Tag 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.


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.

Speculative Execution

Speculative execution is not exactly how thought works, it’s how you work without thinking about it. When philosophers talk about determinism versus free will, they treat the brain as if it were a black box with memory and sensory perceptions going in and actions coming out, with a clear sequence of causality from the first to the last. For the determinists, this is enough. For those who believe in free will, there’s an extra something special added at some point — the Soul, some kind of quantum magic going on in the synapses, whatever sort of swerve away from clockwork perfection seems convincing this decade — but it’s just another station on a linear progression.

Cognitive psychology and neuroscience undermine all of this because the brain doesn’t work like a black box. Without your noticing, it’s continually second-guessing and anticipating in all sorts of different ways. Your visual field is not the beautiful and transparent 360-degree spherical sensorium, God’s own VR headset, that you think it is: it’s a little dot of fine-detailed vision in constant motion with the gaps filled in by how your visual centres have come to assume that the world works. You anticipate what other people are about to say; your own words come tumbling out of your mouth without any conscious composition. The mind isn’t some Cartesian homunculus behind your eyes, marshalling inputs and emitting appropriate commands like some idealised 18th century lord. It’s a democratic and noisy playroom of independently-acting modules, all fighting for what little bandwidth your senses and memory afford them, and only too keen to proceed as far as they can on what guesses they can make.

And just as in CPUs, the goal of all this mess, this willingness to go out on a limb, is efficiency. Err on the side of caution if you think there’s a predator or, more realistically, the hostile or mocking attention of your peers; get distracted by anything which seems promising, an attractive person or an appetising aroma, because who knows that it might not be your last chance.

That’s the evolutionary story, and while we like to locate the life-and-death struggles behind the bundle of hacks we call consciousness in the savage prehistoric past, think of how much more we need to rely on speculative processing in the buzzing and blooming and overcrowded Umwelt we’ve built around ourselves. Sure, we might have evolved on the savannah, but all of these words and walls and works and wills and won’ts are what we’ve built to suit us, and they give our phantom selves such a lot of opportunity to run down the paths of might-have-been.

You’re about to change lanes and you map out the trajectory towards the exit ramp but: there’s someone coming up the inside. Backtrack. You’re indulging in a daydream fantasy about an attractive co-worker and then have to be polite and efficient with him for an hour-long team meeting. Backtrack. You’re following the plot of a movie and then what is he doing? Didn’t she get shot? Backtrack.

And this is just on a small scale. You marry young, anticipating decades of mutual happiness, only to have to unpick it all in a messy divorce in your early thirties. You choose a degree based on a school friend you hero-worshipped but get sidetracked out of it and have to explain it away for the next decade. A swarm of ghost lives, decisions and commitments and purchases and options which, if we’re lucky, we get to retrospectively make sense of, justify, tell ourselves it was destiny or fate, that it was what we were aiming for all along, what we really needed. But perhaps the truth, and it need not be an unkind one, is that a human life needs a sort of virtual scaffolding of possibilities, that the might-have-beens which we’ve unconsciously or consciously rejected are what hold us together.

Certain mental illnesses and mood disorders can be seen as a perversion of this tendency. Depression as the paralysis brought on by too keen an awareness of the sheer volume — number is too narrow a word — of possibilities exploding from every moment: anxiety is a failure of the shielding which lets our minds evaluate them without bothering us with the nagging sense that we are dancing over an abyss. In the manic phase of bipolar disorder there is a dimming of the red light and bell that clangs to signal that it’s time to backtrack, impulses are followed through to their destructive last.

It doesn’t take very much paranoia to imagine that our brain’s talent for speculative execution could be an exploitable vulnerability. Maybe back in the days of the savannah — any predator will have a keen instinct for the false steps and feints of its prey — but now? The misdirection of the magician, the fortune teller’s cold read, the confidence of the con artist, sure in their ability to anticipate just how far down the garden path their marks will lead themselves. The manipulative and abusive, those who gaslight and interrogate, the grandstanding attorney and the demagogue: do they take not take their victim’s or audience’s might-have-beens and magnify them into terrors or seductions? Facebook keeps a record of not only the posts you write, but those you cancel. The algorithms that watch us will have a better map of our shadow self than we will, seeing all the links we follow and then hurriedly click shut, the people we stalk, the products we dare not purchase.

Except that we know from a hundred ads which clumsily ape our ten most recent Google queries that the algorithms are not yet that subtle. The idea that our brains could be hacked by means as delicate as those which can be used to steal the ghosts of data from the might-have-beens of CPU caches is science fiction. And what is fiction, if not a way to coax an audience into the speculative execution of a series of thoughts, a shared illusion, a thing which could never be?