Showing posts with label postmodernism. Show all posts
Showing posts with label postmodernism. Show all posts

Tuesday, February 28, 2023

The Many Excuses for Ignoring Science – Where Did SARS-CoV-2 Originate?

 


The COVID origins story started off with a bang last weekend.  Woody Harrelson gave the monologue on Saturday Night Live comparing pharmaceutical companies to drug cartels and COVID vaccinations to illicit drugs. He was conveniently able to ignore the fact that these vaccinations have saved an estimated 20 million lives and could have saved more if vaccination goals were met. By way of contrast there are about 30,000 drug related homicides in Mexico every year, several thousand per year in the US, and tens of thousands dead from overdosing on illicit drugs. A stark contrast to the way this monologue was presented. There was plenty of commentary on the monologue – mostly focused on Harrelson’s antivaxx stance in the past including a post that he had to remove at one point. Elon Musk enthusiastically supported the monologue – but didn’t say if it was for the comedic or scientific genius. Harvey Levin praised producer Lorne Michaels for not censoring Harrelson, but didn't comment on editing for comedic content. Nobody recited the simple facts listed above.

The monologue was followed Sunday by a more detailed story without much more scientific credibility in the Wall Street Journal (1).  The authors of that story discuss a 5-page report by the Department of Energy stating the opinion that a lab leak was the likely cause of the pandemic but that theory was given a ‘low confidence’ rating.  They describe the DOE as having many relevant scientists.  Other than controversial headings and fueling partisan debate – what good is a low confidence theory?  The FBI has the same theory with “moderate confidence.” They explain that the US has an 18 agency intelligence community implying that there is adequate expertise there for these low to moderate confidence lab-leak theories. Is this the same intelligence community that was confident that there were weapons of mass destruction in Iraq and who seemed vaguely aware of Chinese balloons invading US air space?  They might have better things to do than speculate about pandemic virus origins and rate those speculations.  Protecting US infrastructure against cyberattacks and criminal activity would seem to be at the top of that list.

I would like to see that 5 page report at this point – to see if there is any reference to a recent consensus statement from the virology community on the origins of SARS-CoV-2 (2).  The full text of that report is available online.  If you read that report a few points jump out at you.  First – these are the professionals with the most expertise in viral genetics and evolution. It is their full-time job and they do active research in the area.  Second – beyond claiming expertise virologists have been very successful at reducing the disease burden through their efforts.  They get results. Third – while emphasizing neutrality they point out that the zoonosis hypothesis (wild origin) has the most supporting data and that there is “no compelling data” to support either a lab leak or intentional contamination hypothesis. Fourth they point out that “gain-of-function” is an inexact term but within the field it also means modification for therapeutic purposes.  The term has been used by some politicians to suggest “nefarious” activity. Fifth – they review the extensive oversight of their research.  They conclude that millions of people are alive today because of their research and that there is adequate oversight. All of that clearly stated before the start of Congressional hearings on these issues.

 There is pre-existing research on viral origins from other groups and wild origin is the most likely scenario (3, 11, 12).

In an interesting twist of events the celebrity gossip show TMZ (10:34 to 18 minute mark) ran with the story.  They started out with the Harrelson monologue followed by Harvey Levin’s characterization that the lab leak theory “blossomed” with the Wall Street journal article.  To their credit they brought on Michael Worobey an evolutionary virologist with a previous description of the wild origins of SARS-CoV-2 in Science (4).  Dr. Worobey pointed out that he wrote a letter in 2021 that the ‘lab leak’ hypothesis had to be taken seriously, but since then then there has been “really strong scientific evidence” of a wild origin of the virus and no real scientific evidence of a lab leak.  Just from a probability standpoint he pointed out that all of the cases were in the area of the Wuhan market, there were animals present that carried coronaviruses, and there is really no other explanation for that degree of localization in a city of 12 million people. He also pointed out the severe social media backlash that he received as a result of following the evidence but encouraged a systematic approach to the research.  He suggested taking the DOE report with a “grain of salt”.

A final comment on the DOE report was made on the public radio show All Things Considered.  Michael Osterholm from CIDRAP was interviewed (5).  He describes himself as being agnostic towards the lab leak versus zoonoses but clearly sees the preponderance of data supporting the wild origin.  He goes on to suggest that people want certainty when a high degree of certainty is not possible and that has led to definitive headlines (about lab leak for example) when hard evidence is lacking. He adds the following characterization and challenges the DOE to present their data:

“…. again, there is a very different type of theater being played out here. It's not one that's based on science.”

He also describes a very plausible scenario of a new virus occurring in the Caribbean and how that could be spun into a ‘lab leak’ from the CDC in Atlanta.

Expect a lot of political demagoguery on the issue with Congressional hearings in the months to follow. Unless there is any data as good as the references I have posted - keep an open mind.  In a postmodern world – people with no or vague expertise make unfounded claims about scientific evidence.  The strongest evidence by far is with the experts and scientists listed in this essay. And that is a wild origin of the virus – just like previous coronaviruses. Anyone suggesting otherwise needs to show up with some data and not excuse making or political theater.

 

George Dawson, MD, DFAPA

 

References:

1:  Gordon MR, Strobel WP. DOE Says Lab Leak Is Likely Origin of Covid-19 ---New intelligence about China outbreak spurs assessment; finding is given 'low confidence'.  Wall Street Journal.  Wall Street Journal.  February 27, 2023.

2:  Goodrum F, Lowen AC, Lakdawala S, Alwine J, Casadevall A, Imperiale MJ, Atwood W, Avgousti D, Baines J, Banfield B, Banks L, Bhaduri-McIntosh S, Bhattacharya D, Blanco-Melo D, Bloom D, Boon A, Boulant S, Brandt C, Broadbent A, Brooke C, Cameron C, Campos S, Caposio P, Chan G, Cliffe A, Coffin J, Collins K, Damania B, Daugherty M, Debbink K, DeCaprio J, Dermody T, Dikeakos J, DiMaio D, Dinglasan R, Duprex WP, Dutch R, Elde N, Emerman M, Enquist L, Fane B, Fernandez-Sesma A, Flenniken M, Frappier L, Frieman M, Frueh K, Gack M, Gaglia M, Gallagher T, Galloway D, García-Sastre A, Geballe A, Glaunsinger B, Goff S, Greninger A, Hancock M, Harris E, Heaton N, Heise M, Heldwein E, Hogue B, Horner S, Hutchinson E, Hyser J, Jackson W, Kalejta R, Kamil J, Karst S, Kirchhoff F, Knipe D, Kowalik T, Lagunoff M, Laimins L, Langlois R, Lauring A, Lee B, Leib D, Liu SL, Longnecker R, Lopez C, Luftig M, Lund J, Manicassamy B, McFadden G, McIntosh M, Mehle A, Miller WA, Mohr I, Moody C, Moorman N, Moscona A, Mounce B, Munger J, Münger K, Murphy E, Naghavi M, Nelson J, Neufeldt C, Nikolich J, O'Connor C, Ono A, Orenstein W, Ornelles D, Ou JH, Parker J, Parrish C, Pekosz A, Pellett P, Pfeiffer J, Plemper R, Polyak S, Purdy J, Pyeon D, Quinones-Mateu M, Renne R, Rice C, Schoggins J, Roller R, Russell C, Sandri-Goldin R, Sapp M, Schang L, Schmid S, Schultz-Cherry S, Semler B, Shenk T, Silvestri G, Simon V, Smith G, Smith J, Spindler K, Stanifer M, Subbarao K, Sundquist W, Suthar M, Sutton T, Tai A, Tarakanova V, tenOever B, Tibbetts S, Tompkins S, Toth Z, van Doorslaer K, Vignuzzi M, Wallace N, Walsh D, Weekes M, Weinberg J, Weitzman M, Weller S, Whelan S, White E, Williams B, Wobus C, Wong S, Yurochko A. Virology under the Microscope-a Call for Rational Discourse. mSphere. 2023 Jan 26:e0003423. doi: 10.1128/msphere.00034-23. Epub ahead of print. PMID: 36700653.

3:  Garry RF. The evidence remains clear: SARS-CoV-2 emerged via the wildlife trade. Proc Natl Acad Sci U S A. 2022 Nov 22;119(47):e2214427119. doi: 10.1073/pnas.2214427119. Epub 2022 Nov 10. PMID: 36355862; PMCID: PMC9704731.

4:  Worobey M. Dissecting the early COVID-19 cases in Wuhan. Science. 2021 Dec 3;374(6572):1202-1204. doi: 10.1126/science.abm4454. Epub 2021 Nov 18. PMID: 34793199. (see also the map of SARS-CoV-2 origins)

5:  Contreras G, Brown A, Shapiro A, How an infectious disease expert interprets conflicting reports on COVID-19's origins.  All Things Considered.  February 27, 2023.

https://www.npr.org/2023/02/27/1159821909/how-an-infectious-disease-expert-assessed-how-covid-19-started

6:  Worobey M, Levy JI, Malpica Serrano L, Crits-Christoph A, Pekar JE, Goldstein SA, Rasmussen AL, Kraemer MUG, Newman C, Koopmans MPG, Suchard MA, Wertheim JO, Lemey P, Robertson DL, Garry RF, Holmes EC, Rambaut A, Andersen KG. The Huanan Seafood Wholesale Market in Wuhan was the early epicenter of the COVID-19 pandemic. Science. 2022 Aug 26;377(6609):951-959. doi: 10.1126/science.abp8715. Epub 2022 Jul 26. PMID: 35881010; PMCID: PMC9348750.

7:  Pekar JE, Magee A, Parker E, Moshiri N, Izhikevich K, Havens JL, Gangavarapu K, Malpica Serrano LM, Crits-Christoph A, Matteson NL, Zeller M, Levy JI, Wang JC, Hughes S, Lee J, Park H, Park MS, Ching Zi Yan K, Lin RTP, Mat Isa MN, Noor YM, Vasylyeva TI, Garry RF, Holmes EC, Rambaut A, Suchard MA, Andersen KG, Worobey M, Wertheim JO. The molecular epidemiology of multiple zoonotic origins of SARS-CoV-2. Science. 2022 Aug 26;377(6609):960-966. doi: 10.1126/science.abp8337. Epub 2022 Jul 26. PMID: 35881005; PMCID: PMC9348752.

8:  Bloom JD, Chan YA, Baric RS, Bjorkman PJ, Cobey S, Deverman BE, Fisman DN, Gupta R, Iwasaki A, Lipsitch M, Medzhitov R, Neher RA, Nielsen R, Patterson N, Stearns T, van Nimwegen E, Worobey M, Relman DA. Investigate the origins of COVID-19. Science. 2021 May 14;372(6543):694. doi: 10.1126/science.abj0016. PMID: 33986172; PMCID: PMC9520851.

This is an important reference form May of 2021 signed by Dr. Worobey suggesting that a more thorough investigation of the origins of the SARS-CoV-2 virus needs to be done.  Per the above assay and several references - he has concluded that the virus originated in the wild rather than lab leak since this letter. I think this letter also addresses the censorship comments.  Clearly the suggestion by this group that the lab leak had to be reinvestigated illustrates there was no censorship on the science side. 

9:  Chait J.  The Surprisingly Contrarian Case Against Lying About Science.  The Intelligencer.  February 28, 2023  https://nymag.com/intelligencer/2023/02/lab-leak-hypothesis-lying-about-science-is-bad-for-liberals.html 

10: Garry RF. SARS-CoV-2 furin cleavage site was not engineered. Proc Natl Acad Sci U S A. 2022 Oct 4;119(40):e2211107119. doi: 10.1073/pnas.2211107119. Epub 2022 Sep 29. PMID: 36173950; PMCID: PMC9546612. 

11:  Pekar JE, Magee A, Parker E, Moshiri N, Izhikevich K, Havens JL, Gangavarapu K, Malpica Serrano LM, Crits-Christoph A, Matteson NL, Zeller M, Levy JI, Wang JC, Hughes S, Lee J, Park H, Park MS, Ching Zi Yan K, Lin RTP, Mat Isa MN, Noor YM, Vasylyeva TI, Garry RF, Holmes EC, Rambaut A, Suchard MA, Andersen KG, Worobey M, Wertheim JO. The molecular epidemiology of multiple zoonotic origins of SARS-CoV-2. Science. 2022 Aug 26;377(6609):960-966. doi: 10.1126/science.abp8337. Epub 2022 Jul 26. PMID: 35881005; PMCID: PMC9348752.

12:  Worobey M, Levy JI, Malpica Serrano L, Crits-Christoph A, Pekar JE, Goldstein SA, Rasmussen AL, Kraemer MUG, Newman C, Koopmans MPG, Suchard MA, Wertheim JO, Lemey P, Robertson DL, Garry RF, Holmes EC, Rambaut A, Andersen KG. The Huanan Seafood Wholesale Market in Wuhan was the early epicenter of the COVID-19 pandemic. Science. 2022 Aug 26;377(6609):951-959. doi: 10.1126/science.abp8715. Epub 2022 Jul 26. PMID: 35881010; PMCID: PMC9348750.

13:  Wu Y, Zhao S. Furin cleavage sites naturally occur in coronaviruses. Stem Cell Res. 2020 Dec 9;50:102115. doi: 10.1016/j.scr.2020.102115. Epub ahead of print. PMID: 33340798; PMCID: PMC7836551.

14:  Xiao, X., Newman, C., Buesching, C.D. et al. Animal sales from Wuhan wet markets immediately prior to the COVID-19 pandemic. Sci Rep 11, 11898 (2021). https://doi.org/10.1038/s41598-021-91470-2

15:  Lenharo M, Wolf L. US COVID origins hearing renews debate over lab-leak hypothesis. Nature. 2023 Mar 9. doi: 10.1038/d41586-023-00701-1. Epub ahead of print. PMID: 36890328.

"Michael Worobey, an evolutionary biologist at the University of Arizona, Tucson, who has studied genetic evidence from the early days of the pandemic, told Nature that he found the proceedings “shockingly unscientific” and that they do not bode well for the overall investigation. “Not one of those witnesses had any scientific record of investigating and publishing peer-reviewed research on the origins of this virus in quality journals,” he said."

16:  Cohen J.  Science takes a backset to politics in first House hearing on origin of COVID-19 pandemic.  Science.  March 8, 2023.  doi: 10.1126/science.adh5155

Very useful essay that points out little science is occurring and the intelligence is very sketchy.

17:  Rutledge PE. Trump, COVID-19, and the War on Expertise. The American Review of Public Administration. 2020 Aug;50(6-7):505-11.

This is a good reference to keep in mind because it points out that President Trump and his administration actively promoted the lab leak theory of the pandemic dating back as far as May 2020.  All of the pundits decrying censorship of the lab leak hypothesis should ask themselves how censorship is possible when the theory is being actively promoted by the Executive Branch. 

18:  Maxmen A. Wuhan market was epicentre of pandemic's start, studies suggest. Nature. 2022 Mar;603(7899):15-16. doi: 10.1038/d41586-022-00584-8. PMID: 35228730.

This study links to three preprints describing the origin of the virus in the wild with spillover to humans.  As far as I can tell these preprints became the 2 papers listed below as well as reference 12 above:

19:  Pekar JE, Magee A, Parker E, Moshiri N, Izhikevich K, Havens JL, Gangavarapu K, Malpica Serrano LM, Crits-Christoph A, Matteson NL, Zeller M, Levy JI, Wang JC, Hughes S, Lee J, Park H, Park MS, Ching Zi Yan K, Lin RTP, Mat Isa MN, Noor YM, Vasylyeva TI, Garry RF, Holmes EC, Rambaut A, Suchard MA, Andersen KG, Worobey M, Wertheim JO. The molecular epidemiology of multiple zoonotic origins of SARS-CoV-2. Science. 2022 Aug 26;377(6609):960-966. doi: 10.1126/science.abp8337. Epub 2022 Jul 26. PMID: 35881005; PMCID: PMC9348752.

20:  Mueller B.  W.H.O. Accuses China of Withholding Data on Pandemic’s Origins.  New York Times March 17, 2023.

21:  Cohen J. Anywhere but here. Science. 2022 Aug 19;377(6608):805-809. doi: 10.1126/science.ade4235. Epub 2022 Aug 18. PMID: 35981032.

22:  Cohen J.  Chinese researchers release genomic data that could help clarify origin of COVID-19 pandemic.  Science 2023 March 29; doi:10.1126/science.adi0330.


Supplementary 1:

The director of the FBI came out in the media today (02/28/2023) and reiterated that the FBI has concluded the virus most likely originated as a lab leak but provided no additional data. As far as I know at this point the FBI and DOE data has not been released to the public.

Supplementary 2:

How is science ignored?  I realize after reading the post it contains historical information but nothing explicit about how science is ignored.  Here is the short list:

1:  Science is a process of serial approximations to reality or more to the point - an empirically acceptable model of reality.  Politics, journalism, and entertainment clearly are not. As a result the scientifically informed realize this is often series of hypothetical steps and missteps until a widely agreed upon model is accepted in the scientific community.  That contrasts sharply with a long series of provocative headlines and opinion pieces.  

2:  Science deals with probability statements - politics, journalism, and entertainment exists largely on the plane of dichotomous thinking.

3:  The probabilities on the probability statements can be adjusted in either direction.  As is the case in the Dr. Worobey references above - his probability of a "lab leak or nefarious activity" hypothesis was adjusted drastically downward over time as the probability of a wild origin was adjusted upward to the point where it became most likely.  This adjustment of probabilities is often seen as a "mistake" or "lie" by the nonscientific community. Within the scientific community it can be difficult to change your mind.  Neither of those considerations invalidates the process. 

4:  There are still scientific standards that acknowledge expertise and peer review. Although peer review is criticized by authors it has resulted in conventions that probably limit grand pronouncements like a newspaper headline.  The evidence should be in the 'limitations' section of any scientific paper.  In the postmodern world expertise is seen as relative by those in many nonscientific endeavors - to the point that anyone who can Google is considered an expert. This is also the predominate social media method of operation. 

5:  The legal/political model of ascertaining the truth or reality is highly flawed - and the evidence is obvious in studies of racial profiling, unjustified violent encounters with law enforcement, wrongful convictions, unequal treatment based on economic considerations, fallible eyewitness testimony, and highly flawed interrogations. Focusing only on coronavirus - the interrogations of Dr. Fauci by Sen. Paul is an additional example. And yet - this is the process that is going to be used by the government to decide on the origins of the virus.  Unless the DOE or the FBI have concrete scientific proof - it will be an exercise in rhetoric.

6:  If not science what? Typical analyses presented in the media can occur at several levels that cut science out of the mix. Anytime you hear an analysis by a group of journalists, politicians, regulators, administrators or consultants who lack the requisite expertise to analyze the problem take a close look at that final product. Ask yourself if there is anyone with scientific expertise who should have looked at it.  Be very skeptical of analyses that are not disclosed because they are proprietary or classified.


Supplementary 3 (Updates):

Update 03/02/2023:  As expected the COVID origins appearance of controversy was still whipping up the media today.  TMZ continued with their fractured analysis – continuing to focus on the FBI and DOE reports as a game changer and not mentioning at all what the evolutionary virologist Michael Worobey told them yesterday.  They played a brief John Stewart tape and suggest that he was now “vindicated” for suggesting early in the pandemic that this was probably a lab leak. Harvey Levin pointed out that Stewart was not crowing about being correct in the brief clip that they played and how could he? How can a guy who knows nothing about epidemiology or pandemic viruses and has no information about what transpired in Wuhan suggest there was a lab leak?  The excerpt that I saw had Stewart talking about the need to have both sides represented.  TMZ did touch on the most important aspect of this debate and that was rhetoric and how President Trump’s racist polarizing rhetoric led to conflation of the viral origin hypothesis with racism and that created significant backlash from the left. But we are still dealing with a non-scientific argument and ignoring Dr. Worobey. Harvey Levin seems stuck on these events as primarily a free speech issue.  To me that is obviously not a problem given the degree of bullshit and demagoguery that occurred around this issue.  There was probably no more “free speech” exercised at any other time in the history of the country. Watching TMZ the last two days just illustrates that they can avoid science as rigorously as anyone else – even after talking to a top scientist in the field. As some level the free speech argument just becomes a rationalization.

New York Times political columnist Jonathan Chait wrote a piece in the Intelligencer entitled “The Surprisingly Contrarian Case Against Lying About Science”.  He claims the DOE analysis has weight because there is a division there that is supposed to assess bioweapons threats. To me that just deepens the nonscience of it all. From a rhetorical standpoint we have gone from an appeal to emotion to an appeal to authority.  He goes on to analyze the rhetoric starting with the need to shift blame away from the Trump administration and their “mishandling of the epidemic.”  He is the first journalist I have seen who writes about how China unleashing the virus on their own people (one suggestion) is absurd.  I would add even considering the coronavirus as a bioweapon is equally absurd. In his analysis of Peter Hotez Tweets he gets it wrong.  Dr. Hotez characterizes the antiscience aggression of certain elements of the media and Congress as: “The best defense is a good offense”.  Chait’s response is:

 “I’m neither a professor, a doctor, nor a Ph.D., but I know enough to state confidently that the ethos of the scientific method is not “the best defense is a good offense.”

What about the ethos of journalism and politics? I am confident that is what Hotez is referring to.  He ultimately makes the argument that the left is not skilled enough to parse the anti-science rhetoric of the right and as a result lump legitimate scientific discussion with anti-science crankery and this is not a good thing. He concludes that ideology cannot be used to settle scientific debate. Some good points and some bad points. I will add it is pretty obvious to anyone who knows a thing about science that real scientific debates cannot be settled in the media and every scientist I know has had bad experiences with the media because they are trying to tell the story they want to tell.  My classic example was television interviews that I was asked to give around the Christmas holiday when I was a young psychiatrist. I knew the reporter was trying to sell the story that there were more suicides at Christmas and no matter what I said there would be that suggestion. I finally just told them – no more interviews. After all – in this case what is the more provocative headline ‘COVID is a bioweapon leaked or intentionally released’ or ‘COVID is a coronavirus that jumped from animal populations to humans like all human coronaviruses before it – including the 4 normally circulating coronaviruses that are considered common cold viruses.”  Rhetoric is a very strong component here and if the press wanted to really be useful, they might point out that on a timeline basis.  The arguments are largely rhetorical rather than scientific and factual.  All the press would have to say about the science is that it is not settled and digress a little into how scientific decisions are made. But I have never seen that happen.     

Update 03/03/2023:  The following document reviews some of the history of the controversy and points out that there really is no definitive proof of the viral origins at this point.  In the last few paragraphs the scientists who see zoonoses/spillover as the most plausible scenario are looking for falsifying data but have not found it.

Robertson L.  Still No Determination on COVID-19 Origin.  FactCheck.org 03/02/2023: https://www.factcheck.org/2023/03/scicheck-still-no-determination-on-covid-19-origin/

Update 03/06/2023:  TMZ was at it again today.  They put up a weekend poll on the origins of COVID and posted 2 possibilities -  wet market or lab leak.  The vote went like this:

wet market - 12%

lab leak - 88%

Harvey Levin's analysis was that this showed censoring the lab leak hypothesis at the outset was the problem.  This analysis is incorrect at two levels. First, there are endless headlines from 2021 where Republicans like Senator Rand Paul accused Dr. Fauci of lying about gain-of-function and labs leaks.  The demonized Dr. Fauci about this to the point that he started getting threats and needed protection for himself and his family. The same sequence of events happened to many public health officials who became objects of right wing scorn.  Secondly - I don't know what you expect when you are hyping unscientific proclamations about lab leak for the past week. Let's not pretend the media is a disinterested party here. TMZ chose the story about "censorship" when there was none and chose to suggest that was a better explanation for why two government agencies were suggesting a lab leak over the expert they interviewed last week. Just another clear example of the title of this post. 


Supplementary 4:

House Committee on Oversight - COVID origins:

Here is the web site - not the current references to Fox News and the New York Post - both obviously the farthest information from science:

https://oversight.house.gov/landing/covid-origins/


Graphics Credit:

Eduardo Colon, MD photo is much appreciated.

 

Thursday, December 30, 2021

Waffling - A Rare Window Into Psychiatric Advocacy

 


Consider the following thought experiment:

[Ask yourself if you can think of a well-known proponent of psychiatry.  And if you can is there is a list of proponents as available to your thought process as the easily recalled list of detractors.]

First of all – Congratulations to the author for coming up with that thought experiment and wish I had thought of it myself.  Most psychiatrists are hard pressed to think of a single name.  The proponent  that came to my mind was Harold Eist, MD the only American Psychiatric Association (APA) President I recall who was a staunch advocate for front line psychiatrists, patient privacy, quality psychiatric care and the only outspoken critic of managed care.  But beyond that – nobody comes to mind. I have certainly worked with and become aware of first-rate clinicians, teachers, and researchers – but all of that seems to end when it comes to facing the withering attacks of many against the profession. At that level – the thought experiment is an immediate success.

This thought experiment was proposed by Daniel Morehead, MD in his article It’s Time for Us to Stop Waffling About Psychiatry in the December 2 edition of the Psychiatric Times.  He proposes the experiment after presenting a small sampling of the inappropriate and repetitive criticism against the field.  I started writing this blog with a similar intent and noted from the outset that responding to antipsychiatry rhetoric often resulted in attacks not from the originators of the diatribes – but often psychiatrists themselves. I was contacted by an expert in antipsychiatry philosophies who advised me that it was apparent that many psychiatrists seemed to have self-hatred and associated hatred of the specialty that they were practicing.  I viewed that as somewhat harsh – but did acknowledge a tendency towards self-flagellation as typically evidenced by acknowledging responsibility for criticisms that had no merit.

In Dr. Morehead’s paper – he reviews examples of attacks that nobody in the field seems to respond to and the resulting potential damage.  In his bullet points he lists the political arguments about biological versus psychosocial models of illness and treatment, the familiar identity crisis that only psychiatry seems to have, the accusations of corruption and conflicts of interest, books that describe psychiatry as either a completely failed medical specialty or one struggling for legitimacy as a medical specialty, psychiatric diagnosis is routinely attacked, and medications that have led to deinstitutionalization and have literally saved the lives of hundreds of thousands of people are vilified.  And that is a short list.

His conclusion that these criticisms “generate an image of psychiatry that is both wildly distorted and profoundly destructive” is as undeniable as his observation that there are rarely any responses to these diatribes from psychiatrists or other physicians. I would actually take it a step further and suggest that in many of these cases psychiatrists or other physicians are in the habit of piling on even in cases of the most extreme unfounded criticisms.  In fact, you can find many examples of this in the comments sections of my blog.  In the body of his paper Morehead takes on three common criticisms that are often viewed as definitive by people outside the field including the memes that psychiatric illnesses are somehow less real than physical illnesses, psychiatric medications make conditions worse, and psychiatrists are biological reductionists who are only interested in prescribing pills and some pharmaceutical company conflict of interest makes that bias even worse. I have addressed all of these fallacious arguments and many more on this blog. Morehead certainly provides adequate scientific refutations to these memes and concludes that:

“We live in an intellectual culture that has habituated the public to think of psychiatry as flawed, failed, corrupted, and lost.”

If only that were true. I think what most psychiatrists (and physicians in general) fail to grasp is that these endless arguments have nothing at all to do with science or an intellectual culture. In fact, the best characterization of these arguments is that they are anti-science, anti-intellectual, and rhetorical. Because this is a political and rhetorical process these fallacies give the appearance that they can’t be refuted. Those advancing these arguments seem to “win” – simply by repeating the same refuted positions over and over again.  In some cases the repetition goes on for decades - as long as 50 years! This tactic is a time honored propaganda technique and I would not expect it to go away by confronting it with science or the facts.

We have seen this clearly play out in other medical fields during the current pandemic. Government scientists who have been long term public servants are attacked and attempts made to discredit them – not on the basis of science, but on the basis of rhetoric.  The attacks are not made by scientists but most frequently by people with no qualifications, attempting to rationalize their attacks by whatever information they can glean from the internet or just make up. In some cases – the conspiracy theories being advanced are the same ones that psychiatrists observed in the late 20th century as applied to some clinical conditions.  Many of these attacks have gone from anti-science attacks to attacks on a personal level including threats against the scientist or his family. Financial conflict of interest can be significant as anti-science stars take on celebrity status floating for profit social media and mainstream media companies. Sponsors and believers in the anti-science message flock to these sites and generate significant revenues to maintain the message and the celebrities.  This discourse is the farthest possible from an intellectual endeavor.

This same anti-science and anti-intellectual posture is working against psychiatry and it has similar roots in the postmodernist movement.  Postmodernism was basically a movement against realism and in the case of science - facts.  Postmodernist discourse emphasizes relativism and an inability to construct reality.  One of the best examples is history. A postmodernist approach concludes that due to the limitations of language – actual history is not knowable.  The historian is merely telling one of many possible stories about what really may have happened. That has popular appeal as it is commonly acknowledged that history as taught in American schools clearly omitted a lot of what actually happened to and the contributions made by large populations who were marginalized by racist ideology.  That is as true in medicine as in any other field. But does that mean that the limitation of language and the application of current social constructs make the study and recording of history unknowable? Probably not and the problem with postmodernism is how radical the interpretation – can it be seen to encourage skepticism rather than outright rejection for example.

In the case of science as opposed to history, philosophy, and the arts – postmodernism does not have similar traction. The main features of science including an agreed upon set of facts irrespective of demographic or cultural features and science as a process does not lend itself to political or rhetorical criticism.  In the case of psychiatry, that is not for a lack of effort. The continuous denial that mental illness exists for example stands in contrast with the cross cultural and historical observations that severe mental illness clearly exists, that it cuts across all cultures, and that there is significant associated morbidity and mortality. It is however a classic example of postmodern criticism that it often suggests mental illness is really a social construct to maintain the power structure in society. The associated postmodern meme is psychiatry as an agency for social control over the eccentric defined as anyone who does not accept the predominate bourgeois narrative.

I first encountered this idea when I critiqued a New York Times article about the DSM-5 that suggested it was a blueprint for living (2).  That is an idea that is so foreign to any trained psychiatrist aware of the limitations of the DSM that it borders on bizarre.  And yet – here was a philosopher in the NYTimes making this claim along with several defenders in the comment section. At the time I was not really aware of this postmodernist distinction and responded just from the perspective that it was a statement that was not based in reality. Nonetheless, there were several defenders of the statement.  In retrospect all of this makes sense. Postmodernist critiques can amount to mere rhetorical statements. If you believe that reality is merely a battle of competing narratives – blueprint for living becomes as tenable as the reality of the DSM – a restricted publication with obvious limitations to be used only by trained individuals in a restricted portion of the population for clinical work and communication with other professionals. The large scientific and consensus effort is ignored – as well as the fact that societal control over anyone with a mental illness is the purview of law enforcement and the court system.

Similar repetitive postmodernist arguments are made about all of the examples given by Morehead in his paper.  For psychiatrists interested in responding to this repetitive and inappropriate criticism – it is important to respond at both the content level as Dr. Morehead has done but also the process level because the process level is pure post modernism and at that level realism or the facts on the ground may be irrelevant.

That brings me to what I would refer to as a second order criticism. Suppose you do respond to the criticism as suggested and suddenly find yourself being criticized by the same peers that you hoped to support?  Let me cite a recent example. Drapetomania is another criticism leveled at both psychiatry and the relationship that modern psychiatry has frequently claimed with Benjamin Rush, MD – a Revolutionary War era physician who has been described as the Father of American Psychiatry.  Of course, Rush was never trained as a psychiatrist because psychiatry was really not a medical specialty until the early 20th century.  He was really an asylum physician with an interest in mental illness and alcohol use problems.  He also advised Gen. Washington on smallpox vaccinations for his troops and treated people during Yellow Fever outbreaks. In other words he functioned as a primary care physician at the time.  Drapetomania and Dr. Rush are connected though a meme that suggests that the southern physician who coined the term also “apprenticed” with Rush.  Drapetomania was proposed as a diagnosis by Samuel Cartwright to explain why slaves running away was a sign of psychopathology rather than rational thinking. Cartwright himself was a slave owner and there was widespread interest among his peers in racial medicine. Despite this peer interest and the Civil War being fought around the issue of slavery – nobody ever used the diagnosis. It was openly ridiculed in some northern periodicals and largely ignored in the racial medicine publications. Rush was affiliated with the University of Pennsylvania Medical School over the course of his career and Cartwright graduated from a Kentucky medical school.  There is no evidence he ever matriculated at Penn or met Rush.  Despite that history drapetomania has been consistently marched out as a psychiatric “problem” and evidence of a failed psychiatric diagnosis for the last 40 years.  The implicit connection with Rush is also made – suggesting that as a mentor he may have had something to do with the racist pseudodiagnosis.

I did a considerable amount of research on drapetomania and connecting of Cartwright to Rush.  I was very fortunate to have definitive work available to me from Rush biographer Stephen Fried (4) and historian Christopher D. E. Willoughby (5).  The details of all of that research are available in this post that illustrates the lack of connections of drapetomania to Rush and psychiatry but also a very long period of time where it was not actively discussed.  Szasz (6) resuscitated the word when he published an article in 1971 that essentially concluded: 

“I have tried to call attention, by means of an article published in the New Orleans Medical and Surgical Journal for 1851, to some of the historical origins of the modern psychiatric rhetoric. In the article cited, conduct on the part of the Negro slave displeasing or offensive to his white master is defined as the manifestation of mental disease, and subjection and punishment are prescribed as treatments. By substituting involuntary mental patients for Negro slaves, institutional psychiatrists for white slave owners, and the rhetoric of mental health for that of white supremacy, we may learn a fresh lesson about the changing verbal patterns man uses to justify exploiting and oppressing his fellow man, in the name of helping him.” (4)

If you feel somewhat disoriented after reading that paragraph it is understandable. Szasz not only uses an example with no connection at all to psychiatry, but he creates a completely false narrative by using Cartwright’s racist work as a metaphor for psychiatry and then accuses psychiatrists of being rhetorical. This unbelievable screed was published in a psychiatric journal and the Szasz meme has continued in all forms of media since that time. It also happens to be a classic postmodernist technique of essentially making up a competing narrative and then writing about it like it is true.

Post-modernist memes like this invention by Szasz essentially cut across all of the inappropriate criticisms covered by Dr. Morehead and more. They are basically a vehicle for anyone with no knowledge of psychiatry to bash the field repeatedly over time and recruit like-minded postmodernists to do the same. The best examples of this process include the historical memes dating back to a time before there were any psychiatrists and the familiar themes of identity crisis, chemical imbalance, antidepressant withdrawal, epistemic injustice, psychiatric disorders as disease states, biological reductionism, the Rosenhan pseudo experiment, and more.

These memes are complicated by the fact that psychiatrists themselves are probably the only predominately liberal medical specialty and post modernism has an uneasy relationship with liberal or left-wing politics and overtly Marxism. This may leave many psychiatrists on the one hand feeling that their specialty is being inappropriately criticized, but on the other feeling like the criticism is justified on political grounds – even if it is grossly inaccurate or just made up. As long as it seems to be a liberal criticism, they support it. This may be the reason why the drapetomania meme was included as a legitimate topic in a recent American Journal of Psychiatry article on systemic racism (7).  It may also be why when I attempted to present my drapetomania idea another psychiatrist objected on the grounds of “social justice”.  How is a groundless accusation leveled against the profession a measure of social justice?  

In order to stop waffling, these complex relationships and the rhetoric of post modernism needs to be recognized. As I hope I pointed out – it is as unlikely that these memes will respond to factual refutation any more than I would expect antivaxxers or COVID conspiracy theorists to respond. A basic tenet of postmodernism is that the facts or actual history can never really be known with any degree of accuracy and it is always a matter of competing narratives. That may work to some degree in the case of disciplines where relativism exists, but it does not work well in medicine or science.

There needs to be a far more comprehensive strategy to counter postmodern rhetoric and its use against psychiatry. It needs to be limited in scope at first. It should be recognized in psychiatric publications so the memes are stopped at that level. Drapetomania is a prime example, but as noted above there are many others.   Trainees and residents in psychiatry need to be aware of this rhetoric in order to avoid confusion and demoralization. During an era when we are all more aware of our biases than at any other recent time, political biases that lead to acceptance of inaccurate rhetoric at the cost of the profession also needs to be recognized.

If that can be done – the waffling will be over.

 

George Dawson, MD, DFAPA

 

References:

1: Daniel Morehead. It’s Time for Us to Stop Waffling About Psychiatry. Psychiatric Times December 2, 2021. Vol. 38, Issue 12.

2: Gary Gutting.  Depression and the Limits of Psychiatry.  New YorkTimes February 6, 2012.

3: Gutting, Gary and Johanna Oksala, "Michel Foucault", The Stanford Encyclopedia of Philosophy (Summer 2021 Edition), Edward N. Zalta (ed.),  https://plato.stanford.edu/archives/sum2021/entries/foucault/

4:  Fried S. Rush: Revolution, madness & the visionary doctor who became a founding father. Crown Publishing Group, a division of Random House LLC; New York, 2018

5:  Willoughby CDE.  Running Away from Drapetomania: Samuel A. Cartwright, Medicine, and Race in the Antebellum South. Journal of Southern History
The Southern Historical Association Volume 84, Number 3, August 2018 pp. 579-614; 10.1353/soh.2018.0164

6: Szasz TS. The sane slave. An historical note on the use of medical diagnosis as justificatory rhetoric. Am J Psychother. 1971 Apr;25(2):228-39. doi: 10.1176/appi.psychotherapy.1971.25.2.228. PMID: 5553257.

7: Shim RS. Dismantling Structural Racism in Psychiatry: A Path to Mental Health Equity. Am J Psychiatry. 2021 Jul;178(7):592-598. doi: 10.1176/appi.ajp.2021.21060558. PMID: 34270343


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