Category Archives: psychology

Cracked – Why Psychiatry is Doing More Harm Than Good

James Davies

One of the false starts I made towards the previous post was a review of this book, which I abandoned because it was making me too angry. I’m home sick today and feeling spiteful, so here it is.

I picked the book up one day when I was feeling sullen and grumpy with my side-effects: I’m glad that I bought it in a remainder store, I don’t want its author to earn any money from it, because it’s awful. I wouldn’t call myself an outright antipsychiatrist, but on top of my personal dissatisfaction with my meds, I feel like the profession and the pharmacological industry have serious problems and need some sort of reform, and I’m also fascinated by the history of the discipline. Despite this, I can’t remember the last time I read a book written from a position to which I thought I would be basically sympathetic which left me feeling that its author was not only a bad writer, but a bad person.

From the start, the book’s style, at once matey and hectoring, made me think of the last five years of British political debate, and I thought, facetiously, that people like Davis are why Brexit is happening. I persisted with it only because of a growing horror and fascination with the author’s sins, his smug contempt for patients disguised as concern, his apparent ignorance of how much of psychopharmacology’s flaws are those of the drug and medical industry as a whole, his sentimental and captious argument that what people need instead of medication is “traditional values” without ever having to spell out how exactly these should be delivered. By the time I reached the end, this didn’t feel like a cheap shot. People like Davies, and an intellectual and publishing culture which supports them, are exactly why Brexit is happening.

The single biggest problem I have with the book is its childish binary logic. It is assumed that we as a society or as individuals are faced with a neat choice: either submit to the corrupt technocracy of big pharma and keep swallowing ‘happy pills’, or shape up, go to humanistic psychotherapists like himself, and, one supposes, church. (Putting the phrase ‘happy pills’ in scare quotes is a perfect illustration of the book’s stylistic dishonesty: this is a phrase which is only used by his side in the debate, so they own it, and holding it at arms’ length is cheating.)

Davies never makes plain what he means by traditional values, so the reader is free to imagine his alternative to the status quo as some sort of pre-industrial idyll, at least if they’ve never cracked open a history book. There’s no connection in Davies’ thought with the anti-psychiatric tradition which sees modern society as regimenting and controlling alternate and viable ways of being; there’s no evidence that he’s read or even heard of Laing, much less Foucault. Nor is there any sign that he’s aware of the callous and violent ways in which traditional societies dealt with the mental illness before modern psychiatry, or the desperation and misery which has characterised the lives of the mentally ill for most of human history.

Outside the journalistic games of good guys and bad guys which books like these are playing, people with mental illness don’t just visit their GP, take the pills and hope for the best. They got to twelve-step and other self-help groups: they go to therapists and counsellors and family members and, yes, church. Davies is an anthropologist and psychotherapist, which makes his caricature of the actual experience of mental illness all the more frustrating. I found myself reminded of the rationalist blogger Scott Alexander and Jordan Peterson, both of whom are also clinical psychologists but who seem to have strange or deficient ways of understanding how actual human beings behave. All three seem very far removed, in terms of temperament, from the qualities I would look for in a good therapist or psychiatrist, or a priest or rabbi, for that matter.

If you want to read a good book on the divide between traditional psychoanalytical practice and psychopharmacology, written by an anthropologist who seems to be able to observe and interpret clinical behaviour, rather than just try to score rhetorical points off it, I can recommend T M Luhrmann’s Of Two Minds as a much better alternative.

Having just added the title to this post, I don’t know what I was expecting from a book about mental illness whose title is a clumsy play on a slur against mentally ill people. This might seem like a PC quibble, but it’s actually a distillation of the book’s awfulness. It’s like someone making dad jokes about matters of life or death and then expecting you to thank them for their intellectual bravery. Everyone involved in it can get fucked.

Advertisements

Diaries

I told myself, and I wrote here, that I was going to blog more, about a month ago, and nothing much has come of it. For a while now I’ve been trying to write five hundred words each day, which sometimes is fiction and sometimes essays which end up as blog posts, either here or on mikelynch.org, but which is mostly a diary.

There have been other times when I’ve been going through troubles that I’ve written regularly. After a spell of frantic and introspective journal-keeping after getting divorced in 2003, I went off it, because it didn’t seem to help with my depression and in some ways made it worse. I felt like I was just rolling around in my problems and not doing anything about them. The ritual of putting pen to paper was comforting, but the actual writing wasn’t amounting to anything, and it meant that the most creative activity which I did was also concentrating on all the reasons why I was sad. I’ve still got an envelope somewhere containing a thick wad of foolscap which I sealed away when I decided to stop keeping that journal. I haven’t ever been tempted to open it.

My daily writing now has felt more productive, even if it’s not that much more worth reading. Every now I’ll go back over it — the fact that I’m doing it on a laptop rather than a notepad makes this easier — and it’s sometimes embarrassing to see me write down the same insight, something I’ve figured out in therapy or while running that struck me as particularly helpful or wise, months apart, often using almost the same words, with no self-awareness that I’d already been over that ground. Maybe the lesson here is that keeping a diary is more useful if one re-reads it, so that things don’t get lost.

There’s another reason for this kind of delayed stutter, and that’s fear. Mostly, the repetitions I’m thinking of are writing about, or writing around, something which I need to tell someone or do with someone, and which I’m afraid of. Writing about it is, in a way, a delaying tactic. Instead of getting up the courage to have a difficult conversation, I can write five hundred words about it. It is a useful way to put my thoughts in order, but it’s also a sop: I get the satisfaction of having done something, and ticked off a daily self-care task, without the danger of actually doing the thing which I’m afraid of doing.

I do, eventually, mostly, get around to doing these things, and I shouldn’t be hard on myself about the slow and repetitive nature of the process. There’s far more repetition in my head, where I worry about these things and have imaginary versions of the conversations which I’m delaying. By turning them into something that’s a little more concrete — even if it’s the evanescent form of a text file on a laptop — I make them more real, something I’m less likely, even if only marginally, to forget about or put off.

Various compulsions

I’ve taken Twitter breaks before, from a week to a month in length, because it messes with my head: it’s like I have a little cloud of arguments and jokes following me around, and I’m always distracted, either by anger or by the ever-present urge to turn a situation or a stray thought into a sentence which can get me some dopamine. My current break is the longest I’ve had, and I did it for a slightly different reason.

Once I’ve started checking Twitter in a given twenty-four hour period, I can’t let go of it. I’ll keep checking it at short intervals, unless interrupted by something which forces me to focus my attention elsewhere, like driving or eating. This year, my compulsive urge to check it became dramatically worse, and I tried to stay off it until after 5pm. This seemed to be going OK, until I noticed that every afternoon at 4:30 or so I’d get a massive knot in my stomach. It was the first time I’d ever had Twitter make me anxious before I’d even read it, so I decided to give it a rest for a while, and then the while turned into a couple of months.

I still miss it and one of the things on my to-do list is to prune my follow list back to under a hundred people, or maybe just start a new account and follow back anyone who cares enough to follow me, but neither of these things is very high up my to-do list. Which is annoying: over the years Twitter has provided me with a form of social connection which has been really important to me, and I’m not very good at making connections in more traditional ways, so it’s left me feeling a bit isolated.

What’s also annoying is that the compulsiveness itself hasn’t gone away, it seems to have displaced itself into other behaviours which honestly aren’t much better than Twitter:

Hatereading rationalist blogs. I’ve been unhealthily fascinated with places like LessWrong since I first found out about them, and a few months ago I actually added Slate Star Codex to my RSS reader. These people write so much that following what’s going on at all requires way more effort than it would be worth even if they were any good. But they’re not. I still want someone to do a “Serial” style podcast about a group of American psychiatric outpatients who slowly discover that their doctor is running an incredibly earnest and verbose blog in which he tries to reverse-engineer every form of human activity in order to solve the world and prevent a harmful AI from eating our brains.

Compulsively checking the output of my Twitter bots. Yes, I know that this is a bit sad, but I’m sure I can’t be the only botteur who does it.

Trying to keep up with the Trump megathreads on Metafilter, which is like trying to keep up with a screaming mob. Even if you agree with them, it’s not advisable.

Checking Mastodon. This seems healthier than Twitter, or, at least, it doesn’t wind me up as much. But it’s less worthwhile as a source of social connection. It might improve: I remember a while in 2009 or so when Twitter seemed a bit pointless, and then for some reason, some threshold in my corner of the social graph was passed and it seemed to take off. Mastodon, or my slice of it, has better politics but too many people complaining about how software and computers are terrible and we should burn them down and start again.

Reading Wikipedia articles. I was one of those kids who read an entire encyclopaedia (the World Book) just because it was comforting and full of facts, although I got an aversion to several letters because their volumes contained articles which were not comforting at all: D for Disease, H for Heart (disease). Looking up obscure topics in astrophysics or biology and reading through thousands of words of the output of the internet’s Bouvards and Pécuchets is not something of which I’m proud, but it’s better, again, than reading Scott Alexander.

I’ve started using a site blocker to keep me off the worst of these places altogether and restrict my access to the less bad ones. I’m hoping to get some compulsive behaviours going which are constructive, like posting things here, and drawing again, and writing more stories.

Obvious is the new black

Kevin Kelly, still immanentising the eschaton after all these years:

A major theme of this present century will be the pursuit of our collective identity. We are on a search for who we are. What does it mean to be a human? Can there be more than one kind of human? In fact, what exactly is a human?

Oh, I must have gotten old, because here is what the above quote made me want to do: the next ten times I read something which is urging me to question or problematise or somehow turn my brain inside out about something perfectly obvious, like “what exactly is a human”, I’m going to make a note of it, and also make a note of the commonsense version. And then continue to believe it, of course.

For example: there’s only one kind of human. Your kind, which is the same as mine, and everyone else’s. We can leave the question of transhuman identity aside for now, and probably forever, unless we are sf writers or Kevin Kelly.

The limit of ten is because this rhetorical strategy – the “everything you know is wrong” gambit – is so widespread that I’ve got to stop somewhere.

R.I.P. Arthur C Clarke: who could create a sense of wonder without such cajolery.

Subjective subjects

One endearing feature of folksonomies like del.ici.ous is that they can provide glimpses of other people’s emotional reactions to what they’re browsing. You can mundanely surf by subject tags, but I’m more interested in seeing what other people find to be bewildering, amazing or infuriating.

You can see things that people want you to read, and things that they haven’t got around to reading yet.

On the other hand

I don’t think I really expect to ever see the Coalition give any kind of support to an apology to the Stolen Generations, so I shouldn’t be too schadenfreudey and churlish about it.

It certainly makes me feel better than the levels of coverage which the US primaries are receiving in the Australian media. Something I remember from cognitive-behavioural therapy: excessive dwelling upon circumstances which are beyond one’s control is a very common item in the depressive thought-pattern repertoire. I know that these things don’t just scale up, but obsessive interest with the minutiae of another country’s democracy strikes me as somehow unhealthy, or perhaps the exact term I am hunting for here is ‘tryhard’.

There are probably a lot more West Wing fans out there than I realise, and also my mood has been less than 100% lately, so I could just be projecting.