by Helen Razer
It strikes me that if one is overeating, one is behaving in accordance with the temptations and frustrations of our era. And no, I am not saying that people have no choice. If I said that, Bernard, a real free-will guy, would demand a creative divorce. But I do believe our choices are limited by the diminishing size of our conscious minds and the encroaching size of our BED appetites. Every day, this rational world makes our big, dumb ids just a little bit bigger and dumber.
The era is mad and it is not unreason to act in accordance with its demands. If one is overeating and feeling bad about it, one is probably driven by unconscious desires. The correct way to illuminate these unconscious desires might be, say, a Freudian approach. That is, we would set about illuminating the unconscious and actually shining a light on the individual experiences that led us to repeatedly enact this unwanted behaviour. Psychoanalysis is the process of giving light to individual darkness. We are mostly made of chocolate-eater, says Freud. The chocolate-eater is the city and the conscious mind is the tiny dieter in the garrison. The city stores all of the history and is, in fact, the foundation for this tiny little room to which the city is hostile. The conscious us can be seen as an unwelcome soldier in the city of the self.
In Civilisation and its Discontents, Freud described how this internal conflict plays out in the social. And he talks about how the psychoanalytic approach is a long, and quite unreasonable, process of illumination. From the garrison, we learn to view and even command some of the city. This remains a powerful idea. And it is one that stays with us in a very contradictory form. We absolutely agree with Freud that ‘repression’ is a bad thing and that we MUST talk about our problem; we must shine a light on all the dark. And we do this on talk shows and in newspapers and on our deathbed. But really, in thinking we have conquered the chocolate-eating city, the chocolate-eating city conquers us. Freud would be ‘depressed’ to know that he gave us Oprah, and Stupid people who think that ‘mental illness’ is an explanation and a cure for unwanted behaviour. Mine is a whole generation of twits with a psychiatric industry to support them in the belief that we know about the ugliness of the unconscious city because we see it on TV.
What is that thing Keyser Söze says about the devil in The Usual Suspects? The greatest trick the devil ever pulled was convincing us all he didn’t exist. We believe ourselves, in this age of psychiatric reason, to be emptied of the devil and filled with rational light. But the city is now even darker and our idea of the devil remains. It’s a wasteland filled with chocolate wrappers and electronic memories of suffering. The unconscious is devouring us with a melancholy soundtrack and the delusion it has disappeared.
Psychoanalysis is the attempt to throw light, to take us carefully through the rubble and make sense of it. Whether we have suicidal thoughts or a chocolate problem, it is an approach with value on both a philosophic and individual level. But there is so little demand for it in a world that sees itself as so enlightened.
Now, there are still a handful of psychiatrists who will embark on this individual exploration of the unconscious with a patient. But mostly, there are psychiatrists and general practitioners who will prescribe a one-size-fits-most cognitive or drug approach. And what this supposes is not, as Freud posited, that the individual unconscious needs illuminating but, in the process started by men like Descartes and mutated by an increasingly rational Oprah Age that feels it has absolute knowledge, that we have already illuminated everything.
If I happened to have a serious problem with binge eating—and I know this can be a serious problem; I live in the world’s most obese nation—I think I would benefit more long term from a discussion of the factors that led me to cram things into my face. If I can genuinely see the problem truly illuminated, as Freud would have recommended, and not just falsely illuminated by a GP going through a list of symptoms and prescribing me a factory-made solution, then I think my chances of overcoming the bad behaviour would be much improved.
Here is a case where real enlightenment might work; where really tackling that Stupid that lives in your big, dumb, pleasure-craving, death-loving id and exposing it to light could change your behaviour. Instead, the more common end is to take a mass-produced solution. And for the patient, this is almost as much a faith-based cure as any snake oil. We trust that the professional knows what he is doing and has a fine understanding of the very complex research and theorising that led him to give us a Selective serotonin reuptake inhibitor (or SSRI, such as Prozac or Zoloft). But what we emerge with is no real understanding of the darkness inside us and no way to really illuminate it.
Accepting a standard cure, in which I have no understanding, just doesn’t strike me as a good way to bounce back from an undesirable mental state. This is not to say the new drugs have no place. I was prescribed medication to recover from the ongoing attentions of a stalker. I was also instructed in Thought Field Therapy, an idiot-fringe treatment that required me to tap my ‘meridian points’. My understanding of meridians is about the same as my understanding of how serotonin inhabits the neural cleft; which is to say, hazy-to-none. But I underwent this therapy, which I had no choice but to trust, for a year and I just wish, given that I still feel the effects a decade later of the conditions that the psychiatrist called post-traumatic stress disorder and major depression and generalised anxiety, that I had walked into the office of a good Freudian.
I think what I got was some urgent care that stopped me killing myself. But what came after that was false enlightenment. The diagnosis did no good to anyone but my insurance providers. I got a false cure just as easily as I might get a false diagnosis of BED if I chose to explain my recent eating habits to a doctor.
Just why the DSM-5 felt the need to add a regular feature of my Friday nights to its taxonomy of unreason is uncertain. And not illuminated much by its own explanation. ‘A primary goal is for more people experiencing eating disorders to have a diagnosis that accurately describes their symptoms and behaviors,’ they offer as a justification for BED.
The chief function of psychiatry’s pseudo-science is diagnosis based on symptoms. Diagnosis based on symptoms, usually described by the patient, is all that psychiatry has. It is an improper science behaving like a proper science. It is totally full of shit.
But we buy this idea of the illuminated self and we accept that ‘mental illness’ is itself a rationale for much of our unwanted behaviour.
The editor of the third revision of the DSM is Robert Spitzer. Described by The New Yorker as ‘one of the most influential psychiatrists of the 20th century’, the man diagnosed the DSM itself with delusions of progress. In the foreword to an excellent book on the history of depression, The Loss of Sadness (Horwitz and Wakefield, 2008), he said he had been ‘forced to rethink [his] own position’ on the habits of a medicine that made ordinary sadness a medical concern.
The editor of the fourth revision of the DSM was even more broadly critical of the publication of which he had once been chief architect. Allen Frances called the defence by the American Psychiatric Association of its book a ‘meaningless mantra’ in the Huffington Post. In the journal Annals of Internal Medicine he described an urgent ‘crisis of confidence’ and advised that the revised DSM be used ‘cautiously, if at all’.
There are men and women of science pleading for the DSM to be remade.
If one shows evidence of distress upon a fatal diagnosis and those ‘symptoms’ extend to a period longer than two weeks, one will be diagnosed with depressive disorder. Yes, you can and most likely will be diagnosed with depression along with certain death. These are the plain instructions in psychiatry’s most influential handbook.
Psychiatry may not be rational, but it is certainly rationalised. It may not be medical, but the conditions it purports to treat are certainly medicalised.
There is a widespread belief that there is a stigma associated with mental illness. I have found that the reverse is true. There is a stigma in saying: ‘Hey, maybe something else is going on here that has
nothing to do with “mental illness”. Maybe I am not mentally ill but just responding to a life that pumps waste into my brain and does not permit its outlet.’
I believe in reason. But I don’t know if I believe that if the psychiatric version of reason is much good at treating ‘mental illness’. A great deal of the time—and again I want to be clear that there are obviously people beset by terrible pain who require meaningful therapy—‘mental illness’ is unconsciously defined by psychiatry as the opposite of reason. So if we think about Freud’s city of the unconscious as being a good idea, then psychiatry itself is a rejection of this territory. Psychiatry wants to make us live entirely in the reasonable garrison of the conscious mind. In other words, the reason of the Enlightenment has begun to believe in itself so completely, it does not allow for anything outside it. If psychiatry continues to see unreason as something to treat rather than something that can be explained or even accepted, then it will continue its program of widespread Stupid.
Psychiatry has a great history of imposing its irrational diagnostic reason on people who really didn’t need it: Willy Loman. My grandmother. Nostalgic soldiers. Homosexuals—a disease category that was removed from the DSM in the seventies not thanks to scientific evidence but because of political pressure. In other words, homosexuality ceased to be a disease for exactly the same reasons it was classified as one in the first instance. Scientistic, moralising, half-arsed Stupid.
Occupied for so long with the unambitious and harmful work of normalising people who are not ill and of making illness normal, psychiatry has fallen into darkness. It has abandoned even the pretence of science in its mania for finding a disease to fit a cure rather than finding a cure to fit a disease.
‘Mental illness does not discriminate,’ say the organisations that support the view that nearly everyone is mentally ill and not just, perhaps, in need of a talking cure or a better life. Mental illness does not discriminate and neither does psychiatry. It provides a narrow range of drug therapies for an ever-increasing range of made-up diseases. And in its mania to treat Willy Loman-itis or the sadness of death and other inevitable human states of confusion, it has much less than it should to offer those suffering disorders that might truly have an identifiably medical basis. In other words, how about a little bit less looking for drugs to treat binge eating disorder and a bit more research into suffering that cannot be socially explained?
Practitioners and patients must become more cynical about the false light of psychiatry. There is no branch of medicine which gets away with so much profitable mischief with so few biomarkers. But what it lacks in laboratory evidence or any account of its underlying scientific principles, it makes up for in profit and a broad public enthusiasm for diagnosis. To claim that mental illness may not be as widespread as routinely suggested is not unkind. Nor does it discredit the very real agony people feel or the very real need for its remediation. This is not a moralising claim. It’s just a simple conclusion that even a basic understanding of what is meant by scientific method allows. Psychiatry’s method, by the admission of some of its most notable practitioners, is not scientific. It is a pseudo-science that got lucky with the development of some drugs that changed moods. The hypothesis that low serotonin levels cause depression is losing traction. No one has a good idea of how these drugs work. In 2011, Marcia Angell, a former editor of The New England Journal of Medicine, wrote of psychiatry’s vague ideas of chemical imbalances that ‘researchers have still come up empty-handed’.
This is a science without theories and without any real shifts in its theorising. This is a medical practice that, unlike cardiology, does not have a uniform set of guidelines on what life practices a sick person might embrace or avoid. Of course, a good shrink might dare you to consider that changing your life is a more effective route out of a depression that, meta-studies suggest, in a mild form is resistant to drug treatment. But a profession working to sustain itself in the half-light of reason is too preoccupied to produce that many good shrinks.
Freud may have been dancing in the dark with ideas that bore more relation to philosophy and art than they did to reason and science. But perhaps this approach is what psychiatry needs to save itself and the many, regardless of their ‘diagnosis’, who need it. As much as psychiatric diagnosis might provide some short-lived comfort to desperate people, it has been shown to be an impotent practice. It is not moralising to say that our idea of mental anguish as a disease needs redress. What is moralising is a system of hunches masquerading as theory that can transform non-normative behaviour into a problem.
Depression and anxiety are not beautiful. ‘Mad’ people are not prophets. People in pain need relief. But they’re not going to get it from mysticism in scientific drag. The belief that we are enlightened and not benighted is a poison. It is not a remedy.
The Stupid of failing to acknowledge our ignorance will get us every time.
Pass the fucking chocolate.
HR
8
Political arithmetic, or, Slack hacks lack facts when flacks stack the stats
You know that I have little faith in political arithmetic and this story does not contribute to mend my opinion of it.
—Adam Smith, 1785, after Alexander Webster revised his estimate of the population of Scotland by one-sixth.
Much of the Stupid we discuss in this book is easily spotted by anyone with a functioning brain, even if sometimes we’ve become so inured to it, even if it takes some effort to separate it from its surroundings. But some forms camouflage themselves successfully as the very opposite of Stupid, masquerading as scientific and mathematical evidence, hiding behind numbers, lurking within data, requiring more than just close attention to identify. Some forms of Stupid take some work to unmask and expose, making them all the more dangerous. One of them is the systematic misuse of numbers to mislead and misinform public debate.
Let’s start with a contemporary example, one torn from the headlines of Sydney newspapers. It deals, after all, with an alarming problem. Violence on the nocturnal streets of Sydney was growing worse, caused by an epidemic of alcohol abuse—binge-drinking teenagers and aggressive, alcohol-fuelled males travelling into the city’s entertainment areas and looking for trouble, lashing out, assaulting others, often at random. Young men died, struck down with a single punch. The city’s doctors, sick of treating the victims of this rising tide of damage caused by alcohol, demanded action. The media joined the campaign, calling for tougher laws, heavier sentences and tighter restrictions to curb the epidemic of violence. Eventually, after an intense debate in the city’s newspapers in early 2014, the state government agreed and brought in a set of hard-line laws and new restrictions on alcohol consumption in Sydney. Informed public debate had led to the successful resolution to a vexing public policy issue.
There was only one problem: it wasn’t true. There was no rising tide of violence in inner Sydney—quite the opposite: the actual number of assaults (not the incident rate, which accounts for population changes) in inner Sydney had last increased in 2010 and had fallen more than 20 per cent since 2008. In particular, alcohol-related violence, crime statistics showed, had fallen precipitately in the city. The deaths of young men as a result of ‘king hit’ attacks, tragic and painful as they were, as agonising for their families and friends as they must have been, were increasingly atypical in a city and a state where violence had become significantly less common over a number of years—except for domestic violence, which remained a too-common feature of crime statistics and a too-rare subject of media interest. Moreover, as we saw in an earlier chapter, Australians’ alcohol consumption has been generally declining for nearly thirty years, and data showed more young people weren’t drinking at all and fewer were binge drinking. Data from the Australian Bureau of Statistics showed alcohol consumption in Australia in 2013 was at its lowest since the mid-1990s.
Journalists engaged in the media campaign avoided mentioning the contrary data about falling violence and less drinking
, or declared it ‘confusing’ in a ‘lies, damned lies, and statistics’ way. One campaigning doctor admitted that the level of violence might not be getting worse, but its intensity was, a claim difficult to verify or even assess accurately. But nonetheless, public health lobbyists welcomed the tighter restrictions on drinking that resulted, and called for a national summit to discuss increasing the level of tax on alcohol, which in Australia is already high by world standards. Alcohol was ‘cheaper than water’, journalists and commentators repeatedly said, a claim that, like most of the others made in the course of the debate, could be easily proven false within thirty seconds online.
The whole campaign, in fact, had been invented by Sydney’s major newspapers—both of which, while we’re on the subject of statistics, had lost 15 per cent of their circulation in just one year prior to the campaign—in league with paternalist public health groups and anti-alcohol campaigners. The result of this media-induced wave of Stupid was some very ordinary policies: the government proposed the demonstrably flawed policy of mandatory prison sentences, introduced arbitrary restrictions on inner-urban drinking venues and planned to make the penalties around steroid selling the equivalent of hard narcotics offences.
Now, it would not be a major revelation in this history of Stupid to note that the media beat up stories around the topic of crime. And, it should be noted, as new forms of crime emerge, they receive the same Stupid treatment by the media as more traditional law-breaking. Take ‘cybercrime’, which is frequently labelled ‘the fastest growing form of crime’ by the media and politicians. In the same way as public health lobbyists earn a living offering solutions to ‘problems’ like alcohol, the media hype cybercrime with the aid of companies that make money from selling protection against it. In fact, there have been so many wildly overstated reports about the cost of cybercrime that in 2013 one cybersecurity firm, McAfee, apologised for and retracted a claim that cybercrime cost US$1 trillion globally, after issuing a new report suggesting the cost was less than a third of that. Not long after, Microsoft claimed the cost of cybercrime was actually $100 billion a year. And genuinely independent reports (that is, those not produced by firms that make money from selling cybersecurity products) showing the cost of cybercrime is falling, and falling significantly, are increasingly common.
