It is time for another entry in the mailbag series where I answer feedback email from readers and others. If you want to send me a question, comment or any other kind of feedback, please do so using the contact info on the about page.
Anti-science activism takes many forms. They can oppose specific scientific models such as climate change or evolution. They can oppose entire aspects of medicine, such as alternative medicine or cancer quackery. They can promote conspiracy theories on specific historical events such as 9/11 terrorist attacks or the Holocaust. They can oppose specific products developed by researchers such as vaccines or genetically modified crops. They can even be corrupted by specific ideologies such as natural birth quackery or race pseudoscience.
One form of anti-science activism that will be the focus of this mailbag installment is anti-psychiatry. It works virtually the same way that anti-vaccine pseudoscience does: it downplays or neglects the diseases or conditions (mental illness denial versus claiming vaccine-preventable diseases are not really dangerous), it attacks the treatments (rejects medication and therapy versus rejecting vaccines), rejects the mechanism (deny biological risk factors of mental illness versus denying herd immunity) and promote vile hatred of doctors.
Psychiatry is open to criticism
Jack starts off by explaining that he is a bit concerned with criticism of anti-psychiatry:
Psychiatry as a medical discipline has criticized for many decades by a wide range of groups, both within science and medicine as well as from the outside. Indeed, the very practice of scientific research into the origins, mechanisms and treatment of mental illness is a form of criticism of what existed before. If one were to search for the term psychiatry in the PubMed database, one would find half a million scientific papers. Searching for antidepressant gives 150 000 hits and there are over 190 000 hits when searching for psychotherapy. Looking at the distribution for when these papers were published, we see a long-term trend were more and more papers are being published every year like in most other areas of science and medicine. All aspects of psychiatry are being critically discussed in the scientific and medical literature every day. Nothing of this is being suppressed or stigmatized.
In fact, there is currently a replication crisis going on in e. g. psychology where bad statistics and small sample sizes has meant that some findings cannot be reproduced by other researchers. The fact that this is being openly discussed (and actively mitigated with replication projects and improved statistical treatment) is the ultimate evidence that this discipline is open to criticism and correction. Can anyone seriously claim that anti-science activist groups show this level of openness to honest self-criticism?
In fact, many anti-psychiatry activists contribute to creating a chilling effect on mental illness and stigmatize people with mental illness. Those anti-psychiatry activists who are creationists blame the patient for causing his or her own condition by inviting satanic powers into their lives. Those anti-psychiatry activists who are stuck in new age ignorance also blame patients for having too much negative thoughts and that they can get well just by thinking positively. This, of course, is just as dumb as saying that you can get well from type-I diabetes just by thinking positively. Anti-psychiatry activists who are alternative medicine proponents scam people with mental illness into trying either ineffective or potentially dangerous products at the same time as discouraging them from taking science-based medicine. Because anti-psychiatry activists often spout so much nonsense, people can be discouraged from seeking help for mental health issues.
The anti-psychiatry movement is diverse, but has common features
Debunking Denialism has previously written about how diverse many anti-science movements are. People who oppose vaccines can be misinformed parents, alternative medicine proponent, religious fanatic, environmentalist extremist and opposing the government generally. Similar diversity can be found among anti-psychiatry activists. Some anti-psychiatry proponents are creationists, some are new age believers, some are selective skeptics, some are secular mysterians, some are shrieking conspiracy theorists and some scientologists are also against psychiatry.
Jack wants to use this diversity as an argument:
Indeed, not all anti-psychiatry activists are creationists who believe in satanic contamination. However, there are common features to most or virtually all of these different aspects of anti-psychiatry: there is a general mistrust or denial of mental illness diagnostics or mental illness as a phenomena, there is a general rejection of the mechanisms behind the origins of mental illness, there is a general opposition to science-based treatments such as medication or therapy and there is a general intense dislike for psychiatrists. These common features is why we can group these different anti-psychiatry activists under the label of “anti-psychiatry movement”, while acknowledging that it is a divers movement.
Science gets many things right and updates and improves the stuff it gets wrong
Ah, the classical “science has been wrong before!1” gambit. It is certainly true that science sometimes makes mistakes. But this has to be weighed against all the other times when science does get things right or makes highly empirically accurate models of reality. It is not enough to merely point out a few mistakes and then use this in an effort to undermine science. You have to push away confirmation bias, take it all into account and are not really allowed to cherry-pick selected examples.
Indeed, scientists were among the first to criticize the PACE study and follow-up papers. This is not a weakness of science, but one of it strengths.
Medical diagnoses rest on facts, not merely trivial conceptualizations
Conceptualizations are certainly used in science and medicine as a pedagogical tool to explain whatever needs to be explained in specific situations. However, this does not mean that diseases are a matter of convention or that there are no scientific criteria for them. It is certainly true that cancer is not a single disease, but a category of disease. Every cancer patient is unique. However, the reason for why you can group people with cancer into different categories is because of the large similarity between, let’s say, different cases of leukemia. While blood pressure is a continuous measure, we need to find a region where you have dangerously low or dangerously high blood pressure. How is this done? The answer is by doing medical research. How much of a risk factor are different blood pressures for cardiovascular diseases? Those are scientific questions that can be answered by research.
Thus, when Jack suggests that we “need to create a sensible framework”, he is forgetting that those frameworks already exists and are quite robust.
Note: In this last sentence, I misread what Jack wrote. He wrote “needed” when I incorrectly read it as “need”, creating a clear misunderstanding on my part. I have now retracted that sentence by striking it out. See this comment for additional details (note added 20170124 01:51 UTC+1).
We do not know all the details of how the brain works, but we know enough to refute anti-psychiatry
It is absolutely true that we do not know all the details of how the brain works on different levels. However, we know enough to fill libraries with research papers, medical documents and textbooks. We know that the brain is an organ of the body. We know that our minds are a function of that brain. We know that precise injury or other problems cause precise cognitive deficiencies. We know that the brain, like any organ, can get diseases and conditions. There is no magical barrier that makes the brain completely invulnerable. While it is certainly true that another 100 years of scientific research will create massive improvements, none of it is likely to overturn core facts. This is because these facts are based on a massive amount of independently converging evidence and any future model must make the same predictions as an older one in area where they both apply. This is known as the correspondence principle. It is the same reason for why we landed on the moon using nothing but Newtonian mechanics, even though general relativity can explain a lot more.
Furthermore, this issue is not restricted to psychiatry. Developments in medicine during the next 100 years will likely lead to massive improvements in our understanding in everything from cancer to autoimmune diseases. This does not for a moment justify the stance that cancer is a fungus or that autoimmune disease are caused by having too many negative thoughts. Similarly, 100 years of research will probably not find that the brain is invulnerable to disease or that the mind is actually purely a function of the kidneys.
An anti-psychiatry contradiction
Because anti-psychiatry is a form of pseudoscience it contains a number of curious contradictions where proponents simultaneously tout two different lines of argument that are fundamentally incompatible. Both of them cannot be true at the same time. Previously, we have seen how Jack was quite concerned by the use of structured diagnostic manuals when we do not know everything there is no know about the brain. Now we can read that he is concerned of the exact opposite:
Jack seems to take the opposite position here: now the problem is not so much that psychiatrists consistently use and follow structured diagnostic manuals, but that they randomly go around diagnosing people based on wishful thinking. An equally curious and lethal contradiction.
The risk of false positives or wrong diagnoses exists and it is a real problem. This is one of the reasons for why structured diagnostic manuals exist. It offers a consistent language and criteria that relevant mental health professionals that use as an aid for accurately diagnosing people with mental illness. This is the very opposite of randomness, arbitrariness or wishful thinking.
For any diagnostic algorithm, the issue of false positives must also be weighed against the risk of false negatives. Right now, most people with mental illness who would benefit from getting help are never diagnosed and never receive the medication and therapy that they need. Government cutbacks in healthcare generally and mental health specifically is a major problem and a major threat.
Just imagine what could be accomplished if anti-psychiatry activists would stop recycling myths and misinformation and instead helped mental health advocates fight for mental health funding, treatment availability and access for those who need it.
Good science does need protection from e. g. anti-science forces
Jack finishes his concerns with a statement that seems to suggest that he is not fully aware of the threats posed by pseudoscientific and anti-science forces:
Bad science certainly does not need protection, but good science needs to be constantly defended. This is because there are cranks and quacks out there that spread pseudoscientific nonsense and misinformation in an attempt to undermine solid science. Powerful politicians can also attack science in a wide range of ways, from claiming that climate change is a hoax or block import of life-saving HIV medication (a move that killed at least 340 000 people). Good science is constantly under attack. They can also cut science funding from very important projects that help save lives and develop crucial technology. Mental health professionals can certainly be defensive when someone regurgitates anti-psychiatry misinformation that has been recycled and refuted thousands of times before. This is not a cause for worry, but a badge of honor that they take the time needed to combat pseudoscience.