Cognition & Reality

Sunday, 1 May 2011

Medical Science: An Ideology

In a previous post, I referred to “medical science” as an “ideology.” Modern medicine, since its beginnings in the 19th century, has had a number of amazing successes: Open heart surgery, and the use of insulin to treat diabetes have saved countless lives; orthopedic surgery has literally made it possible for cripples to walk again. Vaccination, pasteurization, and other health measures have virtually rid the industrialized world of a host of plagues. Advances in obstetrics are in a class by themselves because they have been such a huge factor in reducing human misery. These successes have led to the arrogant presupposition that every ill has a cause that will ultimately fall under the purview of the physician.

Although the amalgamation of medicine with biological science has been fruitful, it has led to the belief that the two together can provide the answer to every question. Germ theory has been important, both theoretically and practically, but it has led to the confused idea that every observed “pathology” has an identifiable physiological cause. Medicine has likewise embraced molecular genetics, leading to the similar confusion that every observed variation must represent an underlying genotype. These unsupported propositions have been applied to the understanding of human behavior.

Therefore, the idea that behavior results from physiological substrates has become an article of faith. Behavioral geneticists have more or less deliberately exaggerated the heritability of behavioral traits by using statistical techniques that magnify the apparent “genetic” component. Meanwhile, despite increasing evidence that antidepressants and other advanced pharmaceuticals don’t work or don’t work well, the medical community has continued pushing chemicals that are supposed to modify mood and behavior. In this, they are aided and abetted by the entertainment industry, which continues to make reference to genetic influences on behavior and to the role of “chemical imbalance” in psychoemotional distress.

They can continue to do this as long as the public buys the medical ideology, something that is supported by the news and entertainment media. Although medical community has conceded that “chemical imbalances” do not explain depression and other psychoemotional disturbances, the myth survives, in large part because it’s easy to believe and relieves all parties of responsibility.

As we have seen, the imperium of medicine extends beyond behavioral questions into other areas where medicine has repeatedly failed, but continues to exert an all-powerful influence. The “war on cancer” has gone on for decades without yielding the long-promised cures. Instead, doctors prescribe chemotherapy, which causes great discomfort, often prolonging life at the cost of a patient’s misery. The cure is worse than the disease, or no better, at any rate. For example, after successfully fighting brain cancer that spread to her brain, the wife of a former client has spent the past two years suffering from iatrogenic conditions that resulted from her initial treatment, and has had to have a shoulder and a hip replaced because the medications made her bones brittle. The last I heard, she was still not out of the woods with her cancer, either.

The success of medicine has come at a great price. In the first place, it is literally very expensive. Secondly, we have allowed the many successes to blind us to the many failures. We have forgiven the latter in part because of the ungrounded expectation that present-day failures will turn to success later on. Rarely does that happen. Most advances that have occurred, such as in heart and orthopedic surgery, have been incremental. New discoveries that change the entire life-and-death picture seldom occur. Because of the faith the public and the medical profession have put in genetics, for example, the Human Genome project was long expected, to yield answers about various forms of mental illness, but has not done so.

It is quite possible that the great discoveries that propelled medicine for a long time, vaccination, sterilization, etc., which mostly occurred in its early days, do not in any way predict the future of medicine. The discovery of DNA, over half a century ago, was possibly the most spectacular, but it might also be the last. Those early discoveries bequeathed to industrialized society a false model of medical progress, one that has not applied for some time. The great hope for medicine that remains is based largely on laurels accumulated long ago. It is time to see that our society has idolized and idealized medicine out of all proportion to what it can or will deliver.

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Saturday, 30 April 2011

The Dog Whisperer & Biological Determinism

Through his program, “The Dog Whisperer,” Cesar Millan has made himself into the most famous dog trainer in America, if not the world. His approach features his intuitions about dogs’ motivations. In explaining those motivations, he frequently refers to the descendence of domestic dogs from wolves, and only occasionally refers to the relationship between breed characteristics and a dog’s problem behavior. I have never heard him blame bad behavior on a dog’s genetics. In fact, he is a strong defender of pit bulls and other breeds that have been seen as dangerous because they are bred to be aggressive. Because he almost always sees the roots of a problem in confusion about dominance, he trains owners to reinforce positive, submissive behavior by becoming better “pack leaders.” When it comes to dogs, as the success of Millan’s program demonstrates, the public is willing to believe that behavioral pathology is mostly a product of learning.

It is therefore interesting that, in the popular imagination, human psychoemotional difficulties, not so different from the fearfulness and aggressiveness the Dog Whisperer often addresses, represent underlying physiological anomalies. Although people readily accept that dog psychopathology reflects bad “parenting,” they reject the idea that the same can be true of humans. To explain humans’ dysfunction, the public prefers explanations that seem to be at a remove from the direct experience of learning and developing, such as “chemical imbalance” or physical inheritance.

Cesar Millan’s treatments are invariably behavioral. Although I believe he doesn’t explicitly disapprove of using antidepressants with dogs, he never presents chemical or even dietary interventions on his show. Instead, through careful titration, he focuses on changing behavior, replacing dysfunctional behaviors with functional behaviors. He not only employs himself and other humans to do this, but also the dogs in his own pack, particularly his pit bull Daddy and a few other canine co-therapists.

Right now, I’m watching a touching installment of “The Dog Whisperer,” in which Cesar is rehabilitating a fearful Doberman mix named Baby Girl. When he discovers that Baby Girl refuses to eat, Cesar brings in a vet to examine the dog for physiological problems, but there is nothing physically wrong with her. Cesar concludes that Baby Girl’s eating disorder is “psychological.”

Admittedly, the psychological disorders of dogs do not track exactly the psychological disorders of humans. In addition, the cases that make it on to Cesar’s show, more often than not, involve violent dogs. Not only is an aggressive dog likely to drive owners to seek help, but a violent dog also makes better TV. On the other hand, Baby Girl was not violent. She had symptoms more similar to clinical depression or a personality disorder, and Cesar used a mixture of behavioral approaches to treat her. The point here is not so much that Cesar Millan believes in the efficacy of psychological treatment, but that the audience believes in the efficacy of psychological treatment, when the “patient” is a dog.

When the patient is a human, however, the public has been conditioned to accept the use of pharmaceuticals to treat psychoemotional problems, and they have accepted the notion that much psychopathology is “genetic.” Contrast this set of ideas with the way Cesar Millan operates. Although he does, under some circumstances, take into account a dog’s genetics, he almost always attributes behavioral problems to what we would call “upbringing” in the human context: The problem is really with the owners, an attribution most of the owners on the show readily accept.

One can see how much more difficult a similar conclusion about human parenting is to accept . Parents don’t want to believe that they contributed to the psychopathology of a child. In addition, physicians presently enjoy enormous power in treating psychopathology. It is therefore in their interest to promote a relationship between physiology and behavior that Cesar Millan implicitly rejects in the way he treats the psychological problems of canines.

Sunday, 13 February 2011

Not In Our Genes II

Filed under: Behavioral Genetics,Books,Human Evolution,Propaganda,Race,Science — drtone @ 1:03 pm

I posted recently regarding the 1985 book Not In Our Genes, by R.C. Lewontin, Steven Rose & Leon Kamin. In that previous post, I discussed the reasons, despite its fame, that the book failed to block the increasing popularity of sociobiology. The authors’ criticisms of the latter are trenchant and occasionally funny, but they are couched in neo-Marxist language virtually guaranteed to turn readers off.

In addition, the chapter on the state of the debate, at the time the book was written, regarding the role of women is, thankfully, somewhat dated. Even if they believe it, no one of any substance currently argues that women can’t fill roles in society previously held exclusively by men. Advances in the quarter century since the book was written have favored the inclusion of women in the professional world, which is not to say that true gender equality has been reached, but only to say that it has increased noticeably. Indeed, it could be instructive for young people to read that chapter in order to gain some appreciation of the the character and pace of what was then called “women’s lib.”

That said, Not In Our Genes is a good book, well-written, well-argued and entertaining.

Thursday, 10 February 2011

Not In Our Genes: Why It Failed

Filed under: Behavioral Genetics,Human Evolution,Propaganda,Science — drtone @ 9:40 am

Not In Our Genes, a famous book, notorious in some circles, is a well-written argument against, as the title suggests, the concept that human behavior can be explained as a function of genetics. The authors are all distinguished academics with credentials galore. Despite all that it had going for it, and despite having remained in circulation (if not in print), the book clearly has not had the kind of impact one would have hoped: Since its publication in 1985, the hegemony of the biological reductionists has grown much stronger. There are probably many reasons Richard Lewontin, Steven Rose, and Leon Kamin failed to persuade the world that behavioral genetics is bunk. A chief factor is the steep rhetorical gradient presented by the multifaceted attractiveness of genetic explanations of behavior, a topic I have discussed numerous times. Nevertheless, one reason for the book’s failure to persuade is, as the Beatles announced, “If you go carrying pictures of Chairman Mao, you ain’t gonna make it with anyone anyhow.”

Although the authors’ Marxist account of biological reductionism is interesting and, in some respects, cogent, it came at the wrong time and is addressed to the wrong audience. Neither Brits, nor especially Americans are or were prepared to accept arguments based on Marx about anything whatsoever. That would go double or triple in the period immediately before and after the dissolution of the Soviet Union. Not In Our Genes is sprinkled with references to “bourgeois” society and values; it returns again and again to the tired language of class struggle. Rather than basing their argument simply on the manifest incoherence of behavioral genetics, they based it on an admittedly interesting Marxist historical analysis of behavioral genetics as a reflection of capitalism. As if to demonstrate that they adhere to Lenin and therefore reject John Lennon’s injunction, the authors actually refer positively to Mao as a social “theorist.” So blinded were Lewontin, et al., by their ideology that they could not see how such a remark regarding one of the great mass murderers of all time would land like a clunker with their intended readers, the educated English-speaking public. In addition, they opened themselves up to dismissal as confused commies by those, such as Richard Dawkins, who would rather not respond to the substance of their argument. It’s a shame.

Wednesday, 9 February 2011

The Book Circle

Filed under: Behavioral Genetics,Human Evolution,Psychomyths,Race,Science — drtone @ 10:10 am

The other day, passages in the book I just finished, The Metaphysical Club, regarding the succession of “truths” in science triggered me to look up “sociobiology” in Wikipedia, and I wrote a short post on the subject. In a striking coincidence, the Wikipedia article on sociobiology referred to a New Yorker review of a Steven Pinker book by Louis Menand written about the time he finished the The Metaphysical Club, suggesting to me that perhaps he saw a connection between the content of his book and foolishness of evolutionary psychology. Indeed, Menand’s book is filled with discussions of Darwinian evolution and its uses within debate about social issues, discussions that had stimulated me to post on scientific racism and specifically on Louis Agassiz, making the point that the scientific consensus is often misleading, The same Wikipedia article referred to a 1985 book I had long meant to read, Not In Our Genes, by Lewontin, Rose & Kamin, a famous work deeply critical of  biological reductionism. I decided that it was past time for me to read it, given my own longstanding interest in the subject, and I ordered a copy from Amazon. Almost before they start, the authors of this latter book discuss both Agassiz and the often bogus authority of “science.” It is as if an invisible teacher is guiding my reading.

Saturday, 5 February 2011

Menand On Pinker

Filed under: Behavioral Genetics,Psychomyths — drtone @ 1:12 pm

In a 2002 review of Steve Pinker’s The Blank Slate: The Modern Denial of Human Nature, Louis Menand (who is, coincidentally, the author of the book I’ve mentioned here recently, The Metaphysical Club) captures perfectly my own experience of Pinker, who is among the most arrogant individuals I have ever met and, at the same time, one of the worst informed. The afternoon and early evening a couple of friends and I spent with Pinker was an eye-opener, not at all because of any wonderful revelations he was conscious of offering. On the contrary, he was the revelation, because he showed us how a person who had never had an original idea in his life (and would not know one if it bit him in the ass) could combine sheer chutzpah and a studied ignorance into a successful recycling of things he had heard other people say. That was before Pinker had become a “public intellectual,” but had already begun to attract a great deal of positive attention with a combination of surprisingly good writing and a complete disregard of history and logic. I have subsequently heard Pinker interviewed, and it is amazing how quick he is to toss off bizarre statements as if they were facts with phrases such as “we now know…,” the reference being to the newest scientific discoveries about human nature.

I was therefore pleased to discover Menand’s review, which captures this same quality in Pinker, how his annoying naiveté combines with the aforementioned arrogance. Menand indicates, for example, that Pinker based some of his argument in The Blank Slate on a misquotation of Virginia Woolf that inverts her original point from one that corresponds to Pinker’s world view to one that expresses the exact opposite. Similarly ignoring the obvious, Pinker does not seem to realize that science is far from perfect: As I have pointed out recently, and as Menand emphasizes in his review and demonstrates in The Metaphysical Club, today’s “science” can become tomorrow’s embarrassment. His great talent is a total lack of self-reflection and self-awareness. Not caring that he doesn’t know what he’s talking about is at the heart of Steve Pinker’s act.

Friday, 19 November 2010

Behavioral Genetics: An Alien Invasion

Filed under: Behavioral Genetics,Propaganda,Psychomyths — drtone @ 12:50 pm

This article from about.com offers a balanced, rather critical, appraisal of research on the genetics of alcoholism. It is interesting that a middle-of-the-road organ assumes such a critical stance, showing that the truth about behavioral genetics, that it walks on thin evidential ice, has filtered into the secondary and tertiary literature. Academics have begun to acknowledge the flaws in twin studies and the conundrum posed by the failure of research based on the Human Genome Project to yield direct relationships between DNA and behavior. Presumably because the expected evidence has failed to accumulate, the problems with behavioral genetics are becoming widely known.

Nevertheless, the note at the end of the article, by Enoch Gordis, MD, ignores most of the content that precedes it, passing over the various problems the article explores. “We know,” Dr. Gordis says, “that more than one gene is responsible” for vulnerability to alcoholism. He says this in spite of what it says in the article, that animal studies have so far not found “a single gene responsible for alcohol-related behaviors.” Gordis, making the fundamental error in this domain, presupposes that, in the absence of single-gene linkages, genes will be discovered that account for personality traits related to alcoholism. The level of faith underpinning the medical profession’s belief in behavioral genetics far outstrips the evidence, such that only the faith remains. Physicians ignore rules of evidence that they, as “scientists,” would presumably respect if the issue were, say, the existence of extraterrestrial life, a rational appraisal of which would not begin with the assumption that the search for extraterrestrial life has been successful.

Wednesday, 17 November 2010

Mental Illness: A Holiday Message

During the upcoming holidays, many will renew their awareness of the role families play in “mental illness.” To a parent already blaming himself or herself for the troubles of a decompensating child, that he or she played a role in producing those troubles is a far less acceptable explanation for an ongoing crisis, however, than that it was something in the DNA (“in the blood,” as people used to say). A “genetic” explanation for psychiatric illness comforts parents, gratifies the egos of doctors, and fills the coffers of giant companies. What could be better than that?

The propaganda campaign has been so successful that the burden of proof has shifted from where it would be in an actual scientific debate, on those claiming a genetic component in psychiatric illness, onto those who say there is no connection or very little connection, upending the logic of hypothesis testing that is at the heart of scientific inquiry. That it’s been a very successful campaign is obvious when you consider the slender evidence upon which the claim is based, and that everyone, just about, takes it for granted that bad genes cause depression and other psychiatric disorders. Another piece of evidence for the success of the campaign is that anyone, like me, who questions the assumption is immediately marginalized as a shrill advocate for the mean-spirited notion that individuals are responsible for themselves and for their fellow humans.

Saturday, 13 November 2010

Scientific Authoritarianism

A genuine grasp of current genetics research would take years to acquire and involve the rigors of a postgraduate education. The same is true of any branch of physiology. An ordinary citizen, even one who is otherwise well-educated, cannot hope to bring any level of technical expertise to evaluating claims about the genetics of mental disorders. As I explained in yesterday’s post, even doctors are at sea when it comes to this topic, although they may not realize it. Therefore, belief in those claims depends, at least in part, on faith and obedience.

That is why, rather than supporting explanations of psychoemotional difficulties based on individual experience, which would ostensibly be more consistent with an American emphasis on individual responsibility, our society has gravitated toward explaining aberrant behavior with reference to physiological, “disease” processes beyond a person’s control.

Friday, 12 November 2010

Physicians Aren’t “Scientists”

Although explaining psychological problems as “genetic” disorders as mediated by “chemical imbalances” obviously inflates doctors’ authority and efficacy, their enthusiasm for these types of explanation probably reflects their ignorance of scientific methods more than anything else. You can hardly watch a television “doctor show” without hearing one of the doctors referred to as a “scientist.” In spite of the widely-believed mythology of the medical profession that its members are scientists, however, physicians typically have no scientific training.

The medical school curriculum in North America and in most parts of the industrialized world has two main components, coursework and clinical training. Medical students are notoriously overworked. They take difficult courses, and spend countless hours on “rotations.” In their internships, the excessive length and frequency of their shifts is a matter of some controversy. Given their packed schedule, which really begins when they are undergraduate pre-med majors, and despite the requirement of some schools that they prepare a thesis, medical students have no time for a scientific education. They learn about science, taking courses in the medical sciences, but they do not do science. A  biochemistry course or two, no matter how demanding, does not make you a biochemist, nor does an honors thesis completed more or less as an afterthought.

Because most physicians have not had years of post-graduate training to develop the abilities necessary to a critical appraisal of research results, they tend to rely on secondary sources often issued under the influence of drug companies and other interested parties. They are, moreover, inclined to believe results that comport with the possibility of “curing” psychoemotional problems with medicine. And they’re inclined to propagate myths that magnify their own powers.

 

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