I won't analyze Hubbard, but I'll give you my opinions on scientology.

In this and future postings I refer to scientology as a company, as it has been established here, by a member, that scientology sells a product (spiritual well-being). It is also an elaborate con, so my terminology mixes con and corporate speak.

By the way, dissecting a confidence game is a quick, enjoyable lesson in psychology. Con games and victims' responses make excellent case studies.

The mechanisms by which scientology lures and hooks prospective marks are common to all confidence games. The initial hook is the least efficient part of the scheme because it's left to amateurs for training purposes. Scientology is built to be a volume business: have the amateurs get as many marks in the door as possible. The personality test and free movie are scientology's way of sizing you up. If you look like trouble, you get booted. If you try to walk at this stage, they'll more or less let you go (after trying to sell you a $50 book).

To get in, you have to be right for the game: some combination of curious, gullible, insecure and misfit. If you look right, you're routed to more experienced intake handlers.

Scientology feeds curiosity with its strange-looking e-meter. Its toy- like shape and color are by design. People see the e-meter and want to touch it, play with it. They want to see the needle go "whoops" and watch the blinky lights. The soup can electrodes are meant to look silly. The whole gimmick is engineered to be disarming, unintimidating, even funny. You're turned (graduating from mark to fish) when you stop thinking "what a goofy-looking hunk of junk" and start thinking "this toy couldn't actually work, could it?"

Imagine you walk into a crowded building. Someone hands you a laughable toy, a cheap plastic ray gun. He whispers to you "it's real, but you and I are the only ones who know." The man who gave you the ray gun has one, too. He points it at somebody and pulls the trigger. They clasp their chest in agony and crumple to the ground. Laughing, you choose someone in the crowd and "shoot" them. You're surprised and amused when they fall. You shoot another random person; he falls dead. Oh, okay, he's in on it, too. Wait, here's someone who just walked in--surely she's not in on the gag. Hey, lady! Zap! She dies, too. You shoot another, and another, and another. They're all dead, motionless, victims of your secret death ray. It strains reason to think that every person in the crowd would pretend to be shot by a toy. So maybe it's real.

If a con artist can get you to "maybe," you're toast. Or fish.

The first session is structured to build an air of mystery around the device and awe for the operator's apparent facility with it. The desire to master the instrument and the "tech," to best the teacher, draws the fish in to the stage where he's willing to spend serious money.

The course materials promote a sense of superiority over those less advanced. It's a self-sustaining system of intense competition (think "win") amongst the participants, all of whom are being conditioned to spend every dime to squash each other (by ratting them out), learn more tech and advance in the game. You're taught to value yourself over all others, and to indulge your selfishness even at the cost of separation from those you love.

Old con credo: when you can get someone to give up the thing that's most important to him, you own him.

Anything that doesn't advance you in the game becomes optional: love, children, work, friendship, food...if you slip up and forget that getting to that next level is all that matters, you're systematically humiliated (by people who advance for humiliating you) until you crave the tiniest bit of praise. Forgiveness is withheld until you're desperate for it. When you are allowed back in, you get a high from being restored to humanity. It feels like progress or growth, but in fact the con relies on knocking you back to zero every time you start to feel good. That's built into the tech. You are kept in the game until it's clear the company can extract no more money from you.

Even if you come to believe the teachings are bogus, you can't extricate yourself because the high from the competition is too intense. It's only when the cost of competing (emotional, not financial- -addiction feeds itself until all resources are consumed) exceeds the euphoria from competing that people think of blowing. Of course, that's when the company shifts strategies to fear and intimidation. If it can't keep you inside, it'll make damn sure you don't tip the game to any potential marks.

When you get to what you were told is the last level, they reveal new, "special" levels. Only really special people, so much clearer and better than those beneath you, can learn this tech. Oh, but if you think it's too expensive I can just give it to Jack over here...

You never cross the bridge.

It's a clever scheme, but it relies on secrecy and gullibility, commodities that scientology finds in decreasing supply. Hubbard's so- called "tech" is terribly dated. If scientology doesn't bring its pitch up to modern standards, it won't be able to attract new marks to the game. The retro-sci-fi thing worked while tie dye and bellbottoms were back in vogue, but we're done with the 60s (again). I'm interested to see if the company has the imagination to repackage its product for the modern age.

The company faces an interesting dilemma. To modernize, it has to update its tech. Trouble is, Hubbard wrote into his tech that "the tech cannot be changed except by me." That would be a neat trick. If the company changes its tech, the fish already in the game will freak out and blow. We've already seen how scientologists go nuts when management attempts to make even the tiniest change.

Can't change, can't stay the same. Quite a pickle. I'm glad I don't run the joint.

First, I accidentally left "intelligent" off the list of qualifying attributes. If you're not smart, you'll be frustrated by Hubbard's mumbo-jumbo tech rather than intrigued by it.

I left out an important piece of the ray gun analogy. Half of the people in the crowd are in on the gag, while the other half has been conditioned to believe your ray gun actually kills them.

At the top of any game like this are the ones driving the game and skimming the cash. They don't buy one word of the tech and couldn't possibly think less of the fish below them who believe it. The people at the top have more regard for roaches than for the rank-and-file scientologists.

Who's at the top? I think anybody who escapes the reward/humiliate cycle has graduated to managing the con. Someone has to corral the suckers, and you can only trust sucker trustees so far in that job.

Throw some blood in the water, see which fish go for it, and cultivate your sharks from that group. Give them a taste, figure out which ones you can trust, and slowly let them in on the con.

What trips up these criminals is their narcissistic belief that all people not involved in running the game are idiots (marks). The game can never be found out, you see, because nobody outside the game is that smart. All the smartest people in the whole universe are right here, running this con with me. That attitude breeds complacency.

Whatever brilliance built up the game to begin with gives way to greed and infighting, and eventually the demise of the game.

It's best to get in, make your money, and break up the con before it starts to feed on itself. I wonder if it's too late.

--- Beck, Sokol, Clark, Berchick, and Wright[19] examined the short- and long-term effects of a focused (12-week) course of cognitive therapy (CT) for PD. The authors also used an 8-week brief supportive psychotherapy (BST) group (that was based on Carl Rogers' nondirective therapy) as a comparison group. Using both clinician ratings and patient self-ratings, they found that the focused CT accomplished significantly greater reductions in both panic symptoms and general anxiety after only 8 weeks of treatment. Both groups experienced a significant decline in their depression scores over the first 8 weeks of treatment.

At the 8-week point, 71% of the CT group were panic-free, compared with 25% of the BST group. After 12 weeks, 94% of the CT group were panic- free. At 1-year follow-up, 87% of the CT group remained panic-free and continued to have significantly lower scores (compared with their pretreatment scores) on all of the assessment measures used in the study (eg, Beck Depression Inventory (BDI), Beck Anxiety Inventory (BAI), Specific Fear Inventory). Based on these results, the authors concluded that: (a) panic attacks are particularly sensitive to cognitive (or cognitive-behavioral) interventions and (b) because of the relatively low rate of relapse and absence of side effects, CT offers a promising, nonpharmacological alternative for the treatment of PD.

Côté, Gauthier, Laberge, Cormier, and Plamondon[20] examined reduced therapist contact in the CBT of PD. The participants in this study were assigned to either 17 weeks of therapist-directed or reduced-contact treatment. In the reduced-contact group, treatment was self- administered over 17 weeks with a manual and limited therapist contact (7, irregularly scheduled meetings at the clinic and 8, brief, irregularly scheduled telephone consultations). Both methods of administration produced significant and comparable improvements on all of the outcome measures.

For frequency of panic attacks, there was a significant reduction from pre- to posttreatment, with no significant changes beyond the posttreatment period. For apprehension of panic attacks there was a significant improvement from pre- to posttreatment, from posttreatment to 6 months, and from posttreatment to 12-month follow-up. At posttreatment, 90% of subjects in the therapist-directed group and 82% of subjects in the reduced therapist-contact group were panic-free. At a 6-month follow-up, 90% of subjects in the therapist-directed group and 91% of subjects in the reduced therapist-contact group were panic- free. At a 12-month follow-up, 100% of subjects in the therapist- directed group and 91% of subjects in the reduced therapist-contact group were panic-free.

Significant improvements were also found for both groups on a measure of mobility and agoraphobic cognitions, on a measure of fear of bodily sensations, and on 3 measures of perceived self-efficacy. Treatment credibility and expectancies were high in both conditions, and no significant differences were found between the groups. While there were no significant therapist effects found, the reduced therapist contact was determined to be significantly more efficient (percentage of improvement on each panic attack variable divided by the total therapist contact time) than therapist-directed treatment in reducing the frequency of panic attacks (from pre- to posttreatment, from pretreatment to the 6-month follow-up, and from pretreatment to the 12- month follow-up).

Therefore, Côté and colleagues[20] concluded that their findings support the notion that panic disorder can be successfully treated with CBT, using either the traditional therapist-directed approach or reduced therapist contact, and that both procedures can have long- lasting effects. In this case, the therapeutic effects for both treatments were clinically as well as statistically significant. At posttreatment follow-ups, the percentage of panic-free subjects ranged from 82% to 100%, and half of the subjects who were not entirely "panic- free" after the treatment had only 1 panic attack during the follow-up assessment period (which was longer than normal in this study).

SCIENTOLOGY RELEVANCE: scientology believes disease is a state of mind (reference Jenna Elfman's infamously heartless comment about AIDS).

Only by clearing thetans through auditing can one successfully treat disease. That's pretty cold--they don't unhook you from the cash siphon even when you get sick. If only scientology works, where are the company's independently-verified statistics on its successful relief of Alzheimer's symptoms?

--- Of the 699 patients in the 26-week, B 352, multicenter, double-blind, placebo-controlled rivastigmine trial, 532 (76%) continued in an extension study.[41] In the initial 26-week study, patients on placebo had deteriorated by a mean of 4 points on the ADAS-Cog, while patients on rivastigmine 6-12 mg/day were still 1 point above baseline. In the extension study, all patients, including those in the placebo group and both treatment groups, were flexibly titrated to their maximum tolerated dose of rivastigmine, and followed for another 26 weeks. By 40 weeks, ADAS-Cog scores of patients in the original placebo group who started rivastigmine at 26 weeks had improved by a mean of 2 points, while patients on higher-dose rivastigmine continued to maintain scores almost 1 point above baseline (Figure 7). After 40 weeks, declines were seen in all groups; however, patients from the original placebo group never achieved the level maintained by subjects continuing on high-dose rivastigmine who had started the drug 6 months earlier. A significant difference of 2 points on the ADAS-Cog remained between these groups at the end of the study. The data suggest that the drug may benefit cognitive functioning for up to 52 weeks but that delays in initiating therapy may reduce these benefits.

Some independent long-term care facilities have misused restraints. Now such facilities will lose their accreditation (forcing them to shut down) if restraints or seclusion are applied contrary to these standards.

Psychiatrists have long been subject to laws governing the application of restraints and seclusion. It's simple: you use restraints and seclusion in emergencies when the patient is a serious, immediate physical hazard to himself, other patients or staff. Use them for any other reason and you lose your license, plus you get hauled to court to face federal civil rights violations. These rules now make independent facilities beholden to the same standards. This is long overdue.

SCIENTOLOGY RELEVANCE: Psychiatrists have been fighting the powerful long-term care and insurance lobbies on the restraint issue for years.

We finally won; the rules take effect in 2001. Isn't it odd that our task force should fight so hard against the use of restraints when scientology insists we love strapping patients down?

--- This special Joint Commission standards development initiative was undertaken to address growing concerns about the inappropriate use of restraints and seclusion in psychiatric and other behavioral healthcare facilities. A special Board of Commissioners Task Force that included behavioral healthcare professionals and patients' advocates was established, and the standards revisions were developed with its guidance. Individuals who had been in restraints or seclusion and their families, as well as expert behavioral healthcare professionals, provided important testimony during a series of national public hearings held by the Joint Commission during 1999. The Joint Commission also sought the opinions of other healthcare experts; obtained input from accredited behavioral healthcare organizations; and reviewed the relevant literature.

A draft of the revised standards was made available on the Internet for review in late 1999 and was distributed to professional associations, consumer groups, government agencies, all organizations that are accredited under the Comprehensive Accreditation Manual for Behavioral Health Care (eg, residential treatment facilities, partial hospitalization programs) and all organizations accredited under the Comprehensive Accreditation Manual for Hospitals that are freestanding psychiatric hospitals or have inpatient psychiatric units.

Now to the subject at hand. A scientologist posted a short message condemning the use of end-of-life palliative care. Obviously the poster has never watched anyone die. This isn't some fantasy planet where old father Hubbard protects his children from all suffering. You and everyone you care about is going to die, and dying HURTS.

All psychiatrists are MDs who worked as hospital residents for several years. We know more than we care to about death. Let me tell you about the unmedicated death that scientology would have you endure in the name of noble freedom from narcotics.

What follows is extremely graphic; please tune out if you have a weak stomach.

Instant, "lights-out" death (e.g., burst aneurism, massive stroke, sudden cardiac failure, violent spinal compression above C-5) is extremely rare. Your chances of a quick, quiet or painless passing are fewer than 1 in 100,000. Most humans take several days, sometimes several weeks to die, and we're awake and aware for the entire process.

A cancer patient once told me that dying felt "like some wild animal is devouring me from the inside." Multiple organ failure and edema brought about by heart failure or pulmonary insufficiency (e.g., emphysema, lung cancer) is just as painful.

The pain of death is more agonizing than anything else we experience in life, and it does not subside. It is also terrifying. Morphine is the most effective painkiller and calmative man has devised. Morphine's primary and inescapable side effect is respiratory depression. Those caring for the dying must choose between relieving the patient's extreme pain and wrenching anxiety, or prolonging their life. That choice comes up every 3-4 hours when the prior dose of morphine wears off. As death nears, the liver and kidneys fail and morphine (indeed, all substances including normally beneficial fluids) and its metabolites accumulate in the body. Every substance that can bring you comfort turns toxic when your body loses its ability to clean your blood.

Most deaths are due to a combination of disease-related oxygen starvation and morphine-induced respiratory depression. Morphine hastens death (usually by hours), but it alone brings calm and comfort to the dying. Even at the end, there is no free lunch.

When painkillers are withheld to prolong life, the body will pass the stage civilized society considers "natural death" (aided by morphine).

It quickly progresses to frank decay. Cells die from lack of oxygen, producing gangrene. Gastric/bowel perforation and abdominal cavity sepsis ensue. Bacteria and parasites, always present in your body but kept at bay by your immune system, turn ravenous as nature designed.

Because the brain is usually the last organ affected--the body will sacrifice every other system to keep the brain alive--you get to witness your own decomposition. And no, the pain does not lessen even at this stage.

Believers in palliative care hold that dying patients deserve relief from all suffering, using the best and safest means at our disposal. By the time doctors start your morphine, all less potent methods to control your pain have failed. We recognize that palliative care hastens death. The alternative is inhumane in the extreme.

When the end comes for me and for those I love, I pray our care will be in the hands of skilled, compassionate practitioners of palliative care. A scientology-approved death, racked with noble and holy pain, surrounded by transfixed patrons reading Hubbard aloud, is my vision of hell.

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