Saturday, December 21, 2013

Review of Cracked by James Davies

So I’ve now read James Davies’ Cracked: The Unhappy Truth about Psychiatry

While I’d read the Amazon sample and the chapter available at Salon, I was wary of the book because of some of Davies’ writing about suffering that I’d found online. I’d read several similar books, and didn’t want to waste my time on one contrasting biopsychiatry with some “positive” Christian vision. My concerns were eased sufficiently by Davies’ response to a review of the book by Andrew Solomon for me to take the time to read it.*

Cracked covers a lot of the same territory as other recent books critical of biopsychiatry and corporate psychopharmacology. In fact, Davies, a British anthropologist and psychotherapist, interviews several of the authors whose works I’ve discussed here - Irving Kirsch, Joanna Moncrieff, Pat Bracken, Ethan Watters,… - as well as some other interesting people (e.g., Paula Kaplan, who describes her opposition to the insertion of Masochistic Personality Disorder in the DSM-III). He also talks to the heads of the DSM-III and –IV task forces, Robert Spitzer and Allen Frances; former president of the APA and director of NIMH, Herbert Pardes; and Sue Bailey, current president of the Royal College of Psychiatrists; among others.

The interviews are probably the book’s best contribution. Davies asks the right questions, and receives some shockingly candid answers. He does a good job of recreating his own stunned reactions to the admissions of some of the top figures in psychiatry about the scientific vacuum at the center of the model. I knew about this going in, and even about the extent to which it’s acknowledged, but I was still taken aback when reading some of their statements.

I think this is why I’d probably now recommend this book first to people who haven’t yet read much or anything on the subject. Biopsychiatry’s basic premises are so widely accepted that when we’re first confronted with the overwhelming evidence against them we’re incredulous. “The chemical imbalance thing isn’t true?! Surely you mean it’s just part of the story…” After the reality has sunk in, though, it becomes easy to forget how new and strange and dubious this all sounds to those who haven’t seen the evidence. So Davies’ narrative inclusion of his own surprise and disbelief as he gradually discovers the reality about biopsychiatry could help people to be more open to learning about it.

Most shocking, of course, is how little biopsychiatry and psychopharmacology have to do with science, and how they in fact use the language and appearance of science to hide what’s really going on. The creation of diagnoses through voting and consensus and in response to corporate or social pressure, the secrecy, the manipulation of research, the suppression of data, the constant claims of future scientific vindication, the ignoring and spinning of unwelcome findings, the arguments from authority and popularity,… - none of this has anything to do with science, except to provide an example of what science is not. Ben Goldacre suggests that his arguments about the corruption of medicine by pharmaceutical corporations are general and not specific to any specialty, meaning that in theory it’s all redeemable through reforms. But biopsychiatry is special. There’s no scientific core to corrupt – as Davies’ and so many other works show, and as so many of the field’s leaders admit, it’s fraudulent at its very heart.

Cracked is, like several other books I’ve talked about here, primarily a critical work about biopsychiatry and psychopharmacology. And of all of the books and articles I’ve mentioned, it provides the best overview, synthesizing the other arguments and evidence within a general framework (another reason to recommend it to someone new to the topic). But, like so many others, Davies also devotes some of the book to the social and historical meaning of the rise of biopsychiatry and to advocating constructive paths beyond it.

As I’ve said, I don’t think this is necessary or that writers should feel obliged to provide it. In this case, though, despite the wariness I mentioned above, I was hoping for it. Since Davies is an anthropologist, I thought anthropological insights – about people in the field/industry itself and about its relation to the rest of the culture - would be the book’s most original and distinguishing feature. As it turned out, if I hadn’t known of his profession before I read it, I’d never have guessed it from the content. Though the discussion was interesting and my worst fears weren’t realized, it offered little beyond what others have said elsewhere.

The better aspects are found in the more critical portions. When it came to alternatives, though, the section was fairly disappointing. Davies’ general take, like that of several of his interviewees, is that (bio)psychiatry had filled the void left by the destruction – intentional or otherwise - of older social, especially religious, myths about the world, well being, and suffering. While this is true in one sense, his presentation suffers from two significant flaws. First, he mentions but then proceeds to ignore an entire tradition of secular political-humanist-liberation thought. He seems to be influenced by Jung (and some other strange choices), but where’s Erich Fromm? Where’s Ignacio Martín-Baro? Karen Horney? Albert Camus? Where are the anarchist, socialist, feminist, existentialist, anticolonial, environmental, and animal liberation thinkers who’ve written about these questions?

This picture of traditional-myths-versus-modern-pseudoscience gives the impression that our choices are pretty narrowly circumscribed,** which in turn can lead to fearfulness about rejecting the traditional myths. And Davies steers very close to the idea that psychological arguments are to be respected and valued not on the basis of their correspondence with reality but according to their presumed individual or social usefulness - not “is it true?” but “Does it help someone feel better and/or lead to positive individual or social action?” This is an argument I roundly reject, in this as in all other areas.

On top of being unnecessary (because reality-based alternatives exist!) and just plain wrongheaded, the instrumental attitude toward myth and falsehood undermines the critique of biopsychiatry at the center of the book. The same arguments with which Davies responds to those who would criticize him for calling people’s attention to the placebo mechanism of so-called antidepressants or to the pseudoscientific nature of biopsychiatry more generally could be turned against him: If it helps people, why shouldn’t they accept it? Furthermore, it provides ammunition for the stupid argument about how we need to continue to prop up biopsychiatry because its collapse would usher in a relativistic chaos in which any understanding of psychological distress – even other harmful, oppressive, reactionary ones – would have to be considered valid.

Despite these issues, though, Cracked as a whole is very worthwhile, and, like I said, I would put it at the top of the list for people interested in but not yet familiar with scientific (and social) criticism of biopsychiatry. It’s a good general, synthetic book, and very readable without being oversimplified. His personalized narrative should make the arguments more approachable, and the interview portions make it all the more interesting. At the end of the book, Davies describes asking Peter Breggin about how positive change will come about:
‘I think we need braver journalists and authors, dissident psychiatrists and psychologists’, answered Breggin. ‘This has got to be an educational movement, a political movement we need grassroots disillusionment among professionals, among consumers, and the sciences. From this we can only hope there will be manifested new kinds of organizations, research, and journals’.

Could this be the route to reform, then – a reliance on us? From everything I have learned from my encounters, I have to say as inadequate as this solution feels, it may well offer the most hope in the coming years.
I couldn’t agree more, and this work is a solid contribution to that project.

* He writes:
Stranger still is Solomon’s statement that I believe people, with respect to suffering, ‘should do more of it’. This is another example of Solomon misrepresenting my position: in my clinical experience many forms of suffering that are currently dismissed as medical disease are not disease at all. Rather are they often a call to change; the organism’s protest against inhospitable social or psychological conditions. Therefore, rather than turning to anesthetics as a first response there is often value in working through our suffering productively – trying to discern what it is seeking to communicate so that we can work to put things right. There is nothing in this view that either glamourizes or masochistically encourages suffering. I merely argue what my clinical experience has taught me; that it is oftentimes better to face ones suffering and work through it productively than have recourse to anesthetics.
** To be sure, as described in the note above, Davies does emphasize “working through our suffering productively,” individually and collectively, but he doesn’t discuss any larger frameworks through which this reality-based and constructive work can be understood.

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