ordinary people become killers while imprisoned in a concentration camp in Bosnia.

She saw prisoners beaten beyond recognition and watched camp guards force a Muslim prisoner to rape a Muslim woman in front of everyone.

She was shocked to see people she knew running the camp. "They acted as if they had never seen me before," she said. "It was difficult for me to understand how people could turn into beasts overnight." VideoWatch as Nusreta tells her story »

While some perpetrators participate unwillingly -- they are forced to kill or face death themselves -- many ordinary people are manipulated into participating in the killing machine voluntarily.

Researchers say most perpetrators of genocide were not destined for murder and had never killed before.

"You don't have to be mentally ill or even innately evil or criminal. You can be ordinary, no better or worse than you or me, and commit killing or genocide," said Harvard psychiatrist Robert Lifton, who has studied Nazi doctors.

"The truth is that we all have the possibility for genocidal behavior."

Experts have reached a troubling conclusion: It was actually very easy for the architects of genocide to find more than enough ordinary people to do the killing.

Genocide is often the result of a "perfect storm." A country reeling from political and economic turmoil, a fanatical leader promising to make things better and a vulnerable population targeted for blame -- all combine in a blueprint for mass murder.

Architects of genocide use the same tools to execute their plan.

Group identity

Millions have been killed for being religious, ethnic or simply educated. Group identity is one of the foundations of genocide. This allegiance makes it easier for extremist leaders to stoke age-old animosities between groups.

"We all divide the world into 'us' and 'them,' " said psychologist Ervin Staub, author of "The Roots of Evil: The Origins of Genocide and Other Group Violence."

"Some people are like 'us' because of nationality, religion, race, etc. Those that are not like 'us' are 'them.' "

"Group identity intensifies during difficult times," Staub said.

Jean-Bosco Bizimana, a Rwandan Hutu, slaughtered his Tutsi neighbors 14 years ago. Leaders of the genocide exploited the history of hatred between the Hutus and Tutsis to pit them against each other. But before the genocide, the two groups had overcome their hostility to live peacefully together.

"We were manipulated," Bizimana said. "The government pushed us to kill. Before that, we intermarried, we helped each other in daily life and we shared everything. We ourselves can't even believe what happened."

Bizimana's wife said her husband, "would go around with the mob, and to show them he was part of it, he would kill."

Perpetrators don't want to be seen as weak, and in a mob mentality, individual guilt seems to disappear.

"People will do almost anything in a group and will do anything not to be rejected," said psychologist Philip Zimbardo, a professor emeritus at Stanford and famous for his 1971 Stanford Prison Experiment, which divided student volunteers into "prisoners" and "guards" and showed how easily people could be induced to commit sadistic acts.

"They give up a sense of personal accountability and diffuse responsibility to the leader."

Propaganda and dehumanization

Genocidal regimes use propaganda to incite hatred. During the genocide in Bosnia, for example, a fictitious news report said Muslims were feeding Serb children to animals at the Sarajevo zoo.

When people feel threatened and endangered, they can be led to kill. "Most genocides are shaped on [a perceived need for] self-defense," said Christopher Browning, a University of North Carolina history professor who studied a Nazi police battalion.

Bizimana said Rwandan government radio broadcasts led him to kill. "When instructions come from the government, we believed it was the right thing to do," he said.

"People tend to believe the world is a just place," psychologist Staub said. So the targeted group "is seen as though they did something to deserve the suffering."

The propaganda machine portrays the victim group as less than human. In Rwanda, the Hutus called their Tutsi neighbors 'cockroaches.' In Cambodia, the Khmer Rouge said their victims were "worms." To the Nazis, Jews were "vermin."

Dehumanization is the most powerful psychological tool used in all mass murder and genocides, Zimbardo said. "Dehumanization blurs your vision. You look at these people and you do not see them as human."

Instead, the enemy is treated as a germ -- as something to eradicate, or else face the threat of infection.

"Purification is at the heart of genocide," said Harvard's Lifton. "In that purification ... [the killers] are healing."

Recently discovered photos show Nazi officers at a retreat near Auschwitz relaxing as though they are taking a break from a routine job, not an extermination factory. "In order to carry out the function of killing, one must instill in that environment a sense of ordinariness," said Lifton. VideoWatch images of Nazis relaxing »

In the end, the masterminds of genocide see their visions play out: Foot soldiers carry out the mission and entire populations are displaced or killed.

Perpetrators and victims don't realize what they're involved in until it's too late, said Ben Kiernan, director of the Genocide Studies Program at Yale University.

"It's a conspiracy, a silent secret plan to set up a situation whereby the victims, who are unsuspecting, are brought into a conflict with a large number of people, many of whom are also unsuspecting," Kiernan said.

Looking back at their crimes, some perpetrators are now sorry for their actions, including Bizimana. "What we did to them in the past was very bad," he said. "Deep in my heart, I regret it."

Bizimana has since reconciled with his surviving Tutsi neighbors, and is trying to build unity in his country.

"What happened," he vows, "will never happen again."

1 in 5 Young Adults Have Personality Disorder, Study Finds

Tuesday , December 02, 2008

AP

CHICAGO —
Almost one in five young American adults has a personality disorder that interferes with everyday life, and even more abuse alcohol or drugs, researchers reported Monday in the most extensive study of its kind.

The disorders include problems such as obsessive or compulsive tendencies and anti-social behavior that can sometimes lead to violence. The study also found that fewer than 25 percent of college-aged Americans with mental problems get treatment.

One expert said personality disorders may be overdiagnosed. But others said the results were not surprising since previous, less rigorous evidence has suggested mental problems are common on college campuses and elsewhere.

Experts praised the study's scope — face-to-face interviews about numerous disorders with more than 5,000 young people ages 19 to 25 — and said it spotlights a problem college administrators need to address.

Study co-author Dr. Mark Olfson of Columbia University and New York State Psychiatric Institute called the widespread lack of treatment particularly worrisome. He said it should alert not only "students and parents, but also deans and people who run college mental health services about the need to extend access to treatment."

Counting substance abuse, the study found that nearly half of young people surveyed have some sort of psychiatric condition, including students and non-students.

Personality disorders were the second most common problem behind drug or alcohol abuse as a single category. The disorders include obsessive, anti-social and paranoid behaviors that are not mere quirks but actually interfere with ordinary functioning.

The study authors noted that recent tragedies such as fatal shootings at Northern Illinois University and Virginia Tech have raised awareness about the prevalence of mental illness on college campuses.

They also suggest that this age group might be particularly vulnerable.

"For many, young adulthood is characterized by the pursuit of greater educational opportunities and employment prospects, development of personal relationships, and for some, parenthood," the authors said. These circumstances, they said, can result in stress that triggers the start or recurrence of psychiatric problems.

The study was released Monday in Archives of General Psychiatry. It was based on interviews with 5,092 young adults in 2001 and 2002.

Olfson said it took time to analzye the data, including weighting the results to extrapolate national numbers. But the authors said the results would probably hold true today.

The study was funded with grants from the National Institutes of Health, the American Foundation for Suicide Prevention and the New York Psychiatric Institute.

Dr. Sharon Hirsch, a University of Chicago psychiatrist not involved in the study, praised it for raising awareness about the problem and the high numbers of affected people who don't get help.

Imagine if more than 75 percent of diabetic college students didn't get treatment, Hirsch said. "Just think about what would be happening on our college campuses."

The results highlight the need for mental health services to be housed with other medical services on college campuses, to erase the stigma and make it more likely that people will seek help, she said.

In the study, trained interviewers, but not psychiatrists, questioned participants about symptoms. They used an assessment tool similar to criteria doctors use to diagnose mental illness.

Dr. Jerald Kay, a psychiatry professor at Wright State University and chairman of the American Psychiatric Association's college mental health committee, said the assessment tool is considered valid and more rigorous than self-reports of mental illness. He was not involved in the study.

Personality disorders showed up in similar numbers among both students and non-students, including the most common one, obsessive compulsive personality disorder. About 8 percent of young adults in both groups had this illness, which can include an extreme preoccupation with details, rules, orderliness and perfectionism.

Kay said the prevalence of personality disorders was higher than he would expect and questioned whether the condition might be overdiagnosed.

All good students have a touch of "obsessional" personality that helps them work hard to achieve. But that's different from an obsessional disorder that makes people inflexible and controlling and interferes with their lives, he explained.

Obsessive compulsive personality disorder differs from the better known OCD, or obsessive-compulsive disorder, which features repetitive actions such as hand-washing to avoid germs.

OCD is thought to affect about 2 percent of the general population. The study didn't examine OCD separately but grouped it with all anxiety disorders, seen in about 12 percent of college-aged people in the survey.

The overall rate of other disorders was also pretty similar among college students and non-students.

Substance abuse, including drug addiction, alcoholism and other drinking that interferes with school or work, affected nearly one-third of those in both groups.

Slightly more college students than non-students were problem drinkers — 20 percent versus 17 percent. And slightly more non-students had drug problems — nearly 7 percent versus 5 percent.

In both groups, about 8 percent had phobias and 7 percent had depression.

Bipolar disorder was slightly more common in non-students, affecting almost 5 percent versus about 3 percent of students.