Dear Colleagues,
As a psychiatrist with a lifetime’s interest in relating brain science to real human experience, I am very sympathetic to some of what Natalie T has to say here – or at least to the spirit behind it. But there is also much that, if I may say so, I feel is neither particularly helpful nor accurate. I know we are not here to debate the rights and wrongs of psychiatry, or of one person’s view, but it serves as a fruitful case in point for the larger issues that we are concerned with, in discussing the proper relationship between mainstream science and broader philosophical and spiritual concerns.
Western psychiatry, like Western science, is not a paragon, but neither should it be anathema. It is, in any case, hardly a monolith. It is as flawed as every other attempt by human beings to understand the world, and there is much that it can, and should, learn from other traditions. But it also represents the product of deep thought and hard work by committed clinicians over at least a couple of centuries, not all philosophically naïve, face to face with patients, and desirous to help understand and relieve their suffering. Arguably it has succeeded in doing so to a degree which is far from negligible (it is no part of my argument, however, to defend past, and possibly present, practices that are now thought scientifically useless or even damaging). That some aspects of what is a vast scientific literature are flawed is not disputed. Different strategies need to be tried, some of which will fail. That is always, and inevitably, the case in science: it is indeed how it advances. But do we want just to throw it away?
Of course psychiatric diseases are more than the origins they may have in the brain, and do not necessarily involve ‘chemical imbalances’ exactly, but that is not to say that the brain does not play a significant part (how could it not?), nor that biological psychiatry is defeatist (‘illness for life’ – it could be argued that it is scientific advance that has, precisely, provided relief from some formerly intractable, chronic, conditions), nor that chemistry is irrelevant; nor that psychiatry is ‘racist’ in recognising what is almost certainly a nexus of important biological as well as psychosocial factors that contribute to psychosis, and account for repeatedly observable, and much discussed and researched, differences in individuals and populations. It should be possible for psychiatrists to recognise the spiritual, and at times creative, aspects of mental illness, without in any way glamorising or romanticising human suffering – and in my experience many do. It should equally be possible for psychiatry’s critics to honour its achievements and help heal, rather than exacerbate, the mind-brain divide, without condoning reductionism. A measured, well–argued case here might help bridge differing viewpoints, each with much to be said for them, without imputing bad faith on any side.
I am more than sympathetic to the idea that we can learn from other traditions, and other ways of looking at the world. It is a view I have been known to propound myself. Equally, I believe that reconciliation projects are a powerful and merciful way of healing huge societal rifts after experiences of totalitarian tyranny or civil war; but I am not sure a ‘Truth and Reconciliation project’, based on the tendentious idea, in this context, that one party is the victim and the other an oppressor, has the right overtones, and it might actually help entrench views that are often strongly held by people who have a less than full understanding of the complexities involved in psychiatric practice, and perhaps feel no need, or lack the capacity, to think fairly and dispassionately about the issues. And ‘what happened to trigger the trauma?’ is not something a patient may necessarily be in the best position to answer, but it is in any case fraught with highly questionable assumptions of its own. Having said that, it is a question that is considered in any case by any good psychiatrist to the extent that, and in cases where, it can legitimately contribute to an understanding. The anti-psychiatry movement has its share of far from harmless nonsense.
I agree with much that set out in his first e-mail. It is no good our trying to replace the prejudices of the science establishment with prejudices of our own. We should be asking science to examine its foundational assumptions, its models; but then we have an obligation to be at least as good at doing this with our own. The most dangerous people are those who are not aware of their own biases. Science is a good method for ensuring consistency, but it can only ever be as good as its own assumptions. It has no conceivable way of getting at the ‘truth’: it can only say, ‘if you believe A, B & C, then it seems on the whole reasonable to believe D’. Every examination of the world delivers back to us in kind the assumptions underlying our examination. It is this that many scientists seem not to notice. In the scientific process these assumptions limit what we can see, genuinely illuminating that part of reality that accords with the assumptions, but blinding us to whatever does not. So it is for all of us. What the SMN can offer here is a much needed different way of looking at the world, one that transcends the reductivist, mechanistic model (which, ironically, the ‘life sciences’ still espouse, while physics gave up this mid-Victorian world picture over a hundred years ago). But we must engage with the mainstream if this is to have an impact. (in the The Science Delusion – better entitled in the US Science Set Free) provides a good example of asking science to do no more than what it should be doing anyway – examine its own assumptions fairly. There he cannot be faulted. And he is of course right to point out that the science establishment wilfully refuses to put resources into investigating, with an open mind, phenomena it has already decided can’t be real. Science now is narrower, and arguably less truly inventive, than it once was. There are a number of reasons why this might be the case. Some factors include: emphasis on short-term pieces of research, yielding numerous short papers, rather than longer-term projects that take years to evolve and complete, but break genuinely new ground (the ‘publish or perish’ phenomenon); related to this, an emphasis on positive results which encourages researchers to play safe, whereas science advances equally by negative ones; the recent possibility of a largely technical education unscathed by critical thinking (something impossible even 30 years ago, when a scientist would not have been able to leave school without some immersion in the humanities, in which original and critical thinking is encouraged, and where automatic philosophical assumptions are questioned); the evolution of huge pyramids of labour in science departments, generating and dependent on large budgets, providing (like all overblown, hierarchical organisations) career structures for timid individuals, anxious to keep their noses clean and not rock the boat; the rise of technique over scientific thinking, fostered by complex and expensive machines, which bring with them power structures that are inimical to independent thinking and often lead to substituting mere aggregation of data for imaginative understanding of those data in context; a naïve belief in science as the only purveyor of truth, and an increasing identification of imagination with falsity or distraction from the onward march of ‘scientific truth’, whereas imagination lies at the core of all genuine scientific thought; an ever increasing pressure towards specialisation and narrow focus, out of which novel thinking is unlikely to come; and an increasingly materialist and even nihilist surrounding culture, which is both cause and effect of these developments.
Turning to your questions:
There is a tendency, certainly amongst mainstream scientists, to see anything that is not mainstream as in direct opposition to its own thinking. ‘Alternative’ movements sometimes make the same mistake in reverse. But this is not necessarily the case. With age I have been increasingly struck by the congruence of science and theology, and by how clear a mistake it is to imagine they conflict. Similarly science and the spiritual are not at odds – and neither we nor any one else should be encouraged to think that they are. Modern mainstream science uses outmoded, limited and inappropriate models, and, since models govern what we find, it is failing to see anything that does not already fit with the assumed model. It is in practice, still largely trapped in linear modes of thinking, and it tends to model systems at equilibrium, a state in which they are rarely found in nature. Added to which, as I say, the establishment is over-specialised. Arguably it is no longer possible for any one person to see the broader picture, but people who try to do so, and see patterns that are revealing or interesting, should be encouraged to follow them up with people in other disciplines, or at the very least other parts of their own discipline, in a spirit of ‘what if?’ (All scientific and philosophical thought is always ‘as if’ something or other were the case: progress in science is made by changing the ‘if’.) This has nothing whatever to do with lacking rigour: indeed it is the antidote to lazy thinking. Science is not in any way threatened, but made stronger, by this approach. Departure from the ‘standard model’ should be actively encouraged and subsidised, if necessary, centrally, to stop the scientific world view ossifying. Some of these departures will prove dead ends, but some will not, and if we don’t free up our thinking, we don’t avoid – indeed we cannot help – going down a dead end of our own making. Physicists understand this much better, alas, than do biologists. Additionally I think philosophers should get engaged in interpreting and understanding the meaning and value of scientific research, where they can play an important role; and I believe that science can help cast light on at least some philosophical problems. In other words, let us break out of the silos.
There needs to be a discussion of the value of different kinds of evidence. The mantra of ‘evidence-based medicine’, for example, is hard to oppose: who would ever argue that we should ignore evidence? But the tricky question is, ‘what counts as evidence?’ Research based on what generally counts as evidence is often a very blunt instrument, which produces both false negatives and false positives on an alarming scale. The fear is that it is the best we have, but again that is not necessarily the case. My point is not that we should abandon it, but that our allegiance to one kind should not blind us to others that it would be unwise to dismiss. In the present situation, once something becomes an accepted orthodoxy, it is hardly possible to question it, even when the evidence is non–existent, as the fiasco of two decades of advice on dietary fat exemplifies. And those who know something of the debates in physics between people at the top of their game will know that science is much less certain than most labourers in the science mines realise.
As some may know, I have a particular lens through which to look at these issues, that of the cerebral hemispheres, and it seems to me that an understanding of the different phenomenological worlds made possible for us by each of our two hemispheres could bring people to see that truth is not of one kind, and is never certain or fixed. As Bohr said, however, we don’t make progress in science by convincing our opponents, but by their eventual retirement or death. We need to be a forum for discussion of ideas that are not yet in the mainstream, but we hope will be one day soon, and we need to do this with respect for those who are not yet of our mind. We must not alienate, but invite, not sit proudly in our own ‘silo’, but continue trying to engage the mainstream in dialogue. The mainstream has legitimate concerns about validation, but our point must be not to dismiss such concerns, and retreat into self-congratulation for being more open-minded, but to address such concerns as best we can, while pointing out that actually no scientific approach can avoid such concerns. Our stance should not be one of dismissing, still less of antagonising, but of pointing out the serious limitations that attach to all research – inevitably and intrinsically – that goes under the name of science.
We are vulnerable, but mainstream science is vulnerable, too. A common acknowledgment of vulnerability and humility would be a good starting point, and there are those on either side of this debate that would be happy to embrace such a position. We should make common cause with them. If I have one worry about the SMN, it is that we talk too much to ourselves. Some of the lists of speakers advertised for SMN events look a little too familiar to me. We need to engage in real debate with intelligent, moderate opponents: that way we would all really learn something; and science, real science, might surreptitiously start happening again in our midst. That’s got to be our hope and aim.
Iain
