Tuesday, January 28, 2014

Is Bullshit A Better Term Than Antipsychiatry?

I saw Professor Harry G. Frankfurt on David Letterman a few years ago.  He was there to explain his recently released book entitled On Bullshit.  He was joking with Dave about how somebody called him up one day and wanted to make one of his essays into a book.  When asked how that happens he said "Bigger fonts and wider margins."  I don't know if he was consciously trying to convey the idea that he was no bullshitter.  In the book he is listed as a renowned moral philosopher and Professor of Philosophy Emeritus at Princeton University.  The book is inexpensive and a quick read.  Imagine an essay stretched into a book the size of an address book in 67 pages of 12 point font and 1 inch margins.

Despite the catchy title and obvious magic of marketing, I really like this book.  First off, it is written by a professor of moral philosophy and I always like hearing from the experts.  Secondly, Professor Frankfurt looks at the differences between lying and bullshitting and all points in between. The opening line is classic:

"One of the most salient features of our culture is that there is so much bullshit." (p. 1)

In the opening paragraph he goes on to explain that study of bullshit has not attracted much attention because most people take it for granted that they can recognize it and not get taken in.  The result is a lack of theoretical understanding of bullshit.  His stated goal is to articulate what it is and what it is not.

I will let any interested reader acquire a copy of the book.  With its brevity I run the risk of reciting all of the high points in this post.  I will quote two more lines from the book because of the amount of information they convey:  

"The realms of advertising and of public relations, and the nowadays closely related realm of politics are replete with instances of bullshit so unmitigated that they can serve among the most indisputable and classic paradigms of the concept." (p. 22)

Professor Frankfurt goes on to develop the idea that the bullshitter can be imprecise and that unlike a liar he has no prerequisite that he knows the truth.  He is bluffing and faking his way through.  Bullshitters don't reject the truth, they pay no attention to it.  In the technical sense, bullshit is not false it is phony.   And perhaps the essence as it applies to a professional field (I have to use a third quote):

"Bullshitting is unavoidable whenever circumstances require someone to talk without knowing what he is talking about." (p. 63).

The last requirement is interesting because there are conscious and unconscious components.  The unconscious component is the innate ability that most people have to practice folk psychology.  It is the equivalent of a social brain.  We recognize certain patterns in people and how they behave that allow us to make predictions about their behavior.  I am quite sure that many people mistake that ability for being trained as a psychiatrist.  I base that a lot on what people tell me that they "observe" and "diagnose".  For all of the concern about the "medicalization" of the population - the average folk psychologist has a much lower threshold than any psychiatrist I have ever met.  For example, in various workplaces I have been warned by employee supervisors that three separate coworkers that I would be working with were "paranoid", "obsessive compulsive" and "borderline".  I did not see any characteristics that the amateur diagnosticians warned me about and in all three cases, I found these co workers to be excellent and had absolutely no problems working with them.  This is probably an extension of Dr. Frankfurt's work - the unconscious aspects of bullshitting but I expect that it correlates closely with some descriptions in a classic paper on prevarication.  

But in the case of talking without expertise, I am afraid that the unconscious aspects cover a very small part of the bullshitting spectrum.  You can go to any site where psychiatry is routinely criticized, attacked or vilified and you will see any number of posts by the anonymous posters who talk about their anecdotes and proclamations about psychiatry.  Many are bombastic.  None are challenged.  It is the general tenor of many of these sites that psychiatrists are basically incompetent assholes (yeah I said it) and should be barred from practicing medicine.  Psychiatrists only injure people and have never helped anyone.  If they produce any coherent arguments they generally fit the psychiatrist as bogeyman dynamic that I previously described.  Some people who have seen a psychiatrist may grudgingly admit it, but nobody ever seems to acknowledge that a psychiatrist did anything to help them.  The more erudite approach may be to critique psychiatry without acknowledging that psychiatrists in fact are better critics and have critiqued their own field.  If anyone is questioned they may produce the indignant response: "Are you calling me an antipsychiatrist?"  

Some of what passes for criticism actually ignores what really happened and attempts to cast modern psychiatry in a light that is based more on historical spin than what is applicable today.  Some of these efforts are actually considered to be "good" criticism, even though it is clear to any trained psychiatrist that the author knows little to nothing about the field.  You would think that anyone interested in developing a negative narrative about psychiatry would do the basic research of picking up a copy of  Shorter's A History of Psychiatry and reading about the ways things were before there was any psychiatry.  In his text Shorter describes severe mental illness as a death sentence (p. 2) and the following historical observation:  "In a world without psychiatry, rather than being tolerated or indulged, the mentally ill were treated with a savage lack of feeling.  Before the advent of the therapeutic asylum, there was no golden era, no idyllic refuge for those deviant from the values of capitalism.  To maintain otherwise is a fantasy." (p. 4).  But the ignorance of psychiatry extends far beyond the historical.  It is apparent that many of the critics have no knowledge of the current current psychiatric literature.  They often reference the New York Times as though it is authoritative.  They criticize highly technical subjects and it is apparent that they have not read a journal or a book from that field.  Like Frankfurt's definition they pay no attention to the truth.

Based on Professor Frankfurt's essay, I conclude that bullshit is a much more appropriate characterization of many of the misrepresentations of psychiatry.  I would also suggest it may be more politically correct than implying that the author is a member of a cult or a school of philosophy. (see the footnote at this link)

They are quite simply a bullshitter and bullshit remains as it always has been (even pre-Frankfurt) - bullshit.

George Dawson, MD, DFAPA

Harry G. Frankfurt.  On Bullshit.  Princeton University Press, Princeton, NJ, 2005.

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