Category: psychiatry

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.

The woke termites burrow their way into therapists’ offices

August 14, 2021 • 10:30 am

You’d think that the last places one would start treating individuals as embodying characteristics of their “tribe” are the offices of therapists.  After all, both psychologists and psychiatrists are expected to deal with their patientS as people with unique problems, and not impute to the patient “group” characteristics based on stereotypes or political ideology. Nor should they impose their own political views on their patients, which is a real no-no for therapists. (They do, of course have ideas on how to treat patients, and make suggestions, but not of the genre, “hey, maybe you’d feel better if you wore a MAGA hat.”)

Well, the idea that therapy is ideology-free is, of course, dead wrong, especially now when there is no tent in the Universe where the Woke Camel won’t stick its nose. And so the nose goes onto the couch, as recounted in this Persuasion article by Sally Satel. Click on the screenshot to read:

Now activist therapists aren’t new; for years we’ve had specimens who impose their own views on patients rather than sussing out a patient’s problems from their own words. These activists include “recovered memory therapists”, who, it seems, already know what memories are supposed to be recovered, and try to convince the patient about the truth of things that might never have happened.

You’ve heard of the McMartin preschool case, in which recovered memory therapists dug up instances of sexual and even Satanic abuse of children that never happened. The accused people spent several years in jail, but were eventually acquitted. Right now Jerry Sandusky is sitting in prison for sexual abuse of young boys, with a lot of the testimony that put him there “recovered” by therapists digging around in the minds of young people. (Some said they weren’t abused but, after some bouts with the therapists, suddenly remembered that Sandusky committed sexual acts on them).

These therapists are clearly activists, and one would, based on their activities and the political leanings of therapists, expect them to often be on the Left.

Sally Satel, a psychiatrist who wrote this piece, is against activism, though she is affiliated with the Right-Wing American Enterprise Institute. Wikipedia says she’s a “political conservative” and has also written several books about the incursion of Left-wing doctrine into medicine, like this one (click to go to Amazon site):

Satel’s also identified as working at a methadone clinic in Washington D.C. and as a visiting professor at Columbia University’s Vagelos College of Physicians and Surgeons. If you’re one of those, you can ignore her views simply because she’s a conservative, but you might be missing some truths. And her claimed truth in this piece, which can be at least partly checked by following the links she gives, is that therapy is increasingly turning into the instillation of woke attitudes into patients as the world because woker. I doubt that, in these times, you’ll find that thesis inherently unlikely! But here’s what she says:

Until roughly five years ago, people seeking mental health care could expect their therapists to keep politics out of the office. But as counselor education programs and professional organizations across the country embrace a radical social justice agenda, that bedrock principle of neutrality is crumbling. Mental health professionals—mainly counselors and therapists—are increasingly replacing evidence-driven therapeutics with ideologically motivated practice and activism.

The Graduate Counseling Program at the University of Vermont, for example, intends to “structurally align” itself with the Black Lives Matter movement and begin “the work of undoing systemic white supremacy.” After George Floyd’s death, the Johns Hopkins University Counseling Center advised would-be students to “consider us one of many resources in the difficult but necessary work of engaging with internalized bias, recognizing privilege, and aligning values of anti-racism and allyship with embodied and sustained practice.”

Such sentiments are not limited to mission statements—they are playing out in the real world of clinical training. Some counseling programs encourage students to engage in social justice activism. Most troubling of all, trainees are being taught to see patients not as individuals with unique needs, but as avatars of their gender, race, and ethnic groups. Accordingly, more and more counselors encourage their patients to understand their problems as a consequence of an oppressive society. White patients, for instance, are told that their distress stems from their subjugation of others, while black and minority patients are told that their problems stem from being oppressed.

The stakes for patients are high. When therapists use patients as receptacles for their worldview, patients are not led to introspection, nor are they emboldened to experiment with new attitudes, perspectives, and actions. Patients labeled by their therapists as oppressors can feel alienated and confused; those branded as oppressed learn to see themselves as feeble victims. It is difficult to imagine how a healthy therapeutic alliance between counselor and patient—a core bond nurtured through a clinician’s posture of caring neutrality and compassionate detachment—could thrive under these conditions.

Is it hard to imagine that therapists might engage in this form of indoctrination when secondary-school and college teacher do it all the time? Satel goes on:

The American Counseling Association, “the world’s largest association exclusively representing professional counselors,” has a Code of Ethics that explicitly cautions against such boundary violations: “Counselors are [to be] aware of—and avoid imposing—their own values, attitudes, beliefs, and behaviors.” Yet the association has said nothing about the overt ideological stance of some programs, or blatant instances of imposition.

It’s hard to argue with that paragraph’s advice. Nor is it hard to believe that any form of propagandizing patients will be aimed at moving them toward the left because, at least according to Five Thirty Eight, social and personality psychologists are about as liberal as college professors:

When New York University psychologist Jonathan Haidt asked about a thousand attendees at the annual meeting of the Society for Personality and Social Psychology in 2011 to identify their political views with a show of hands, only three hands went up for “conservative or on the right.” Separately, a survey of more than 500 social and personality psychologists published in 2012 found that only 6 percent identified as conservative overall, though there was more diversity on economic and foreign policy issues.1 The survey also found that 37.5 percent of respondents expressed a willingness to discriminate against conservative colleagues when making hiring decisions. Psychologists, it appears, tend to fall on the liberal end of the political spectrum.

I expect therapists will line up pretty much the same way.

Now it’s okay if a patient’s problems involve politics. Perhaps he was driven to fury by Trump, and it’s upsetting his life. Or he can’t live in a world in which race seems to be the main driver of everything. Then the therapist can draw out the patients and suggest ways to improve their lives. But I don’t think it’s ever valid to impose your own politics on a patient, nor to treat them as a member of a political or ethnic group rather than an individual, like trying to urge them to be “more black or Hispanic” or “less white”.  Satel has a couple of anecdotes about this, but remember, they are anecdotes.

Central to the ideology that’s creeping into the field of mental health care is a growing aversion to recognizing personal responsibility and agency. One colleague of mine who works in a prominent psychiatry department told me that during a group discussion of the growing problem of stress and suicide in black youth, her colleagues were unwilling to discuss explanations that pointed to factors coming from within beleaguered communities. Thus, participants who pointed to fear of police aggression and societal discrimination were greeted with nods, but when she suggested they also consider bullying by classmates, chaos in the home, or neighborhood violence, she was ignored.

I have had my own encounter with this growing illiberal strain. Following a lecture I gave earlier this year to a group of psychiatrists and trainees, I was castigated by several attendees for drawing attention to personal agency in overcoming drug addiction. My transgression, as they saw it, was to “blame the victim” and take focus away from factors such as racism, poor education, and poverty—which, as I had noted in my presentation, also predispose people to heavy drug use. But I was not “blaming the victim,” I explained in an icy Q-and-A; rather, I was drawing attention to the patients’ capacities to improve their lives and, therefore, to hope.

As a palliative, she touts an organization, The International Association of Psychology and Counseling, dedicated to promoting “critical thinking over indoctrination” and to an organization called FAIR in Medicine, a group designed to combat the incursion of ideology into medicine as a whole.  As Satel says at the end (her emphasis):

Though I am worried for my profession, for colleagues who feel pressure to conform, and for the patients who depend on them, I take heart from these flares of resistance. I am confident that there is a silenced majority of clinicians who see the need to resist the ideological encroachment into the field of mental health care and the health sector more broadly. These new organizations are in their early stages but have the potential to attract the critical mass needed to rebuff politicized narratives and re-assert the primacy of individual patients in all their complexity.

Dr. Sally Satel

Scientific American: religious or “spiritual” treatment of mental illness produces better outcomes

June 19, 2021 • 11:00 am

Scientific American continues to circle the drain, even after it retracted an anti-Semitic op-ed this week. Several readers have commented that they’ve canceled their subscriptions, and I’ve never had one.  Perhaps the old-fashioned Sci Am that we knew and loved is no longer sustainable in a world where people want their science as short, click-baity pieces.

The latest dire piece is not an op-ed but an article, appearing in the “Mind” section under “mental health”. It’s a justification for including religious and spiritual therapy in mental health treatment, and could be taken as, in part, a defense of the value of religion. Indeed, it may be the case that for believers—though I haven’t checked the references; readers are invited to—some kind of god-infused therapy might ameliorate mental illness. The author gives references supposedly showing this. After all, if you’re already religious, you’ve drunk the Kool-Aid, and so buttressing the comforting bits of what you already believe might make you feel better. After all, that’s what a lot of church is about.

But there are a few problems with Rosmarin’s thesis. First, religious therapy enables religious belief, i.e., faith. Part of what is said to “cure” you involves reinforcing falsehoods rather than facing real or potential truths. I don’t object to that so much, though, as an antitheist, I don’t like it. Second, although “spiritual” therapy is mentioned many times, and is said to help even nonbelievers, the author never tells us what spiritual therapy really is. Given how broad the boundaries of the concept “spiritual” extend, almost any therapy that helps could be said to include a “spiritual” element. For example, one could tell a secular patient  to learn to accept both good and bad as inevitable parts of life. That is the doctrine of many Buddhists, and could be said to be “spiritual”.

Importantly, there’s no mention of religion actually exacerbating or instigating mental illness, and I have no doubt that it does. Martin Luther is a famous example, but think as well of the many children who have been terrified by thoughts of heaven or hell, the people who do horrible stuff because they think God told them to, or the priests who, formally prevented from having sex, become pedophiles. I could go on, but will refrain. But there’s not a word about any of this.

Finally, why on earth is Scientific American publishing stuff like this? I suppose you could include it in the ambit of “popular science”, but barely. They might as well be writing about the value of acupuncture in helping physical ailments. Like acupuncture, religion is a regimen based on false assumptions, and its use encourages a naive reliance on faith: on stuff that is either untested or palpably false.

Rosmarin is a Ph.D. psychologist identified as “director of the Spirituality and Mental Health Program at McLean Hospital and an assistant professor of psychology in the Department of Psychiatry at Harvard Medical School.”

Here’s the evidence adduced by Rosmain:

  • His own SPIRIT program “suggests that spiritual psychotherapy is not only feasible but highly desired by patients”
  • During the last pandemic year, religious people were “the only group to see improvements in mental health”
  • Spirituality, says Rosmarin, is woefully lacking in most forms of therapy, as psychiatrists are the least religious among all medical specialties.
  • As Rosmarin says,

My own research has demonstrated that a belief in God is associated with significantly better treatment outcomes for acute psychiatric patients. And other laboratories have shown a connection between religious belief and the thickness of the brain’s cortex, which may help protect against depression. Of course, belief in God is not a prescription. But these compelling findings warrant further scientific exploration, and patients in distress should certainly have the option to include spirituality in their treatment.

You can check the references for yourself. They may show what he says they do. But I still would be wary of religious treatment, since it uses falsehoods and belief in falsities to help people get better. I don’t necessarily oppose that, but I would have liked to have seen a mention of how religion causes or exacerabates mental illness. It using religion any different from telling patients that acupuncture in their ears could help them, or that everybody really likes them?

Rosmarin winds up giving a few anecdotes as evidence for the efficacy of “spiritual” therapy (I suspect that a lot of the “spirituality” is old-fashioned religion), and asserts that the biggest group of patients who come to his SPIRIT counseling are individuals “with no religious affiliation at all.” These are, of course, the “nones,” but nones may be religious, and simply not affiliated with an established church or sect. Only a minority of “nones” would consider themselves atheists.

When I read this article, the words of Marx kept coming back to me—words from a famous passage usually (and unfairly) truncated to just the last sentence, implying pure religion-dissing. What’s left out is the first sentence in which Marx asserts that religion is often embraced because its the only form of help available to people in bad situations like poverty, illness, lack of social support, and so on.

“Religion is the sigh of the oppressed creature, the heart of a heartless world, and the soul of soulless conditions. It is the opium of the people.”

I doubt that Scientific American will ever get back to the format that attracted many of us to the magazine in the first place. Just have a look at its contents these days, which have become more overtly political with a good dose of fluff.

h/t: Will

A new paper by a psychoanalyst looks like a hoax, but isn’t

June 11, 2021 • 10:30 am

When I first saw the paper below, which is still on the pages of the Journal of the American Psychoanalytic Association—a journal I expected to be peer-reviewed journal and have a modicum of rigor even if it is about psychoanalysis—I thought it was a joke: a hoax “grievance” paper à la Pluckrose, Lindsay, and Boghossian.  But I don’t think it is. Instead, it’s a horrid, racist gemisch of obscurantist chest-beating in the guise of antiracism. Click on the screenshot to read it, or download the pdf here. (The full reference is at the bottom of the page.)

Just three quotes, besides the abstract above, give the tenor of the paper:

Parasitic Whiteness infiltrates our drives early on. The infiltrated drive binds id-ego-superego into a singular entity, empowered to dismiss and override all forms of resistance. The drive apparatus of Whiteness divides the object world into two distinct zones. In one, the Whiteness-infiltrated drive works in familiar ways—inhibited, checked, distorted, transformed—susceptible, that is, to standard neurotic deformations. In the other, however, none of this holds true. There the liberated drive goes rogue, unchecked and unlimited, inhibited by neither the protests of its objects nor the counterforces of its internal structures.

. . .Parasitic Whiteness generates a state of constantly erotized excitement, a drift toward frenzy.1 Fix, control, and arouse; want, hate, and terrorize. Whiteness resides at this always volatile edge, in a state of permanent skirmish, always taking on the never obliterated resistances of its nonwhite objects. Opaque to itself and hyperconscious of those objects, Whiteness pursues the impossible, a stable synthesis, an end point. It can therefore never rest. Blindly, then, it continues forward, unendingly bent on conquering. There seems no backward path, no mode of retreat. It faces an interminable forward march. If only it could totally and permanently transform these objects, turn the once feared and unknown into the now reduced and measured; turn the once unique and overwhelming into the now fungible and owned.

Whiteness originates not in innocence but in entitlement.

. . . Psychoanalytic work, then, need not properly target Whiteness itself here. Instead, it can effectively target the psychic receptor sites that provide Whiteness the interior vertical mapping on which it depends. The vertical map disrupts the identificatory bond that might once have bound subject to object. The bond persists, though, reshaped and hardened now into a vertical format. Identification morphs into disidentification, similarity into difference, affectionate care into sadistic cruelty. Diminish the spread and influence of these interior vertical receptor sites and, indirectly, the parasite of Whiteness is dislodged, loosed, itself becoming susceptible to exposure, as a differentiated and alien presence. Psychoanalytic work, in its most radical, fundamental, and, finally neutral forms, targets any and all of the effects of vertical mapping. Where verticality was, there horizontality will be.

Ah, the termites are dining well!  Imagine if this paper used any ethnicity other than “whiteness”. It would not have been publishable, and the author would have been damned and demonized forever for racism. Indeed, I’m baffled why the editor of this journal even published the screed. It appears to say nothing beyond whiteness being a parasitic infection of the mind that needs to be cured by psychoanalysis (of course).

Is this a joke or a hoax? I don’t think so. The author has written quite a few articles for the journal and is identified at the article’s end this way:

Faculty, New York Psychoanalytic Institute [NYPI]; co-founder of the Green Gang, a four-person collective working with climate change denial and the relation between the human and the natural worlds; Chair, Program Committee, American Psychoanalytic Association.

Indeed, he’s listed as a faculty member on the New York Psychoanalytic Institute website. He’s a real person!

Here’s a photo of Moss from the NY Post:

Now there’s a different Donald Moss, another physician, who hastened to tweet that he wasn’t the guy who wrote this execrable paper. I don’t see the “correction and apology” on the website, though.

Lee Jussim, a psychologist at Rutgers, points out the similarities between Nazi racism and Moss racism:

I don’t want to delve further into this steaming pile of psychoanalytic scat, as you can read the paper for yourself, and perhaps delve further into the writings of Dr. Moss. But you can conclude two things. First, this Donald Moss is off the rails, perhaps in need of treatment himself (but not psychoanalysis!). Second, the Journal of the American Psychoanalytic Association has no credibility and, apparently, no standards.

I wonder what his colleagues at the NYPI are thinking. . .

______________

Moss, D. 2021. On Having Whiteness. Journal of the American Psychoanalytic Association 69:355-371.

Should mental-health professionals diagnose Trump as mentally ill?

October 3, 2020 • 12:30 pm

It’s one thing for us to call Trump a narcissist or a sociopath, but it’s another thing entirely when a group of mental-health professionals argue that Trump should not be allowed to debate—or should be impeached—because he’s sick in the head.

Psychiatrists generally refrain from diagnosing people whom they haven’t examined, adhering to what’s called the “Goldwater Rule”. That rule, put into place by the American Psychiatric Association, came into being in 1973 when a group of over 1000 psychiatrists questioned Barry Goldwater’s fitness for office based on their long-distance diagnosis. Other Presidents, including Clinton, have also been diagnosed as mentally ill by the pros.

After the diagnosing of Trump started in 2016, the APA issued a statement in January, 2018 that reaffirmed the Goldwater Rule:

Today, the American Psychiatric Association (APA) reiterates its continued and unwavering commitment to the ethical principle known as “The Goldwater Rule.” We at the APA call for an end to psychiatrists providing professional opinions in the media about public figures whom they have not examined, whether it be on cable news appearances, books, or in social media. Armchair psychiatry or the use of psychiatry as a political tool is the misuse of psychiatry and is unacceptable and unethical.

The ethical principle, in place since 1973, guides physician members of the APA to refrain from publicly issuing professional medical opinions about individuals that they have not personally evaluated in a professional setting or context. Doing otherwise undermines the credibility and integrity of the profession and the physician-patient relationship. Although APA’s ethical guidelines can only be enforced against APA members, we urge all psychiatrists, regardless of membership, to abide by this guidance in respect of our patients and our profession.

A proper psychiatric evaluation requires more than a review of television appearances, tweets, and public comments. Psychiatrists are medical doctors; evaluating mental illness is no less thorough than diagnosing diabetes or heart disease. The standards in our profession require review of medical and psychiatric history and records and a complete examination of mental status. Often collateral information from family members or individuals who know the person well is included, with permission from the patient.

“The Goldwater Rule embodies these concepts and makes it unethical for a psychiatrist to render a professional opinion to the media about a public figure unless the psychiatrist has examined the person and has proper authorization to provide the statement,” said APA CEO and Medical Director Saul Levin, M.D., M.P.A. “APA stands behind this rule.”

I generally agree, for professionals should behave professionally. Doctors don’t diagnose patients without an exam, and psychiatrists are doctors. As an article in the Canadian Medical Association Journal (CMAJ) noted,  

. . . One reason for The Goldwater Rule is the likelihood of error in a diagnosis made at a distance. A proper diagnosis requires much more than “a review of television appearances, tweets, and public comments,” the American Psychiatric Association noted in its statement. “The standards in our profession require review of medical and psychiatric history and records and a complete examination of mental status. Often collateral information from family members or individuals who know the person well is included, with permission from the patient.”

You can say we already know enough to agree that Trump is mentally ill, but remember, if you want to assert that in court, the perp has to be examined by mental-heath professionals. Courts won’t accept diagnoses without direct examinations.

Now some mental-health professionals say that there’s a “duty to warn” that overrides the Goldwater Rule, a “duty to warn” about the effect of Trump not just on the well being of America, but on the well being of Americans themselves, making them unstable, liable to suicide, and so on. And so a group of 27 mental-health professionals, including psychiatrists, issued a statement last October warning about Trump. An excerpt from that:

Efforts to bring Duty To Warn into the spotlight have been ongoing since Trump first stepped into the political ring. We are joined by mental health professionals from various field including, but not limited to, psychiatry, psychology, medicine, public health, public policy, and social work; in every field, professionals have been voicing their concern about the president’s instability.

We Are Mandated Reporters
Mental-health professionals are mandated reporters with a duty to warn our patients and the community around us if we feel there is a potential danger.  In this case, we collectively feel there is a duty to warn the public of the threat Donald Trump poses both to our nation and the planet.

It is our duty to notice when an individual is a danger to themselves and/or others.

What about the Goldwater Rule?

“The Goldwater Rule is not absolute. We have a ‘Duty to Warn,’ about a leader who is dangerous to the health and security of our patients.” Mental-health professionals are “sufficiently alarmed that they feel the need to speak up about the mental-health status of the president.”

CMAJ counters:

Last October, when a group of 27 mental health professionals, including psychiatrists, published a book arguing that the current US president’s mental state was a danger to the nation, they said they were honouring another medical principle: the duty to warn. The idea behind “duty to warn” is that if you are in a position to know about a danger and have time to alert others, you should do so. Psychiatrists, for instance, are allowed to break doctor–patient confidentiality if they suspect a patient is about to harm a third party.

But part of that duty rests on having done a proper evaluation, according to Dr. David Goldbloom, a psychiatry professor and senior medical adviser for the Centre for Addiction and Mental Health. “You are intervening to abrogate fundamental civil freedoms,” he said. “You can’t do that from having read an article or watched television.”

Of course, we know that Trump is a danger to the country simply because of his statements and actions, and that seems to me independent of whether he has an official DMC diagnosis by professionals.

But Yale psychiatrist Bandy Xenobia Lee, in an interview with Salon (of course), says that it’s her duty to warn people about Trump’s instability.

Lee has a history of trying to publicize her views that Trump is mentally ill; see the section on this in Wikipedia, which also describes her lobbying Congress. That section says this:

in 2017 [Lee] was editor of The Dangerous Case of Donald Trump, a book of essays alleging that Trump suffers from psychological problems that make him dangerous.

. . . 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 it’s possible that some of this has to do with, yes, inequalities in American society:

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.

She continues her efforts in the Salon interview (click to read):

First, she argues that Trump shouldn’t be allowed to debate:

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

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.

I’m not sure people treated his behavior as normal; the media was full of people saying that he seemed unhinged. Having someone like Lee weigh in that he’s mentally ill and shouldn’t have been allowed to debate adds little to that; in fact, I thought the debate was salutary in one sense: Americans got to see how unhinged Trump is. If they want to elect him after that, well, they’ll get what they deserve.

One gets the feeling, throughout this interview and in Lee’s other writings, that part of the reason for her crusade goes beyond her view that an unleashed Trump will harm America; it may well also involve her blatant dislike of his politics. In that respect she goes over the top in emphasizing the psychological toll of Trump on America, a toll that presumably should have mandated his impeachment:

The reinterpretation of the “Goldwater rule,” as happened at the onset of this presidency, has been exceedingly harmful, in my view, for silence in the face of grave dangers facilitates conditions for atrocities. Last month, we created a blow-by-blow account of how we exactly foretold the president’s mismanagement of the coronavirus pandemic, based on his psychological makeup. We could not effectively convey this in advance, because the public was led to believe that the “Goldwater rule,” which is a guild rule applying only to 6% of practicing mental health professionals, was universal, or worse yet, some kind of law. But in truth, to change a guideline whose purpose is to protect public health to protect a public figure at the expense of public health violates all core tenets of medical ethics.

Yet Lee has been broaching the Goldwater Rule for a long time (I don’t know how she gets away with this if she’s a member of the APA), and yet nothing has happened to Trump despite her books and her many interviews, all making the same point.

And she may well be right that Trump meets the ever-shifting psychiatric criteria for mental illness. I’m no professional, but Trump’s behavior seems way, way out of line—the tails of the human behavioral distribution. Still, I’m not comfortable with professionals giving a professional opinion by observing Trump the same way we do: scrutinizing his tweets, his press conferences, his debate performance. The man is out of control. But don’t psychiatrists need to talk to a patient before they tell the world he’s nuts? The effect of Trump on people is obvious, and you don’t need to be a mental health professional to see that his Presidency is risky to America. Having Dr. Lee tell us that, in our professional opinion, he’s nuts, adds nothing to our fear of the man.

In fact, if people tried to remove Trump from office, or prevent him from debating, based on Lee’s opinion that Trump is mentally ill, it wouldn’t work. People would just laugh at the attempt, and impeachment on the grounds of mental incapacitation wouldn’t do, either, at least not with a Republican Senate.

I can see where Lee is coming from: she’s a forensic psychiatrist and presumably sees nuances in Trump’s behavior that we don’t see. But we don’t need nuances—we know all we need to know, and if a liberal psychiatrist says Trump is certifiably a bull-goose loony, that will have no effect in swaying his supporters. We already have the means to stop Trump, and we can exercise it in the next four weeks by casting our ballots against him.

Bandy Lee and her book.

h/t: Randy

What is it like to be Trump?

September 9, 2020 • 9:00 am

Most of you probably know about Thomas Nagel’s famous article, “What is it like to be a bat?” (article here), which denies a materialistic understanding of consciousness based on our inability to understand what a bat’s consciousness is really like. While philosophers have argued over Nagel’s thesis, there’s little doubt that, at least for the present, we have no way of getting inside a bat’s head to answer his title question.  (I often wonder, while tending the ducks at Botany Pond, what it’s like to be a duck.)

While a bat’s mind is inaccessible for the nonce, that’s also true of any other creature, including other humans. We don’t know what it’s like to be Christopher Walken, for instance. But we can be pretty sure, based on the fact that the neuronal wiring and acculturation of humans in our society is fairly similar, and because we also can get self-reports from people, that the consciousness of our fellow hominins is pretty similar to ours. There are of course exceptions: people in vegetative or comatose states, people with severe mental illnesses, and so on.

Speaking of the latter, when I woke up in the middle of the night last night (I don’t sleep well during the pandemic), it suddenly struck me that I have no idea what it’s like to be Donald Trump—in a way that’s similar to Nagel’s question. More than most other humans, Trump’s inner life is largely inaccessible to me.  That is, his behavior and mentation seems so alien compared to those of other people, that I have no idea what’s going on in that depilated noggin. Surely, though, he thinks that although he appears narcissistic, erratic, and foolish to most of us, he thinks he’s just fine—tremendous, as he says. He’s a “stable genius.” He surely thinks that it’s other people who are the problem.

The disparity between how Trump describes himself and how he comes across is greater than that of most people, though all of us have a self-image somewhat at odds with how we seem to others. It’s just that in Trump this disparity seems huge. And I wonder if others have entertained this same question.

As a determinist, I can’t fault Trump for making the wrong choices about what he does and what he says, or about who he’s become. That’s all a product of his genes and his environment and he never really had a choice in the ” libertarian free will” sense. But of course we can—and should—call him out for his behavior, because, though influencing the man himself is a lost cause, we might influence others to vote against him.

What is it like to be a Trump? I doubt that it’s pleasant given his obsessive monitoring of how people regard him and his frequent bursts of anger and invective. But I’m sure that if you asked him, he’d respond that he’s “perfect”, that “there’s nobody on Earth happier than I.”

So go the 2 a.m. thoughts during a pandemic.

 

Source

Freud: Charlatan of the mind

March 24, 2020 • 10:00 am

About fifteen years ago, I decided to read Freud. After all, he was touted as one of the three greatest thinkers of our time, along with Einstein and Marx (all Jewish men), and while I found Marx boring, I could at least try to read Freud. And I did: I read a lot of Freud, including his major books on dream analysis, the psychopathology of everyday life, The Future of an Illusion, his book on jokes, his General Introduction to Psychoanalysis, and many of his famous case studies, like “Little Hans” and the “Wolf Man.”

I was appalled. As a scientist, I recognized that his works were tendentious in the extreme. He wasn’t following the data, but massaging the data to conform to his preconceptions. In other words, he was ridden with confirmation bias. In fact, I couldn’t find a single idea in his works that was new (the “unconscious” had been suggested by others), and a lot of ideas that were complete crap (e.g., the Oedipus complex). In the end, I couldn’t figure out why he was regarded as such a great thinker. While psychoanalysis was touted by Freud as a “science,” there was no science in it: it was in fact the opposite of science—pseudoscience based on faith (a religion, really) and, ultimately, on Freud’s ambition to be famous.

Then I discovered that a professor named Fred Crews, once chairman of English at UC Berkeley, had devoted a lot of his writing to criticizing Freud in an objective but hard-hitting way. He had several articles on Freud in The New York Review of Books (e.g., here and here), as well as two excellent books on Freud, which I show below (click on screenshot to go to the Amazon site):

And this more recent book (2017):

The second book, involving years of diligent scholarship, is delightful though distressing, for you’ll discover the true mendacity of this ambitious, preening, and narcissistic man. Crews, once a literary critic adhering to the school of New Criticism, writes extremely well (this is a biography of the early Freud), and simply takes Freud to pieces.

Although some critics dissed the book, I couldn’t find a single critique that took issue with Crews’s painstakingly-accrued facts about Freud’s life. These critics seemed to be of the pro-Freud school—that group of people who, even if they decry psychoanalysis, can’t bear to hear that the Emperor had no clothes. At any rate, I would urge you to consider the second book for your quarantine reading. It’s a page-turner.

Now LiveScience has an article about Freud with a provocative title (click on screenshot):

The spoiler is given in the title, but there are a few pungent quotes from Crews:

“Statistically, it’s conceivable that a man can be as dishonest and slippery as Freud and still come up with something true,” Crews said. “I’ve tried my best to examine his theories and to ask the question: What was the empirical evidence behind them? But when you ask these questions, then you eventually just lose hope.”

As damning an assessment as that is, it wasn’t always like this for the founding father of psychoanalysis, who wrote that mental health problems could be cured by bringing unconscious thoughts back into the conscious realm. In his own time, Freud enjoyed celebrity status as a leading intellectual of the 20th century.

Chief among Freud’s overflow of opinions was the “Oedipus complex,” the hypothesis that every young boy wants to have sex with his mother and so wants to murder his father, whom he sees as a rival. But there’s a catch. The boy also has the foresight to realize that his father is simultaneously his protector. Presented with this challenging scenario, the child is forced to repress his homicidal cravings.

“It’s just about the craziest idea that anyone ever had,” Crews said. When people asked about young girls, Freud hastily came up with another idea, the Electra complex. “It’s just a cut-and-paste job. Suddenly, the little girl wants to have sex with her father,” Crews said. “It’s completely ludicrous.”

I wrote a post about the second book when it came out, and referred to a podcast with Crews. That’s still available, and you can listen to it or download it by clicking on the screenshot, where you’ll get 51 minutes of food for thought:

 

h/t: Bill