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.

Sunday, 24 April 2011

Disease, Disorder, Distraction

Responsible scientists who are familiar with the research but want to preserve the disease concept of alcoholism have had to redefine their terms. They define “disease” as whatever doctors choose to call a disease (Jellinek, 1960)! The point of using the word, they acknowledge, is “social” rather than medical. There is a lack of consistent self-control that leads to harmful consequences (Vaillant, 1990). Of course such sweeping uses of the term make almost every human and social problem into a “disease.”

In the above passage, from a book chapter published over 20 years ago, Herbert Fingarette prefigured the current obsession with attributing any troubling behavior to an underlying disease. The extension of medicine into areas where it does not belong, because its methods do not apply, is an insidious ongoing process. We have not only given doctors great power within the legal domain, but we have also permitted the ideology called “medical science” to dominate the cultural definition of many types of behavior.

Sadness and worry are now perceived as symptoms of an underlying disease, although they could result from a wide range of potential causes. To be in a down mood is the natural response to various circumstances, such as a bad marriage or financial difficulties; and events, such as the loss of a job or loved one. As the beginning of this piece from The Guardian suggests, however, the medical community and the pharmaceutical industry have succeeded in redefining a psychiatric condition called “depression” as a common disorder. Because it is presumed to have an underlying physiological cause, a critical feature of this newly redefined disorder is that it can be addressed with certain expensive medications.

Accordingly, the official numbers indicate that 9% of the US population count as “depressed,” with 3.4% meeting the criteria for Major Depressive Disorder, while doctors write millions of prescriptions for antidepressants yearly, at a rate that continues to accelerate. From one perspective, these figures raise questions about a society with a tenth of its members bummed out, some seriously bummed out, many of them dependent on daily doses of drugs having limited efficacy and unknown long-term effects. From another perspective, the same figures raise questions about what counts as a mental disease or disorder such that so many people suffer from such conditions.

Our society had become addicted to medicalizing social, moral and spiritual problems. As Fingarette predicted, many troubling behaviors have been reconceived as disease states. Doing so puts money in the pockets of pharmaceutical companies and physicians, while it reassures members of both the medical profession and the general public. Insurance companies and government agencies like it, too, because the treatment of medical disorders usually involves medication and other courses of treatment that are much less expensive than traditional psychotherapy, with its emphasis on developmental issues.

First of all, there are “food addiction,” and “sex addiction,” new names for otherwise normal activities that have reached an unacceptable level of excess. Although eating too much can be injurious to one’s health,and reckless promiscuity can wreak havoc, putting these problems into a category with dependence on intoxicants places them within the same disease-oriented framework. As discussed in a previous post, conceptualizing substance abuse as resulting from “disease” is misleading as a guide to treatment and unjustified by empirical evidence, and the same is true, of course, for destructive patterns of behavior to which the addiction metaphor has been extended. Nevertheless, there are many intensive, expensive treatment programs, modeled on programs for substance abuse, dedicated to treating overeating and promiscuity.

The emergence of Asperger syndrome as a diagnosis shows that the redefinition of human behavior as disease does not stop with sadness, overeating, and fucking too much (however much that is). Most people realize that this “syndrome” is nothing more or less than “nerdiness,” as it was called before it became a disease. A look at the diagnostic criteria for Asperger’s illuminates its shaky foundation. A child need only meet two diagnostic criteria by exhibiting “impaired social interaction,” and “repetitive and stereotyped patterns of behavior”; other criteria, such as having “inadequate relationships,” or “impaired nonverbal communication,”among others, belong in the “Maybe” category. Treatment for this “syndrome” is a joke, consisting mainly of medications insurance companies will pay for, and therapeutic modalities that, by their nature, are limited in duration: physical therapy, occupational therapy, cognitive behavioral therapy, social skills training, and parenting classes. It need hardly be said that none of these has yielded reliable improvement of the identified problems. Nerdy children may suffer some pain as a result of their behavior, although the very nature of the “syndrome” presupposes that they don’t notice the inadequacy of their relationships. For sure, children who fit the criteria for Asperger’s are annoying, and they can grow into adults with horrible manners, which may explain the amount of attention this “disorder” has received from physicians and psychologists.

Attention deficit hyperactivity disorder (ADHD) is another instance of the “diseasing” of behavior that is deemed to be troubling and disruptive. The controversy over ADHD is so old and so fraught with emotion that there is no point in revisiting it here. Suffice it to say that a recent study, conducted under the auspices of the National Institutes of Health, found that, despite initial improvement, children treated for ADHD through a variety of different recognized modalities, either singly or in combination, fare far worse than children who have not been diagnosed with ADHD. The children received the best treatment the medical establishment can offer, including advanced medications, for at least 14 months, and some were still receiving treatment years later, when they were assessed for their school performance and many other variables relevant to social  and psychological adjustment. Nevertheless, as the results summarized in this table show, they compared unfavorably with comparison subjects on almost every measure chosen by the investigators, who undoubtedly believed in the efficacy of treatment. If ADHD is a disorder with physiological substrates that reflect a genetic disposition, as has long been claimed, “medical science” has not succeeded in discovering how to treat it.

Much the same can be said about the medical approach to the other problems surveyed here. Recidivism by alcoholics and drug addicts who have gone through draconian rehabilitation regimes is notorious. Depression remains a significant problem, as one can tell from the number of commercials one sees for antidepressants. No one is suggesting that there is a reliable treatment for Asperger’s or ADHD. In spite of this abysmal record, physicians continue to operate under the questionable assumption that these conditions represent underlying, circumscribed causes, and continue to treat these conditions as if they know how to ameliorate their effects.

Saturday, 23 April 2011

Antidepressant Addiction

Filed under: Chemical Imbalance,Diagnosis,Medical Morality,Propaganda,Science — drtone @ 12:08 pm

I doubt that I’m the first one to bring attention to the purely American tolerance of addiction to drugs that don’t actually make you high, the antidepressant medications. The United States, responding to a cultural mandate inherited from some of the earliest European settlers, has fought relentlessly to control and eradicate the use of all intoxicants. Nevertheless, established medical practice, encouraged and promoted by the authorities, involves offering selective serotonin re-uptake inhibitors and the other newer antidepressants to those complaining of a wide variety of ills, not confined to clinical depression. Despite evidence mounting since the first flush of Prozac’s popularity that they are ineffective, antidepressants are still prescribed to millions of patients, many of whom are suffering from the loss of a loved one or a job, as well as from headaches and a variety of other ailments, rather than from clinical depression.

Years ago, I began telling people that. as the end of the patents on the new antidepressants approached, evidence would begin to come out that they are dangerous and ineffective. My prediction was based on the fate of Valium and other benzodiapenes, relatively benign medications that actually do what they’re supposed to do. I remember when those were the “wonder drugs.” Then they were prescribed to hundreds of millions of people around the world. It is no wonder, partly because they are efficacious, that problems appeared among those taking them. I would suggest that it’s not a coincidence that these negative consequences emerged into the public consciousness when the price of these drugs approached zero AND the major pharmaceutical companies were releasing a new generation of drugs intended to address many of the same ills for which benzos were prescribed. Benzodiazapines were also easy to attack because they actually can produce a high. The medico-legal establishment, including the drug companies, clearly recognized both the necessity and ease of targeting benzodiazapenes as yet another group of intoxicants the use of which was seriously out of control.

Instead of “epidemic” use of drugs that work, such as Valium and Xanax, we have the specter of hundreds of millions of people chronically taking medications, such as Prozac and Paxil,  that are relatively ineffective. Although discontinuing their use can produce serious negative side-effects, SSRIs and similar drugs don’t make you high. For that reason alone, they will remain on the market for a long time to come. This is a country in which doctors will cut the supply of opiates to a terminal patient for fear that he or she will become an addict, but refuses to describe as “addiction” the dependence of millions on expensive medications that may do nothing.

I know from personal experience that antidepressants produce a condition indistinguishable from addiction. In about 2002, I started taking Paxil, having been offered it for the nth time as a treatment for headaches I have had since age five. The headaches diminished, and it’s also possible that my mood evened out. My weight, already a minor problem, ballooned by 40 pounds, probably putting the added strain on my lower back that resulted in the bulging disk at L4-5 that still fucks up my life. I was taking Wellbutrin in an attempt to counteract the weight gain. I began taking double doses of both drugs in 2008, after my most recent marriage blew up.

A year or so after that, having read many warnings about the problems attendant on discontinuing Paxil in particular, and discussed those warnings with physicians, I began a months-long process of tapering off one dose of the drug; I followed that not long ago, with a similar procedure to take myself off the other dose. I had to do the same thing with the Wellbutrin, of course. Imagine, therefore, the negative incentive for a patient who takes these drugs to stop taking them. It took me a long time to take the plunge. There must be many people who stay on these drugs, with the collusion of their physicians, because of legitimate fears about the potentially severe effects of discontinuing their use. What could be better for corporate drug dealers?

The difference between dependence on antidepressants and opiate or cocaine addiction is that those drugs make you feel good, whereas antidepressants, at best, make you feel OK. Consequently, the latter don’t count as “drugs of abuse.” Nevertheless, the circumstances under which they are used seem to me to constitute abuse of the public by physicians and pharmaceutical manufacturers.

Wednesday, 20 April 2011

“Alcoholism”

As I read a history of the disease theory of alcoholism, there is much about how describing addiction to alcohol as a disease de-stigmatizes those deemed to drink too much. For example, Bill W. thought that portraying excessive drinking as a “disease” was a useful metaphor, rather than a medically accurate description of the syndrome, because it removed blame from users. The problem with such metaphors, as the history of the “computer metaphor” in cognitive psychology shows, is that they are inevitably taken too seriously, leading to massive confusion and misunderstanding. In the case of alcoholism, it is widely assumed that it is, indeed, a disease of the brain, subject to treatment by medical professionals, although the the evidence that it represents an actual disease entity is thin, at best.

There are many reasons why the disease concept of alcoholism persists, among them that the confusion caused by applying the disease metaphor to the excessive use of alcohol benefits the makers of alcoholic beverages. If those who ruin their lives with alcohol are suffering from a “disease,” that takes the onus off alcoholic beverages and those who make them. It’s a perfect out. Temperance advocates at the turn of the previous century did blame the makers of alcoholic beverages for the “scourge” of drunkenness, as well as the moral weakness of those who drink. For that reason, the sellers of beer, wine and spirits have to be extremely happy that the approach of the rehabilitation movement blames neither them nor the users of alcohol. Instead, the problem is caused by a disease entity.

By taking the blame away from the substance and from the the user, the treatment of alcoholism as a disease resembles the date rape drugs phantom.

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.

Monday, 7 February 2011

The 4 Humors & Chemical Imbalances

Filed under: Chemical Imbalance,Psychomyths,Science — drtone @ 12:33 pm

Not entirely as a matter of coincidence, the first sentence of the Wikipedia entry on “chemical imbalances” and the first sentence of the Wikipedia entry on the Four Humors of ancient (and not-so-ancient) medicine each describe the corresponding concept as “discredited.” The latter theory (if that is a historically correct term) dominated medicine until fairly recently, the middle of the 19th century. A hundred years later, in an attempt to bring mental and emotional disorders within the structure of Western medicine, physicians of the late 20th century reinvented the concept of humoral imbalance to explain something they could not quite explain otherwise, probably without recognizing the historical significance of what they had done.

Although the Wikipedia article on the chemical imbalance hypothesis denies its validity, it makes two other moves that are worthy of mention. First, it quotes a prominent expert who describes chemical imbalances as a “useful heuristic” for understanding mental illness. Let me say that it’s difficult for a construct to be misleading and useful at the same time. Second, it mentions that “no other demonstrably superior hypothesis has emerged,” as if that somehow supplies validity to an otherwise discarded framework. It is a way of keeping “chemical imbalances” on life support and at the service of the pharmaceutical industry.

Friday, 21 January 2011

Why Science Brooks No Opposition

Filed under: Propaganda,Science — drtone @ 2:58 pm

Recently, as I have sometimes expressed through my entries here, I have been annoyed at the way science is used to further political ends, such as in the so-called “debate” regarding climate change. It is such an unholy alliance, science and politics, with the latter inevitably polluting the former, which easily becomes a weapon in the hands of anyone with a regulatory, legislative or financial agenda. That said, science itself has an imperialistic cast that it cannot shed, and that should frighten the shit out of anyone attempting to use it to further a political argument.

A central feature of Western science is its claim to universality. Science has, in effect, issued a permanent IOU, promising that it will eventually explain everything, a conception of science that not only has deep roots in the philosophy of science, but also in the public consciousness. Consider the scientific studies of extra-sensory perception or the whole edifice of social science. Although there are competing systems of thought, principally within non-traditional and non-Western religious doctrines, to most people in the industrialized world the operation of explaining a phenomenon means giving it a scientific explanation. Even when what is in dispute is a key scientific construct, the opposition tends to function from a competing conception of science that preserves most of its main characteristics, as has happened with “intelligent design,” a supposedly scientific alternative to evolution by natural selection. Why should this be?

One need look no further for an explanation than to the history of science itself. Western science developed entirely within the walls of institutions controlled by the Catholic Church. Note that “catholic,” a term the Church began applying to itself almost from its beginnings as an establishment, means “universal.” Note, as well, that the institutions where science came into being and in which it remains are called “universities.” The claim to universality, central to Church doctrine, passed directly to science as it developed within the Church and at the centers of learning founded by the Church. Roger Bacon and William of Ockham were both English Franciscan friars, operating  under the discipline of the Pope and his bishops. Even after the Reformation, universities and the activities they housed remained under religious discipline, and were dominated by the study of theology until well into the nineteenth century.

It is not entirely a coincidence that science as we know it today emerged at the time when control of universities began to pass out of the hands of priests and ministers and into the hands of laymen. In Europe and America during the Victorian era, academic professors (a title that, BTW, derives directly from “professing” faith through the taking of religious vows), attained a high degree of autonomy from the religious authorities who, in effect, owned the universities in which they taught. Science was therefore freed from the direct interference of religion, but it was not freed from the forces that formed it, in particular from the claim of the Church to have an infallible hold on the Truth. Through constant exposure, you could say, science picked up the same habit, one so deeply ingrained as to be essential to its existence.

This is one of those self-evident truths that, once heard, cannot be dispelled. Science is a direct descendant of the Church. For that reason, it embodies the critical features of the Church, an imperialistic institution, in every sense of the world, founded upon and defined by its claim to infallible access to the truth. Although “Papal infallibility” as a separate doctrine is a late product of the counter-Reformation, the notion that the Church fathers have an exclusive channel to God and therefore both the right and duty to promulgate God’s Only Truth is as old as the Church, and inseparable from it. Science, which developed within that same Church, inherited those same “genes,” if you will, and therefore has as its central feature a claim to owning the Truth.

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