Category: psychiatry

The Supreme Court, free speech, and therapy: a big screwup by the Supremes

April 1, 2026 • 10:15 am

Yesterday, by a rare vote of 8-1, the Supreme Court struck down Colorado’s ban on “conversion therapy” for minors (we’re talking about a ban on speech, not medical procedures).  Judge Ketanji Brown Jackson dissented, breaking from her two liberal colleagues.

The background: in 2019, Colorado passed a bill banning “conversion therapy for a minor” (HB19-1129), which you can see here.  it defined “conversion therapy” this way:

(5.5) (a) “CONVERSION THERAPY” MEANS ANY PRACTICE OR TREATMENT BY A LICENSED PHYSICIAN SPECIALIZING IN THE PRACTICE OF PSYCHIATRY THAT ATTEMPTS OR PURPORTS TO CHANGE AN INDIVIDUAL’S SEXUAL ORIENTATION OR GENDER IDENTITY, INCLUDING EFFORTS TO CHANGE BEHAVIORS OR GENDER EXPRESSIONS OR TO ELIMINATE OR REDUCE SEXUAL OR ROMANTIC ATTRACTION OR FEELINGS TOWARD INDIVIDUALS OF THE SAME SEX.

(b) “CONVERSION THERAPY” DOES NOT INCLUDE PRACTICES OR TREATMENTS THAT PROVIDE:

(I) ACCEPTANCE, SUPPORT, AND UNDERSTANDING FOR THE FACILITATION OF AN INDIVIDUAL’S COPING, SOCIAL SUPPORT, AND IDENTITY EXPLORATION AND DEVELOPMENT, INCLUDING SEXUAL ORIENTATION-NEUTRAL INTERVENTIONS TO PREVENT OR ADDRESS UNLAWFUL CONDUCT OR UNSAFE SEXUAL PRACTICES, AS LONG AS THE COUNSELING DOES NOT SEEK TO CHANGE SEXUAL ORIENTATION OR GENDER IDENTITY; OR

(II) ASSISTANCE TO A PERSON UNDERGOING GENDER TRANSITION.

This is aimed only at minors—people under 18.  Conversion therapy was not characterized as a criminal offense, but as a violation of professional discipline—a form of “unprofessional conduct” that could be punished by licensing boards, including suspension of licenses and fines.

Note that although we hear a lot about the law banning “affirmative therapy,” most of us see that as a kind of therapy that urges children who are gender dysphoric to alter their gender or their sex. But the law as written also bans “gay conversion therapy”: attempts, once in vogue when homosexuality was seen as a mental illness, to prevent people from being gay—to keep them “straight.” There are laws in 27 states and the District of Colombia, as shown in the map below from the Measurement Advancement Project, prohibiting this kind of therapy.

As the SCOTUS blog reports (as does the Supreme Court’s decision, linked below), the ban was challenged by a therapist who wanted to help her clients transition the way they wanted:

The Supreme Court on Tuesday sent a challenge to Colorado’s ban on “conversion therapy” – treatment intended to change a client’s sexual orientation or gender identity – for young people back to the lower courts for them to apply a new standard. By a vote of 8-1, the justices agreed with Kaley Chiles, the licensed counselor challenging the law, that the ban discriminates against her based on the views that she expresses in her talk therapy. A federal appeals court, Justice Neil Gorsuch wrote for the majority, should have applied a more stringent standard of review, known as strict scrutiny, to determine whether the law violates the First Amendment as applied to Chiles.

But the Supreme Court also strongly hinted that the ban would fail that test. In his 23-page opinion, Gorsuch stressed that in cases like Chiles’, Colorado’s ban “censors speech based on viewpoint.” Because the First Amendment “reflects … a judgment that every American possesses an inalienable right to think and speak freely, and a faith in the free marketplace of ideas as the best means for discovering truth,” Gorsuch continued, “any law that suppresses speech based on viewpoint represents an ‘egregious’ assault on both of those commitments.”

Justice Ketanji Brown Jackson was the lone dissenter. She argued that the majority’s opinion “could be ushering in an era of unprofessional and unsafe medical care administered by effectively unsupervised healthcare providers.”

Chiles went to federal court in Colorado to challenge the constitutionality of the 2019 law and block Colorado from enforcing it against her. She contended that she did not attempt to “convert” her clients. Instead, she said, she merely tried to help them “with their stated desires and objectives in counseling, which sometimes includes clients seeking to reduce or eliminate unwanted sexual attractions, change sexual behaviors, or grow in the experience of harmony with one’s physical body.”

A divided panel of the U.S. Court of Appeals for the 10th Circuit allowed the state to continue to enforce the law. The majority concluded that the conversion therapy ban simply regulated conduct – a licensed mental health professional’s treatment of a client – that also happened to involve speech. Therefore, the court of appeals concluded, it would review the ban using the least stringent test for constitutional challenges, known as the “rational basis” test – a relatively low bar, the court of appeals said, that the ban passed.

Chiles came to the Supreme Court in 2024, asking the justices to weigh in. On Tuesday, they reversed the 10th Circuit’s ruling and sent the case back to the lower courts for another look.

Curiously, Chiles apparently wasn’t trying to force her clients to adopt one course of action over another, but to achieve the course of action they wanted:

[Chiles] contended that she did not attempt to “convert” her clients. Instead, she said, she merely tried to help them “with their stated desires and objectives in counseling, which sometimes includes clients seeking to reduce or eliminate unwanted sexual attractions, change sexual behaviors, or grow in the experience of harmony with one’s physical body.”

The issue here is that it’s still “affirmative” in that Chiles went along with what their (minor) patients wanted rather than examining what they wanted.

The grounds for the decision were narrow: banning conversion therapy violated the First Amendment’s provision for freedom of speech (my bold below):

Gorsuch characterized the question before the justices as “a narrow one”: whether Colorado’s ban on conversion therapy violates the First Amendment as applied to the talk therapy that Chiles provides, and in particular whether the 10th Circuit was correct in applying “rational basis review” to the ban.

The Supreme Court, Gorsuch observed, “has long held that laws regulating speech based on its subject matter or ‘communicative content’ are ‘presumptively unconstitutional’” and therefore trigger strict scrutiny, which requires the government to show that a restriction on speech is narrowly tailored to serve a compelling government interest. “Under that test,” Gorsuch added, “it is ‘“rare that a regulation . . . will ever be permissible.”’”

The court has also acknowledged, Gorsuch continued, “the even greater dangers associated with regulations that discriminate based on the speaker’s point of view. When the government seeks not just to restrict speech based on its subject matter, but also seeks to dictate what particular ‘opinion or perspective’ individuals may express on that subject, ‘the violation of the First Amendment is all the more blatant,’” Gorsuch stressed. “’Viewpoint discrimination,’” Gorsuch said, “represents ‘an egregious form’ of content regulation, and governments in this country must nearly always ‘abstain’ from it.”

“Applying these principles,” Gorsuch continued, “we conclude that the courts below failed to apply sufficiently rigorous First Amendment scrutiny in this case.” First and foremost, Gorsuch wrote, although “the First Amendment protects many and varied forms of expression, the spoken word is perhaps the quintessential form of protected speech. And that is exactly the kind of expression in which Ms. Chiles seeks to engage.”

. . . The majority rejected the state’s contention that the conversion therapy ban targets conduct or medical treatments, rather than speech, and therefore should be subject to a more deferential standard of review. Although the ban “may address conduct—such as aversive physical interventions” – Gorsuch wrote, Chiles “seeks to engage only in speech, and as applied to her the law regulates what she may say,” as well as “what views she may and may not express.” “Colorado,” Gorsuch concluded, “does not regulate speech incident to conduct; it regulates ‘speech as speech.’”

Note as well that Colorado’s ban wasn’t fully negated, nor were similar bans throughout the U.S.. Rather, the case was sent back to the lower courts for reevaluation on these grounds (from Grok, with sources); the applicable appellate courts must:

  • Apply strict scrutiny (the most demanding level of First Amendment review) to the law as it applies to Chiles’s talk therapy. Under this standard, Colorado bears the burden of proving that the restriction on Chiles’s speech is narrowly tailored to serve compelling state interests.
  • Reconsider the case in light of the Court’s determination that the law engages in viewpoint discrimination (banning one set of views on sexual orientation/gender identity while expressly permitting the opposing “affirmative” views, such as acceptance, support, identity exploration, or assistance with gender transition).

The Court’s opinion, concurrences, and Justice Jackson’s dissent can be found by clicking on the screenshot below:

I’ll be brief here (I hope): the Court screwed up big time here, failing to recognize, as Justice Jackson said in her 35-page dissent (which she read from the bench in toto), that in the case of therapy, medical or psychological, talk is more than just speech, it’s treatment. From her dissent:

No one directly disputes that Colorado has the power to regulate the medical treatments that state-licensed professionals provide to patients. Nor is it asserted that, when doing so, a State always runs afoul of the Constitution. So, in my view, it cannot also be the case that Colorado’s decision to restrict a dangerous therapy modality that, incidentally, involves provider speech is presumptively unconstitutional. In concluding otherwise, the Court’s opinion misreads our precedents, is unprincipled and unworkable, and will eventually prove untenable for those who rely upon the long-recognized responsibility of States to regulate the medical profession for the protection of public health.

Remember that medical therapy uses speech as well. Any doctor who simply told a patient to go home and drink vinegar with herbs to treat their cancer would be guilty of professional misconduct. Note that here the doctor doesn’t do anything, but could still be punished for malpractice.  The doctor must adhere to reasonable and accepted forms of treatment, and that includes treatments suggested only through speech.

Brown notes that conversion therapy is “dangerous,” and nearly everyone would agree with that vis-à-vis gay conversion therapy. It’s long been recognized by therapists and their organizations that trying to force someone out of becoming gay, instead of simply talking over the issue, is acting unethically and, insofar as this causes stress and may change someone’s life in a negative way, i.e. causing harm.

We’re beginning to recognize that the same holds for “affirmative therapy” as well.  If it works, affirmative therapy puts young people on a one-way treadmill leading to to puberty blockers, then to adult hormones, and perhaps to surgery.  Britain’s Cass Review, as well as studies in Scandinavian countries, have already recognized that “affirmative therapy” that leads to blockers and hormones is of unproven efficacy and could be dangerous over the long term. Insofar as talk therapy promotes these actions, then, it too is dangerous—much like telling someone they should take vinegar for cancer. It seems only rational that when a minor has a psychological problem around gender or sexuality, the therapist should be giving objective treatment—helping the patient sort out their feelings—and not imposing some outside ideology on the therapy. For outside ideology is exactly what is polluting “conversion therapy”: you shouldn’t be gay on the one hand, and on the other your gender dysphoria should be roundly affirmed (e.g., you feel like a girl inhabiting a boy’s body, and thus should go that route) rather than examined.

Perhaps when this case is remanded to lower courts, they will clarify these issues, notably that talk therapy is equivalent to action.  But surely the Supreme Court could have said that, and, as far as I can see, they messed up big time. I’m especially disappointed that the other two liberal justices, Kagan and Sotomayor, deemed the Colorado law a case of “viewpoint discrimination.” It may have been that way for legislators, but the law as written doesn’t deal with motivations. It is trying to prevent harm to minors.

I disagree strongly with the Court’s decision, while at the same time remembering that the law it banned is aimed at minors, not adults.

Antisemitism flourishes in psychotherapy

January 26, 2026 • 9:45 am

I’ve known for a short while that psychotherapists (both psychiatrists and psychologists) are increasingly evincing antisemitism in their professional communications, despite the fact that the field was started by—and still largely consists of—Jews.  One would think that therapists, trained to be empathic and caring, wouldn’t go so far as to criticize and even refuse to treat Jewish patients, but that is sometimes the case. I know it’s true in Chicago, where the American Psychological Association had an online discussion group that became increasingly antisemitic, to the point where the APA President had to stop the bigotry.

In the post below from Commentary (click on screenshot, or find it archived here), psychiatrist and Yale lecturer Sally Satel describes how the Jew-hating termites are boring into the structure of American psychotherapy:

Some excerpts. Note that Jewish therapists or patients are often called “Zionists”, even when their views on Israel are unknown. This shows more than ever that “anti-Zionist” is simply a euphemism for “Jew hater” or “antisemite”.

It starts in Chicago:

Shortly after October 7, 2023, an Arizona-based group called the Jewish Therapist Collective received a sharp increase in calls from Jewish therapists. The collective is an online community that offers support to Jewish therapists and helps Jewish patients find welcoming practitioners. Its director, Halina Brooke, learned that in the wake of Hamas’s attack on Israel, many Jewish therapists were being told by their colleagues that their very presence was ‘triggering to non-Jewish therapists.’”

A therapist in Chicago named Heba Ibrahim-Joudeh felt that patients, too, needed to be protected from Zionist therapists. In winter 2024, Ibrahim-Joudeh, a member of the Chicago Anti-Racist Therapists Facebook group, organized a “blacklist” of local Zionist therapists. “I’ve put together a list of therapists/practices with Zionist affiliations that we should avoid referring clients to,” she wrote to colleagues, who responded with thanks.

As I understand it, that list was put together not even knowing whether all the blacklisted therapists were Jewish; some were included simply because they had “Jewish names.”

In 2025, a young Jewish woman had her first appointment with a psychotherapist in Washington, D.C. During the session, she mentioned a recent months-long stay in Israel. The therapist, who was part of a group practice, smiled and said, “It’s lucky you were assigned to me. None of my colleagues will treat a Zionist.”

The intolerance is not confined to isolated examples. It’s roiling the American Psychological Association (APA), the nation’s foremost accreditor for psychological training and continuing education programs. Tensions reached a new level last winter when more than 3,500 mental health professionals calling themselves Psychologists Against Antisemitism sent a letter to the APA’s president and board. The signers called upon the association to “address the serious and systemic problem of antisemitism/anti-Jewish hate.” The letter told of APA-hosted conferences for educational credits in which speakers made “official statements and presentations [including] rationalizations of violence against Jews and Israelis; antisemitic tropes; Holocaust distortion; minimization of Jewish victimization, fear, and grief.”

Singled out by name was the former president of the APA Society of Psychoanalysis and Psychoanalytic Psychology from 2023 to 2025, Lara Sheehi. In addition to diagnosing Zionism as a “settler psychosis,” Sheehi had posted expletive-laced messages on social media, including one stating “destroy Zionism” and another describing Israelis as “genocidal f—ks.” Her sentiments infiltrated the annual meeting of the APA in Denver last summer, where, according to psychologist Dean McKay of Fordham University, professional Listserv postings urged attendees to wear keffiyehs at the convention and read a “land and genocide statement” before giving their presentations, some of which contained Hamas propaganda. McKay has alsodocumented cases of therapists urging their clients to go to anti-Israel protests as part of what they see as their role in promoting activism.

Satel describes how some therapists reject patients who say they are Zionists, with the therapists explaining that “their values do not align”.  That is a violation of how therapists are supposed to work, without regard to whether their political opinions are in synch.  Yes, therapists can reject patients who are hostile, or those whom they think they can’t help because of other factors. (One example: patients who seek treatment for alcoholism “because my wife told me to come here,” for therapy won’t work unless the patient comes in of their own volition.) But requiring an alignment of politics a professional violation.

. . .one might be surprised to read the APA’s current Ethical Principles of Psychologists and Code of Conduct: “Psychologists establish and maintain knowledge and awareness of their professional and personal values, experiences, culture, and social contexts. They identify and limit biases that may detract from the well-being of those with whom they professionally interact.”

These tenets do not preclude therapists from making choices about whom they will treat. Such decisions, however, should spring from an individualized consideration of whether they can serve a patient well, not whether they morally disapprove of him. A therapist who lost a loved one on October 7, for example, might not want a patient who is a pro-Hamas activist. A therapist with relatives in Gaza could understandably pass up a potential patient who organizes pro-Israel marches.

But those tenets don’t matter.  The culture of therapy is becoming an ideological enterprisem with spreading “social justice” takes priority over helping the patient. Bolding below is mine:

. . . the culture of psychotherapy is changing. Before the murder of George Floyd, an identitarian approach to therapy had been simmering for at least a decade. Afterward, it burst upon the clinical scene. My colleague Val Thomas, a psychotherapist in the UK and editor of Cynical Therapies: Perspectives on the Antitherapeutic Nature of Critical Social Justice, calls it Critical Social Justice Therapy. Untested as a form of therapy, it views patients as either perpetrators or victims of oppression and understands this simple dynamic as the root of their problems.

Social justice therapists—who see themselves as activists first, healers second—usurp the goals of therapy. They override patients’ needs and preferences in favor of their own politicized aims, such as “dismantling racism.” To the extent that Zionism is, in some quarters, considered a form of racism or white supremacy, pro-Israel patients face an uncertain reception when they show up at therapists’ offices.

. . . Yet now, regardless of the best interest of patients, the post–October 7 therapist seems to feel entitled to make his own comfort paramount, to quell his own anxiety. In the realm of responsible psychotherapy, this is a grave transgression.

If you’re Jewish and seeking therapy, it might be useful to ask potential therapists about their reaction to your beliefs. As Satel says, “Today, Jewish and Zionist individuals who seek psychological care must search carefully for an experienced therapist who, no matter his or her politics, will regard the patient, foremost, as a fellow human who is suffering.”

Even if you’re one of the rare Jews who doesn’t favor the existence of Israel, you’re still considered a “Zionist” (you’re still a “racist” and “white supremacist”, something I was called this morning), and shouldn’t have to spell that out for a therapist.

I had this post in draft, and saw this morning that Steve Pinker posted about Sally’s article, noting that he’d quit the APA some years ago.  Apparently at that time antisemitism was already on the rise.

Fred Crews died

June 27, 2024 • 9:30 am

If you’ve studied Freud, or read the New York Review of Books, then you’ll surely have heard of Fred Crews.  Although I met him only once (see below), we exchanged tons of emails over the years and, after reading his works, became a big fan and admirer. Sadly, according to the NYT, Fred died six days ago at his home in Oakland. He was 91.  The NYT gives a fair accounting of his accomplishments; click on the link below or see the archived obituary here. Indented quotes in this piece, save for the last one, come from this NYT piece:

Fred was a literary critic—and later a Freud critic—and taught English at UC Berkeley for 36 years, eventually becoming Chair before retiring. He told me he left because he couldn’t stand the way literary criticism was going, becoming too tendentious and ridden with various “theories”, effacing the value of a work of literature itself. He made fun of these schools of criticism in two of his books (The Pooh Perplex and Postmodern Pooh) in which the Winnie the Pooh stories were analyzed through the lenses of various literary schools. The books are hilarious, and the NYT says this about them:

As a young professor at Berkeley, Mr. Crews made a splash in 1963 with “The Pooh Perplex,” a best-selling collection of satirical essays lampooning popular schools of literary criticism of the time; they carried titles like “A Bourgeois Writer’s Proletarian Fables” and “A.A. Milne’s Honey-Balloon-Pit-Gun-Tail-Bathtubcomplex.”

Writing in The New York Times Book Review, Gerald Gardner called it a “virtuoso performance” and “a withering attack on the pretensions and excesses of academic criticism.” (In 2001, Professor Crews published “Postmodern Pooh,” a fresh takedown of lit-crit theories.)

The Pooh Perplex should be read by all English majors, or anyone who likes literature. It’s a hoot! Click below to see the Amazon site:

Fred was perhaps the most scientific literary critic I know of.  This was seen both in his willingness to change his mind (he began as a Freudian critic but later repudiated Freud), and in one of the big projects of his life, debunking Freud, which he did elegantly, trenchantly, and in a thorough way that nobody has rebutted (the critics didn’t like his analyses mostly because they were imbued with love of Freud).

And having read a lot of Freud myself and being appalled as a scientist by its empirical vacuity, I agreed with Fred: Freud was simply a charlatan, fabricating theories that were never tested, pretending he had hit on the truth, and stealing ideas from others.  As you know, Freud did, and still does, dominate the mindset of Western intellectuals.  But Freud was also tendentious, an intellectual thief, and a miscreant in his own life, as well as a cocaine addict whose addiction influenced his work. If you want to read one book to show what a fraud the man was, go through Fred’s book Freud: The Making of an Illusion (2017), which is at once a biography and a demolition of Freudianism as a whole.  You can get the book on Amazon by clicking on the title below. Anybody who has the pretense of being an intellectual in our culture simply has to read this book; and it’s best read after you’ve read some Freud, so you can see the effectiveness of Crews’s demolition.

The NYT says this about the book:

“Freud: The Making of an Illusion” was his most ambitious attempt to debunk the myth of Freud as a pioneering genius, drawing on decades of research in scrutinizing Freud’s early career. Writing in The New York Times Book Review in 2017, George Prochnik found the book to be provocative if exhaustingly relentless: “Here we have Freud the liar, cheat, incestuous child molester, woman hater, money-worshiper, chronic plagiarizer and all-around nasty nut job. This Freud doesn’t really develop, he just builds a rap sheet.”

But Freud didn’t develop: his ambition was overweening from the start, as was his tendency to fabricate stuff and steal ideas from others.

I read many reviews of that book, and virtually all were negative, for they were written by acolytes of Freud, many of whom, lacking a scientific mindset, had no idea that his theories were fabricated, false, or untestable. Even now Freud has a strong grip on the therapy culture, and you can still find expensive analysts who will make you see them several times a week at unbelievable prices. They may mutter a few tepid disavowals of Freud, but their technique is based on Freud’s model.

Fred was a great guy, and in the face of this criticism, he simply moved on, unleashing other attacks on Freud, and on other unpopular views. More from the NYT:

Professor Crews started writing for The New York Review of Books in 1964, beginning with a review of three works of fiction, including a story collection by John Cheever. His essays over the decades covered a lot of territory, literary and otherwise, and while his writing was invariably erudite and carefully argued, it was often mercurial, by turns sarcastic, penetrating, acerbic and witty.

What’s wrong with mercurial?  Here the NYT is trying to sneak in some criticism, but I urge you to read some of his essays yourself (you can find many of the NYRB  essays here, and some are free).  The writing is wonderful and stylish. I don’t get why “mercurial”, turning at times to humor, sarcasm, and penetrating analysis, is pejorative.

Another unpopular cause that Fred took up after retirement was the reexamination of the case of Jerry Sandusky, which I posted about (and about Fred’s commentary) in 2018.

One unlikely cause that he devoted himself to in recent years was to assert the innocence of Jerry Sandusky, the former Penn State assistant football coach who was convicted in 2012 of sexually abusing young boys and is now in prison.

“I joined the small group of skeptics who have concluded that America’s paramount sexual villain is nothing of the sort,” Professor Crews wrote in one article in 2021, adding, “believe it or not, there isn’t a shred of credible evidence that he ever molested anyone.”

He also went after “recovered memory therapy” in league with his friend Elizabeth Loftus (see my post here, which contains a comment by Fred). That, too, rests on no empirical evidence, but simply on the wish-thinking assertions of therapists and prosecutors.

Professor Crews linked the charges against Mr. Sandusky to another of his notable targets, the recovered memory movement, which took hold in the 1990s and which he saw as stemming from the excesses of psychoanalytic theory. His two-part essay, “The Revenge of the Repressed,” which appeared in 1994, was included in his collection “Follies of the Wise,” a finalist for the 2006 National Book Critics Circle Award.

“Thanks to the ministrations of therapists who believe that a whole range of adult symptoms can probably be best explained by the repression of childhood sexual abuse,” he wrote in The Times in 1997, “these people emerge from therapy drastically alienated not only from their families but also from their own selves. In all but the tiniest minority of cases, these accusations are false.”

Professor Crews’s work “was and remains an invaluable weapon, wielded on behalf of sanity and science, against the forces of ignorance, self-interest and moral panic,” Carol Tavris, a social psychologist and another longtime critic of recovered memory therapy, said in an email.

His recovered memory essay prompted a series of no-holds-barred exchanges with readers that spilled over into multiple issues of the magazine. Professor Crews was often at his most full-throated in The Review’s letters to the editor column, where intellectual debates can border on trench warfare.

He proved to be a merciless adversary over the decades, especially for Freud supporters, and in the process helped elevate the letters column into something of an art form.

“Mercurial” my tuches!

And some on his other efforts (he was a busy man):

Frederick attended Yale University and received his Ph.D. from Princeton in 1958 with a dissertation on E.M. Forster. He joined the faculty at Berkeley in 1958 and taught there until his retirement in 1994. In the mid-1960s, he became involved in the antiwar movement, serving as a co-chairman of Berkeley’s Faculty Peace Committee, “but when even moderate Republicans joined the antiwar cause around 1970, I felt that my activism wasn’t needed anymore,” he told an interviewer in 2006.

In addition to his essays and critical works, Professor Crews wrote “The Random House Handbook,” a popular composition and style manual first published in 1974, and edited several anthologies and style guides. He was a member of the American Academy of Arts and Sciences.

Fred helped me once or twice by suggesting edits on my own popular writing, and in gratitude I purchased, at long distance, a good bottle of Italian red wine at a store in Berkeley, and then told Fred to go pick it up.

As I said, Fred was a great guy, and despite the academic squabbles in which he participated (which show both his heterodoxy and his courage), he was a man of sanguinity and of even keel.

His emails were works of art themselves, and during one of our exchanges I asked him what, given his numerous achievements (and battles), he thought was his most memorable accomplishment. I still have his response, and here it is (I’ve given a link to what he cites):

My most memorable feat, though it originated simply from a book review assignment, was the exposé “The Unknown Freud,” in NYRB, issue of 11/18/93. It caused the biggest hubbub in the magazine’s history. When there was a similar stir, a year later, regarding my piece on recovered memory, NYRB decided to turn the two controversies into a book (The Memory Wars: Freud’s Legacy in Dispute). Because I’ve always been a debater, the sparring with shrinks was a special pleasure.

Indeed!

After many years of e-communication, I finally met Fred and his wife Betty for lunch in Chicago in 2009. That was a great pleasure, and here’s a photo of Fred and Betty that I took in the restaurant. He doesn’t look like a man who would battle with shrinks and academics, does he?

No prayers need be offered, for Fred was a diehard atheist, but I’ve given a few thoughts in this short memoriam.  The world in general, and especially the literary world, is poorer for his absence.

An international group of gender-change specialists urges caution for American doctors and therapists

July 16, 2023 • 10:00 am

A bunch (21) of doctors and Ph.D.s from nine countries (Finland, the UK, Sweden, Norway, Belgium, France, Switzerland, South Africa, and the U.S.) published the following op-ed in Friday’s Wall Street Journal. It might be paywalled, so I reproduced the entire short letter below.

First, be aware that this, as noted below, was in response to a letter from the President of the Endocrine Society published recently, a letter that staunchly defends the efficacy of “gender-affirming care.” That care involves a combination of therapy and, nearly always, medical intervention through hormones. That letter, from Dr. Stephen Hammes, said this:

Roy Eappen and Ian Kingsbury’s op-ed “The Endocrine Society’s Dangerous Transgender Politicization” (June 29) ignores scientific evidence and the conclusions reached by the American Medical Association, the American Academy of Pediatrics and other reputable medical organizations. More than 2,000 studies published since 1975 form a clear picture: Gender-affirming care improves the well-being of transgender and gender-diverse people and reduces the risk of suicide.

If you already know the evidence, you’ll know that this claim is wrong: there is not enough evidence to form a “clear picture” of either well-being or suicide. In response, the signers of the letter below (not shown) took issue with Hammes’s claims.

Click the headline to read, but here’s the whold thing.  And I’ve put the important parts in bold:

As experienced professionals involved in direct care for the rapidly growing numbers of gender-diverse youth, the evaluation of medical evidence or both, we were surprised by the Endocrine Society’s claims about the state of evidence for gender-affirming care for youth (Letters, July 5). Stephen Hammes, president of the Endocrine Society, writes, “More than 2,000 studies published since 1975 form a clear picture: Gender-affirming care improves the well-being of transgender and gender-diverse people and reduces the risk of suicide.” This claim is not supported by the best available evidence.

Every systematic review of evidence to date, including one published in the Journal of the Endocrine Society, has found the evidence for mental-health benefits of hormonal interventions for minors to be of low or very low certainty. By contrast, the risks are significant and include sterility, lifelong dependence on medication and the anguish of regret. For this reason, more and more European countries and international professional organizations now recommend psychotherapy rather than hormones and surgeries as the first line of treatment for gender-dysphoric youth.

Dr. Hammes’s claim that gender transition reduces suicides is contradicted by every systematic review, including the review published by the Endocrine Society, which states, “We could not draw any conclusions about death by suicide.” There is no reliable evidence to suggest that hormonal transition is an effective suicide-prevention measure.

The politicization of transgender healthcare in the U.S. is unfortunate. The way to combat it is for medical societies to align their recommendations with the best available evidence—rather than exaggerating the benefits and minimizing the risks.

This letter is signed by 21 clinicians and researchers from nine countries.

There’s also a coda to this letter, which appears to be a kind of addendum (like a Supreme Court Justice’s partial dissent) coming from someone who may have been asked to sign the op-ed:

Transgenderism has been highly politicized—on both sides. There are those who will justify any hormonal-replacement intervention for any young person who may have been identified as possibly having gender dysphoria. This is dangerous, as probably only a minority of those so identified truly qualify for this diagnosis. On the other hand, there are those who wouldn’t accept any hormonal intervention, regardless of the specifics of the individual patients.

Endocrinologists aren’t psychiatrists. We aren’t the ones who can identify gender-dysphoric individuals. The point isn’t to open the floodgates and offer an often-irreversible treatment to all people who may have issues with their sexuality, but to determine who would truly benefit from it.

Jesus L. Penabad, M.D.

Tarpon Springs, Fla.

I agree with that letter, too. I would never ban transsexual medical treatment for those people old enough to make an informed decision (I’m thinking about 18 years old), but young people need objective therapy, not “rah rah—>hormones” therapy.  If a therapist prescribes puberty blockers for a young person on the very first visit (or worse, sends them to doctors prescribing gender-change hormones), that is not a good therapist.

Of course the solution to this dilemma is research, which is why several European countries have put puberty blockers into the class of “clinical experiments” and are starting to practice less “rah-rah: transition” therapy in favor of actually listening to children without instantly affirming their desire to transition. That’s especially important because the large majority of young people experiencing gender dysphoria (about 80%, I think), eventually grow out of it, often by simply becoming gay.  And being gay doesn’t run the risks of medical complications, sterility, and the inability to have orgasms: some of the side effects of hormone treatment.

And it would help if extreme gender activists would stop politicizing this issue. In all my years of writing on this site, I don’t think I’ve ever gotten such nasty and ignorant pushback as I have from gender activists who accuse me of transphobia simply because I think we need more research before we start injecting hormones into children and adolescents, lopping off bits of their bodies, and giving them objective rather than “affirmative” therapy. That view is not “fear of trans people”, for crying out loud. But the activists, who have ideology but not evidence on their side, resort to name-calling to intimidate their opponents. And it often works.

The pile-on also comes if one suggests, as did Abigail Shrier, that there can be social pressure that influences people to change their gender, a claim that by now I think is undeniable. (Adults, of course, are free to make their own decisions, but again, these should be informed decisions, and the long term effects, both medical and psychological, of transitioning are not often discussed. One reason is that gender activists rain down hatred on anyone who brings up these issues.)

In Friday’s Weekly Dish, Andrew Sullivan picked up on this letter and wrote about it, giving some statistics in response to the oft-heard claim made by some doctors and therapists advising parents of gender-dysphoric children, “Do you want a live boy or a dead girl?” That, of course, implies a very high risk of suicide by girls who aren’t allowed to transition to the male gender. Sullivan:

To give a sense of the bullshit, here’s Stephen Hammes, president of the Endocrine Society:

More than 2,000 studies published since 1975 form a clear picture: Gender-affirming care improves the well-being of transgender and gender-diverse people and reduces the risk of suicide.

Note the vagueness, and the absence of any mention of children — the only population we need to be concerned about. And here is the Endocrine Society’s own study on sex reassignments for kids:

We could not draw any conclusions about death by suicide.

Today, in the Wall Street Journal, 21 pediatric clinicians from nine countries call Hammes out. In those countries that have conducted systematic evidence-based reviews of all the studies involving children, all of them have concluded that “the evidence for mental-health benefits of hormonal interventions for minors [is] of low or very low certainty.” The risks — permanent sterility, inability to experience orgasm ever, irreversible changes to the body, voice and face — are very real. Yet the American Academy of Pediatrics refuses to conduct a similar systematic review, five years after its last guidance.

A survey of a decade of child transitions in the UK, from 2010 to 2020, found that the data “shed no light” on whether reassignment affects the suicide rate. But here’s the stunner: of the more than 15,000 children treated for gender dysphoria, the number of suicides was four. It is insane to believe that every child with dysphoria will kill themselves if not subjected to a sex change. If a doctor tells you this, find another doctor.

Why would they lie like this? I honestly don’t know. Here are some possibilities: misguided compassion for children in distress; believing you are part of a cultural revolution that starts with children; banking on the vast revenues of having patients for a lifetime of treatment; or just following ideological fiats, intimidated by woke peers, and fearing liability for past missteps.

I think that pretty much covers all the possibilities. I’m not sure why the U.S., compared to other countries, is particularly resistant to discussion of medical and psychological issues like this, especially given that this isn’t just an ideological discussion, but a discussion with medical consequences.  As far as I can see, we should be doing what the Europeans are increasingly doing about this issue: collecting more data.

Can therapists diagnose Trump as mentally ill, and warn people about his potential to promote violence, without examining him?

June 13, 2023 • 9:00 am

I’ve written twice about this subject:  the controversies involving Yale clinical and forensic psychiatrist Bandy X. Lee (no longer at Yale). Lee has been accused of violating the Goldwater rule, which involves giving professional psychiatric opinions about public figures you haven’t examined—in this case Donald Trump. The article below from Mother Jones magazine describes her travails around “diagnosing” Trump and warning of his potential to incite violence. As I wrote in November of 2020:

I agree that Donald Trump is mentally ill, but I’m not a professional, and thus am not bound by the strictures of professional associations to avoid diagnosing someone you haven’t personally examined. And those strictures exist most prominently in the American Psychiatric Association’s (APA’s) “Goldwater rule“, created after a number of psychiatrists pronounced Barry Goldwater unfit for office in 1964. Here’s the rule from the APA’s “Principles of Medical Ethics,” and this rule is still in force:

On occasion psychiatrists are asked for an opinion about an individual who is in the light of public attention or who has disclosed information about himself/herself through public media. In such circumstances, a psychiatrist may share with the public his or her expertise about psychiatric issues in general. However, it is unethical for a psychiatrist to offer a professional opinion unless he or she has conducted an examination and has been granted proper authorization for such a statement.

There doesn’t seem to be a penalty for psychiatrists who flout this rule, however, as psychiatrists who have diagnosed Trump as ill, or even lobbied Congress to proceed with the Trump Dump, have suffered no penalties.

In general I tend to agree with the Goldwater Rule, even if it’s nonbinding and the APA levies no penalties for flouting it (other people, as you’ll see, can punish violators). Yes, I think Trump is mentally ill, afflicted with narcissistic personality disorder, but I still think, as I did three years ago, that giving a professional diagnosis, whether you be a doctor or a psychiatrist (who are doctors), is pretty close to slander, and has far more potentially deleterious consequences than a statement by average Joes like me. “Professional” statements can be used for impeachment, removal from office, and so on. That said, I don’t see a problem with professionals warning the public about the dangers of someone based on their past behavior, without giving them a professional diagnosis. That’s what Lee claims to have done, and she was fired for it.

But in the past, Lee, who never examined Trump, appears to have come pretty close to diagnosing him. In a debate in Salon, Lee not only pronounced Trump to be mentally ill, but then went on to say the Goldwater Rule is itself harmful. Wikipedia notes this:

Lee then stated in an interview with Salon in May 2017 that Trump suffers from mental health issues that amount to a “state of emergency” and that “our survival as a species may be at stake.” She also discussed her political views, linking what she sees as increasing inequality in the United States to a deterioration in collective mental health.

And she discusses the 2020 debate with Biden.

[Salon]: Trump spent most of the debate heckling and interrupting, mixed with some blatant lying. How would you assess his debate performance?

[Lee]: The huge error was in allowing the debate to happen in the first place. “How was his debate performance?” is the wrong question to start. A debate presupposes mental health. We cannot pretend to have one when management of psychological impairment is what is warranted. The majority of the country may be horrified at what he is doing, but we continue to help the disorder in every way possible by treating his behavior as normal. It applies first to the politicians, then to the media and then to pundits who do not come out and honestly say: “This is beyond anything I have seen and beyond what I can understand — can we consult with experts?” And experts, for a psychological matter, would be mental health experts. Perhaps even specialists of personality disorders or sociopathy would be necessary, given the severity.

To me that comes close to giving a professional opinion, but it’s not 100% clear cut. She does say that he has a mental health disorder, and to me that’s a professional opinion. (After all, one psychiatrist said that “he may just be a jerk.”)  There is, of course, a continuum between jerks and the mentally ill, and where to draw the line is unclear.

Bandy went on to organize a conference of mental-health professionals in April, 2017, that resulted in a collection of essays by various therapists,  The Dangerous Case of Donald Trump, a book that became a bestseller. (Note: I haven’t read it.)

Mother Jones reports on the fallout, and on Bandy’s firing from Yale (click on screenshot):

Bandy certainly has the expertise to warn people about potential violence, and that’s what she continued to say about Trump after her book came out: the man has the behavior that tends to lead to violence among his followers, something instantiated in January of 2021.  She has studied criminal gangs and their leaders, and sees their behavior mirrored in Trump’s. She also notes that these leaders lose their influence when they are put in jail. (Bandy also argues that since 1900, violence tends to spike whenever there’s a Republican President.)

At any rate, Bandy continued her warnings about Trump’s likelihood to inspire violence, which of course came true. And she continued to be criticized by the APA.  She appears to have been skirting the Goldwater rule, saying that she didn’t violate it, yet also asserting that the rule doesn’t really apply when there’s another rule that overrides it. This is from her Wikipedia bio:

Lee says that when meeting with lawmakers, she was adhering to the American Psychiatric Association’s guideline, which precedes the Goldwater rule, and which urges psychiatrists “to serve society by advising and consulting with the executive, legislative, and judiciary branches of the government.” In an interview she also said, “whenever the Goldwater rule is mentioned, we should also refer to the Declaration of Geneva, established by the World Medical Association 25 years earlier, which mandates physicians to speak up if there are humanitarian reasons to do so. This Declaration was created in response to the experience of Nazism.”

And from the Mother Jones article:

According to Lee, Trump’s extreme dangerousness puts him in a completely different category from previous Republican presidents, who merely endorsed a set of harsh economic policies that are associated with increased violence. In contrast to past presidents with likely personality disorders, she believes, Trump has a psychological profile that is common among violent offenders. “There is typically a developmental arrest caused by early trauma or abandonment,” Lee says. “As adults, they still act like children in the playground; convinced that might makes right, they often can’t stop bullying others. “Trump’s mother, Lee points out, became chronically ill when he turned two, and his father was cruel and emotionally unavailable, repeatedly urging his son to be “a killer.”

. . . Despite the scolding directed her way by influential psychiatrists, Lee contends that she has never broken the Goldwater Rule, which, as she wrote in 2017, “is the norm of ordinary practice I happen to agree with.” In The Dangerous Case of Donald Trump, she and her co-authors challenged Trump’s fitness to serve based on his behavior rather than on a diagnosis per se. “The issue that we are raising is not whether Trump is mentally ill,” Gilligan writes in his chapter. “It is whether he is dangerous.” As proof of the psychological peril at hand, the authors point to Trump’s angry tirades and verbal abuse of subordinates, his admiration of authoritarian leaders, conspiratorial fantasies, aversion to facts, and attraction to violence.

You can see the conflict here. In the first paragraph, Lee implies that Trump has a personality disorder, and has a psychological profile—connected with childhood abandonment—that leads to bullying and promoting violence.  That sounds very much like a claim derived from professional psychiatric experience. Yet in the second paragraph she says she’s never broken the Goldwater Rule: she was just warning people about Trump’s propensities given his behavior.  But this is a distinction without a difference: that warning comes from professional experience. (Of course, people like us could also make such prognostications without penalty, but a prediction derived from professional experience comes awfully close to violating the Goldwater rule.)

Well, does it matter? Lee turned out to be right, of course, and Trump was impeached (unsuccessfully) as Democratic members of Congress, like Nancy Pelosi, called him “unhinged.” And then there was January 6, and other calls from Trump for his supporters to beat up people.

In the meantime, Lee was fired from teaching at Yale after 17 years following a Twitter kerfuffle with Alan Dershowitz (she said Dershowitz “had taken on ‘Trump’s symptoms by contagion'”, which again skirts the Goldwater rule). Dershowitz complained to Yale about this “violation,” and Yale dumped Lee.  She’s now suing the University and, as she’s become un-hireable in universities, got a degree from Yale Divinity School. She’s now a visiting professor at Union Theological Seminary, where she’ll start a violence prevention institute.

So, if Lee turned out to be right, did she still violate the Goldwater rule? This is a close call, but on balance, and based on the fact that her opinions and warning were derived from her professional expertise, I’d say “yes”.

But two questions remain. First, is the Goldwater rule a good one? I’d say “yes,” given the dangers of chilling public discourse by giving quasi-professional medical opinions. It’s for the same reason that administrators of the University of Chicago don’t make pronouncements on public issues, even when speaking for themselves. It’s because even in private speech, their words carry an imprimatur of authority, and that could chill speech in the University. In some cases violations of the Goldwater rule are clear; if Bandy had diagnosed Trump from afar with narcissistic personality disorder, she would be in violation of the APA’s rule—even though she wasn’t a member of the APA.

But there are no professional sanctions that come with violating the rule.

This leads to the third question: should Bandy have been fired by Yale, even if her predictions about Trump were right? Here I say “no.”  She was fired because Dershowitz complained to Yale about her violations of the Goldwater rule. But even if she violated it, Yale didn’t have an obligation to let Bandy go. And given that she claims, with some justification, that she warned about Trump based on his behavior, not a clinical diagnosis, I don’t think she should have been dumped. After all, Yale derailed the career of an accompanlished psychiatrist. Note how Wikipedia begins her bio:

Bandy Xenobia Lee is an American psychiatrist whose scholarly work includes the writing of a comprehensive textbook on violence.  She is a specialist in public health approaches to violence prevention who consulted with the World Health Organization and initiated reforms at New York’s Rikers Island Correctional Facility.  She helped draft the United Nations chapter on “Violence Against Children,”  leads a project group for the World Health Organization’s Violence Prevention Alliance, and has contributed to prison reform in the United States and around the world.  She taught at Yale School of Medicine and Yale Law School from 2003 through 2020.

That is positive accomplishment, which to me argues against her firing.

And had she been wrong about Trump’s incitement of violence, I still don’t think she should have been fired.  And, as I said, there is some justification for what she did even if she did break the Goldwater rule. After all, she didn’t give a formal diagnosis just to criticize the man: she did it to warn people about what he was capable of doing. (Remember, psychiatrists are allowed to break rules about professional confidence if they think their patients are likely to commit crimes of violence.)

As I said, I haven’t read all of Lee’s writings. But based on what I have read, and on the description in Mother Jones,  which of course does lean way Left, I think Lee was acting according to both her training and her conscience.  Although her warnings didn’t have any effect in impeaching Trump or preventing the insurrection he promoted, she didn’t deserve to have her career forced off the rails by Yale.

Bandy Lee (from her Twitter account)

h/t: Fred

More debunked or questioned psychological studies

December 31, 2022 • 9:45 am

From the site armin gravitas, characterized as “a simulacrum standing in for Gavin Leech“, a consultant, we have a three-year old piece that gives many examples of once widely-accepted psychological claims that didn’t stand up to (or were severely weakened by) attempts at replication. There are many more than the few I give below, but I’ve chosen a couple that I’ve written about or that readers may be familiar with.  On the webpage below (click to access), each weakened or refuted claim comes with a link to the original paper or book making the claim, and then a list of the studies that failed to replicate it.

I would avoid citing any of the research listed below, including the Dunning-Kruger effect: a staple of internet discourse characterized on Wikipedia as

. . . a cognitive bias whereby people with low ability, expertise, or experience regarding a certain type of task or area of knowledge tend to overestimate their ability or knowledge. Some researchers also include in their definition the opposite effect for high performers: their tendency to underestimate their skills.

 

The fields and claims:

SOCIAL PSYCHOLOGY

No good evidence for many forms of priming, automatic behaviour change from ‘related’ (often only metaphorically related) stimuli.

  • No good evidence of anything from the Stanford prison ‘experiment’. It was not an experiment; ‘demand characteristics’ and scripting of the abuse; constant experimenter intervention; faked reactions from participants; as Zimbardo concedes, they began with a complete “absence of specific hypotheses”.

 

  • No good evidence from the famous Milgram experiments that 65% of people will inflict pain if ordered to. Experiment was riddled with researcher degrees of freedom, going off-script, implausible agreement between very different treatments, and “only half of the people who undertook the experiment fully believed it was real and of those, 66% disobeyed the experimenter.”

 

  • At most weak use in implicit bias testing for racism. Implicit bias scores poorly predict actual bias, r = 0.15. The operationalisations used to measure that predictive power are often unrelated to actual discrimination (e.g. ambiguous brain activations). Test-retest reliability of 0.44 for race, which is usually classed as “unacceptable”. This isn’t news; the original study also found very low test-criterion correlations.

POSITIVE PSYCHOLOGY

  • No good evidence that taking a “power pose” lowers cortisol, raises testosterone, risk tolerance.

    That a person can, by assuming two simple 1-min poses, embody power and instantly become more powerful has real-world, actionable implications.

After the initial backlash, it focussed on subjective effect, a claim about “increased feelings of power”. Even then: weak evidence for decreased “feelings of power” from contractive posture only. My reanalysis is here.

COGNITIVE PSYCHOLOGY

  • Mixed evidence for the Dunning-Kruger effect. No evidence for the “Mount Stupid” misinterpretation.

 

  • In general, be highly suspicious of anything that claims a positive permanent effect on adult IQ. Even in children the absolute maximum is 4–15 points for a powerful single intervention (iodine supplementation during pregnancy in deficient populations).

DEVELOPMENTAL PSYCHOLOGY

  • No good evidence that tailoring teaching to students’ preferred learning styles has any effect on objective measures of attainment. There are dozens of these inventories, and really you’d have to look at each. (I won’t.)

BEHAVIOURAL SCIENCE

  • The effect of “nudges” (clever design of defaults) may be exaggerated in general. One big review found average effects were six times smaller than billed. (Not saying there are no big effects.)

NEUROSCIENCE

  • No good evidence that brains contain one mind per hemisphere. The corpus callosotomy studies which purported to show “two consciousnesses” inhabiting the same brain were badly overinterpreted.

PSYCHIATRY

  • At most extremely weak evidence that psychiatric hospitals (of the 1970s) could not detect sane patients in the absence of deception.

PARAPSYCHOLOGY

  • No good evidence for precognition, undergraduates improving memory test performance by studying after the test. This one is fun because Bem’s statistical methods were “impeccable” in the sense that they were what everyone else was using. He is Patient Zero in the replication crisis, and has done us all a great service. (Heavily reliant on a flat / frequentist prior; evidence of optional stopping; forking paths analysis.)

h/t: Luana

Indigenous psychiatry: how valuable is it?

July 5, 2022 • 12:30 pm

I’ve written a lot about how New Zealand is valorizing indigenous knowledge, and the educational system is on the path to teaching Mātauranga Māori (“MM”)—a mixture of myth, legend, practical knowledge acquired by trial and error, and spirituality—as “science”, coequal to science in science classes.  There is some science in MM, but as a whole it is certainly not the same thing as modern science, and many of its claims are either dubious or palpably false. To teach MM in science classes is to deprive the children of New Zealand of an understanding of science.

Many New Zealanders seems to regard everything about its indigenous people as not only valid, but admirable. A lot of it is, but many Kiwis are too cowed to stand up to some of the more  questionable claims of the Māori, including the claim that their Polynesian ancestors discovered Antarctica centuries ago. I know about this fear because Kiwis who do stand up against nonsense get persecuted, and I get emails from lots of them who agree with me but say that they dare not speak up because they’ll lose their jobs.

The latest effort to “indigenize” knowledge is the bestowing of a huge pot of money on Māori organizations to use “ancestral knowledge” to help cure mental health issues among the indigenous people. This is described in the Newshub article below, which you can click to read:

The article notes that “The new Māori Health Authority has a budget of half a billion dollars and CEO Riana Manuel has allocated $100 million of that to support centuries-old treatments.”

And there is a need for treatment, for the article also notes this:

Māori have the highest suicide rates of all ethnic groups in New Zealand. Mental distress among Māori is almost 50 percent higher than non-Māori and 30 percent are more likely to be left undiagnosed.

Now of course we can’t attribute this to problems that are unique to Māori, as I doubt there was a control for levels of income and other stressors that differ among ethnic groups. But there is a push to use Māori-centered therapy to cure mental illness in that ethnicgroup, and 100 million dollars for using “centuries-old treatments” is a lot of money.

What are these treatments? It’s not clear, but they’re based on lunar cycles and what can only be called psychoastrology. It’s confusing because the article is, as so often happens in Kiwi news, larded with Māori terms that even non-Māori can’t understand. See if you can suss it out:

Not so well known to non-Māori is their tradition of using the moon and stars to help treat mental health issues.

It’s called maramataka and will be incorporated into treatment by the new Māori Health Authority.

Rereata Makiha is on a mission to share ancestral knowledge with the next generation.

He’s an expert on maramataka Māori, or the Māori lunar calendar, and forecasting based on the moon cycles, star systems, tides, and the environment.

“The maramataka helps you, helps us to predict when things are going to happen, to tell us when the fish are going to run, when the eels are going to run – all those sorts of things,” he said.

“When you understand it a lot it’s a brilliant guide on when you should be doing certain things.”

Rikki Solomon teaches at-risk rangatahi and whānau how to use maramataka for improving mental health and knowing when to spend time doing certain activities in nature or around whanau.

“If we find that a whanau has had a low time or they may feel low, what we use is the maramataka to identify their cycles, their highs, and their lows,” Solomon said.

“What we observe in those low areas is what are some rituals at that time. And what I mean about rituals is what is the environment that they can connect to, because our environment is our biggest healer.”

That doesn’t really clear things up, but here’s more on the practice, with quotes from Riana Manuel, CEO of the Māori Health Authority:

“Connecting people back to those spaces and places that have been long forgotten is certainly something that will be investing in,” Manuel said.

Just like they do with Matariki, Māori use maramataka as a way of reading the cosmos to prepare for what’s coming.

“It’s a way of rebuilding the body, your wairua, and rebuilding your energy and getting prepared for the high energy days ahead,” Makiha said.

“So it goes in waves like that and if people understand it and go back to that rather than rush, rush, rush every day, I think that’s what drives a lot of the ill-health.”

If you can figure out what they’re doing from this, you’re a better person than I am.

Now there may indeed be a benefit to using Māori practitioners and ancient Māori practices to treat mental illness. After all, people often feel that therapists who have a background similar to their own are more desirable.  Women, for example, often feel that a woman therapist will treat their problems better, and the same goes for ethnic minorities.  So there may be something to shared experience and background that is therapeutic (there’s also, of course, a placebo effect).

My criticism here is simply that these practices are being adopted in the absence of clinical trials, and so there is only a “traditional” basis for the therapy. Might Māori be helped more with other practices, like cognitive behavioral therapy, practices that have been tested and shown to be efficacious? Or even medication, which has a significant effect on things like depression. (A combination of talk and drug therapy seems to be the most curative).

As a colleague wrote me, this absence of scientific testing of a method that will absorb $100 million is the same issue raised with MM: what is claimed (or assumed) to be “scientific” has not been vetted using the scientific method. To quote the colleague:

This is exactly the problem that led me to raise concerns about MM versus science in the first place. We now have two alternate sets of “facts.” One is based on scientific evidence, and the other may be supported by some evidence but has never been tested in a way that would be considered acceptable for medical science.

Mental health is a form of health, and this is like treating diseases using astrology and “traditional methods” that have never been subject to genuine scientific tests. Doesn’t it seem wise, before investing $100 million in mental-health treatment, that the government of New Zealand be sure that those treatments actually work? 

Sadly, that’s not the way the New Zealand government rolls.