Wednesday, April 2, 2014

On quackery and compassion, and the case for speaking out

I’ve been writing about psychiatry in the science-based community now for about four years. I’m angry and frustrated that so little has changed.

On the one hand, I understand. I understand that people’s hostile responses are often based on mistaken interpretations of what I’m arguing, as I discussed in the note to my previous post.*

More broadly, I understand the feeling: “I’m struggling a lot of the time just to get through the day, I’m posting about my personal problems to connect with other people going through similar things and would just like some sympathy and support and thoughtful suggestions, and I don’t have the time or energy to deal with these large criticisms, which seem abstract and dubious, right now.” I do understand it, even though several years of trying to have my case heard has led to some reflexive anger, which sometimes emerges as sarcasm and probably gets directed at the wrong people.

But, while I appreciate this, there are two factors which can’t but come into play. First, the posts about psychiatry, including those about people’s personal experiences, implicitly or explicitly make what I believe to be false and harmful claims of fact about the validity of psychiatric diagnoses and about psychiatric drugs. Again, these are in my view pseudoscientific, quack claims. Obviously, expressing my compassion can’t take the form of agreeing with or condoning them. I can’t imagine that this would be in dispute in the community; I don’t think I’ve ever heard anyone seriously argue that they should be indulged in any other circumstance.

Some people would probably argue that in this case, then, the compassionate response is silence (though even Greta Christina has exempted quackery, so maybe not). I’ve sometimes gone that route, or remained quiet until the second or third post on the subject. I don’t know that this is either considerate or moral, though, and I’m ambivalent about it. I would want to know if I was making decisions on the basis of pseudoscience. Furthermore, the information that biopsychiatry is pseudoscience is positive, in my view. You’re wrestling with your diagnostic label and concerned about possibly having to remain on psychiatric medications indefinitely? The good news is that the label is scientifically invalid and, well, those aren’t medications.**

I would also want to know if I was promoting pseudoscience, even though it might be hard to hear. This is where the second factor comes in. Our community has, slowly, become more attuned to the problem of privilege, more willing to recognize how even in our own struggles against oppression we can unknowingly harm others. I am, I admit, angry that so many bloggers don’t seem to realize how privileged they are to have a choice (relatively speaking) about accepting a psychiatric label, a choice about whether to enter a psychiatric facility, a choice about whether or not to take psychiatric drugs.

I read articles like this and this, and I’m angry that I’ve repeatedly raised the subject of forced detention and drugging or of the drugging of children as violations of basic human rights and the cause of mass suffering and death, I’ve discussed the psych rights movement, and freethought bloggers don’t seem to give a shit. I don’t think I’ve heard a single response to these posts or comments – not an expression of concern, not a question, not an interest in learning more. Nothing. I have compassion for these bloggers, which as I’ve described already pushes me to speak out, but my compassion for people who are forcibly detained and drugged, justified by the pseudoscience the bloggers are promoting, also influences my response.

I’m concerned that in remaining silent about or promoting biopsychiatry, the science-based community is contributing to what is already a public health, and generally human, catastrophe. This concern leads to frustration: Why the hell can’t the proponents of science and science-based medicine, I ask, fucking read a handful of books and articles pertaining not just to their own well-being but to the health and rights of millions of others? How on earth can people, especially those who have received psychiatric diagnoses themselves or who are entering mental health fields, be actively hostile to engaging with these arguments and evidence? The books and articles I’ve recommended aren’t by a couple of kooks. They’re by an accomplished science journalist, respected psychologists and professors of psychology, a former editor-in-chief of the New England Journal of Medicine, a Senior Lecturer in psychiatry at University College London, the head of the Nordic Cochrane Center,… How could people not want to take some time to read what they have to say, if only to try to develop a stronger case for biopsychiatry?***

What we as science advocates can bring and should try to bring in particular to social justice and humanistic movements is a commitment and dedication to the evidence and the skills and desire to evaluate it fairly, a skepticism toward arguments from authority or popularity, and a recognition of other fallacious evasions of reality. Our duty to believe according to the evidence entails an obligation not to turn away from evidence we don’t think we’ll like and, I think, an obligation to actively oppose harmful pseudoscience.

* I don’t, though, understand the widespread impulse to impute motives to and make assumptions about the critics of biopsychiatry, somehow determining from those comments that we have no personal or social experience of these struggles and are therefore emotionless “outsiders” responding from a position of relative privilege. Oddly enough, I’ve generally tended to assume the opposite – that people devoting time to the subject have personal reasons for doing so – which is probably equally wrong in many cases.

** This isn’t the end of it. Like recognizing that there are no deities doesn’t resolve questions about how we should live, recognizing these claims as pseudoscience is just a first step: a liberation from false ideas that frees us to find reality-based explanations and solutions.

*** Once again, here’s a partial list: Robert Whitaker, Mad in America and Anatomy of an Epidemic; James Davies, Cracked; Marcia Angell, “The Epidemic of Mental Illness: Why?”, “The Illusions of Psychiatry,” and “‘The Illusions of Psychiatry’: An Exchange” (all available free online); Joanna Moncrieff, The Myth of the Chemical Cure and The Bitterest Pills; Irving Kirsch, The Emperor’s New Drugs; Stuart Kirk, Tomi Gomery, and David Cohen, Mad Science; Gary Greenberg, The Book of Woe (I can’t speak to the quality of this one); Brett Deacon, “The Biomedical Model of Mental Disorder: A Critical Analysis of its Tenets, Consequences, and Effects on Psychotherapy Research” (available free online); Jonathan Leo and Jeffrey Lacasse, “Serotonin and Depression: A Disconnect between the Advertisements and the Scientific Literature” (available free online); Ethan Watters, Crazy Like Us. Oh – and Christopher Lane, Shyness.

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