Wednesday, July 17, 2013

Credo Quia Absurdum Est

 I'm glad I read Mad Science before I read Allen Frances's Saving Normal, because it gave me a grounding against which to read Frances's rather biased presentation.  His survey of the overuse of psychotropic drugs, for example, puts all the blame on Big Pharma for pushing all those medications and on the public for demanding them.  He admits that psychiatrists should have stood their ground against the hordes of Better Living Through Chemistry, but it wasn't their fault.  Nobody could have foreseen the diagnostic inflation that misused the Diagnostic and Stastical Manual III and IV, even though diagnostic inflation had historically been a problem in medicine and psychiatry, and the overuse of drugs was no novelty either.

But some things would have made me skeptical anyway.  Try this excerpt from Frances's discussion of diagnostic fads, past and present.  He calls Demonic Possession a fad, though he admits it's thousands of years old and never really went away, but he has a theme to sustain in this chapter, okay?
The belief in demonic control is universal across cultures and enduring through time because it makes so much sense to most people; it taps into something basic in human psychology and explains a large part of human experience in a simple and plausible way.  The battle against demons appeals to the theological mind; cures most of the system that ails us; ministers to the soul; and binds the tribe.  Demons are a completely logical, if prescientific, way of understanding the changes caused by psychiatric and medical illness (and also by drugs, dreams, and trance states).  It appears silly only to us children of the Enlightenment who believe in biological causes of strange behavior.  But there is one unavoidable problem with this otherwise useful diagnostic category -- it has provided a wonderful excuse for the persecution, torture, and murder of the mentally ill.  The very most inhumane treatment could easily be justified on the spurious grounds that it was part of a holy fight against the devil [119].
The "theological mind" is actually the rational mind, bearing "Garbage In, Garbage Out" in mind: logic is only as valid as the premises it begins from.  The demonology of the late Middle Ages was highly rationalist, as the historian Hugh Trevor Roper wrote in The European Witch Craze of the Sixteen and Seventeenth Centuries, "The sixteenth-century clergy and lawyers were rationalists. They believed in a rational, Aristotelean universe, and from the detailed identity of witches’ confessions they logically deduced their objective truth."

The same applies to modern science, including outliers like psychiatry.  Notice Frances's proud claim to be a child "of the Enlightenment who believe[s] in biological causes of strange behavior."  Earlier in Saving Normal he devoted a chapter to a glib, simplistic, and misleadingly linear history of approaches to understanding and treating madness, which he depicted as a brave march toward the recognition of biological causes of strange behavior -- even though he admitted at the beginning of the book that "Billions of research dollars have failed to produce convincing evidence that any mental disorder is a discrete disease entity with a unitary cause" (19).  There is, in other words, no scientific evidence that mental disorder does have biological causes, but Allen Frances has true faith and won't be led astray by the absence of evidence.

The concluding two sentences are completely wrong.  First, there's no inherent reason why belief in demon possession should lead to cruel treatment of the victim, particularly in Christendom.  Jesus was a pre-eminent exorcist, and the gospels teach that Christians will be empowered to follow his example: they contain a fair amount of advice for driving out demons.  Jesus freed people from demonic possession not by beating or torturing them, but expelled them by divine power: he ordered them to leave, and they had to obey.  Occasionally he encountered resistance, as when the demons would counter that they knew his true identity ("I know who you are: the Holy One of God!"), which should have given them power over him, but it didn't even faze Jesus; he ordered them out, and they obeyed.  One powerful argument against the claims of Christianity, especially modern Christianity, is that its practitioners can't drive out demons with the power Jesus promised them.

Second, modern psychiatry has its own history of inhumane treatment of the mad.  In addition to the interventions I mentioned and criticized in previous posts, proponents of Assertive Community Treatment endorsed coercion against patients on the ground that they were "Obviously … not … a group of fragile, broken-spirited persons but rather … tough, formidable adversaries who were 'pros' and who had successfully contended with many different staffs on various wards in defending their title of 'chronic schizophrenic'" (quoted in Mad Science, 99-100).  Even the comparatively mild use of psychotropic drugs, prescribed to patients with abandon whether they needed them or not, has a serious downside: some of those drugs' adverse effects include anxiety and suicidal ideation; they may bring on diabetes and other serious physical conditions, and patients on such medications have a significantly lower life expectancy than other people.  All this despite the fact that these drugs are not much (if any) more effective as treatment than placebos.  I'd say that punitive, abusive attitudes toward the mentally ill aren't a result of theology or a rejection of the Enlightenment, but of the practitioner's temperament.

There are some problems, then, at the core of Allen Frances's apologia for modern psychiatry.  Like any apologist, the need to defend his faith leads him to distort the facts in predictable directions.  That's too bad: his intentions are good, but good intentions aren't enough.