“Medical Gaslighting” Is The New Term For When Doctors Tell People There’s Nothing Wrong With Them: “Medical gaslighting” is common, especially among women.
Of course, sometimes doctors will be wrong, because in my experience most of them are not great diagnosticians. And it will usually involve women because women visit doctors with complaints much more often than men. But “medical gaslighting” imports a notion of bad faith instead of error. It’s the medical version of “believe all women”, and you know how well that turned out …
Glenn Reynolds, Instapundit, 2022-07-17.
October 20, 2022
QotD: “Medical gaslighting”
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October 19, 2022
Jonathan Kay reviews 18 Months by Shannon Thrace
At Quillette, a review of a new book on the breakdown of a once-happy marriage when one partner decides that mere transvestism isn’t enough any more and becomes transgendered:
The trans community is diverse, especially when it comes to attitudes toward sex. As writer Angus Fox noted in a seven-part Quillette series, When Sons Become Daughters, some biologically male trans-identified teenagers live a sexless existence; and are drawn to puberty blockers and androgynous aesthetics precisely because they seem to offer safe harbour from male sexual development. In the case of middle-aged men who abruptly adopt a trans identity later in life, on the other hand, it can be the opposite: the presentation is often hyper-sexualized.
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October 18, 2022
“On average, a twenty-five year old man has the same level of impulse control as a 10 year old girl”
Rob Henderson considers how early humans managed to overcome violent tendencies as human communities got larger, and specifically considers the social role of young men, then and now:
One challenge to overcome involves the behavioral tendencies of young males.
[Oxford evolutionary psychologist Robin] Dunbar writes:
When males (and younger males, in particular) are deprived of social, economic, and mating opportunities, they are prone to behaving in ways that both stress other group members (especially reproductive females) and threaten the stability and cohesion of the group. This is as true of the more social primates as it is of humans, and is often associated with high mortality rates. Under these circumstances, males are also likely to indulge in raiding neighbouring groups, which can result in poor inter-community relations as well as retaliation. Managing male behaviour may, thus, be critical to maintaining an environment conducive to successful reproduction.
Young males are (unknowingly) experts at disrupting social cohesion. To be fair, they are also required to maintain and defend it. They’re a mixed bag.
Disputes that spill over into violence and homicide have been an ever-present risk in both contemporary and pre-modern small scale societies. Young men make up the overwhelming majority of such conflicts, both as perpetrators and as victims.
[…]
The vast majority of violence is carried out by young men.
Psychologically, a key reason for this is that women are more sensitive than men to penalties. Men are more inclined to take risks, oblivious to the punishments they may receive. Men also have lower levels of empathy and a higher tolerance for pain.
The psychologist Simon Baron-Cohen has posited the hypothesis of the “extreme male brain”, suggesting that males are at higher risk for a clinical diagnosis of autism because of the constellation of traits men tend to score higher on (e.g., systematizing over empathizing, favoring things over people, etc). It also implies that most males may be a little bit autistic. Of course, some women score highly on these traits, and there are girls and women who are diagnosed with autism. Just at much lower rates than males.
I have wondered if, in addition to autism, the idea of the “extreme male brain”, could just as easily apply to psychopathy.
For both psychopathy and autism, the ratio of males to females is about three to 1.
Men (especially young men) are more pronounced than women on just about every trait that characterizes psychopathy.
Relatively low impulse control, low empathy, low fear, high sensation seeking, relatively shallow emotions, need for stimulation, proneness to boredom, violent fantasies, desire for revenge, and increased likelihood of criminality. Of course, some women score highly on these traits, and there are women who are psychopaths. But far fewer than males.
The psychologist John Barry has pointed out that when he was a student, he learned he couldn’t use standard adult psychopathy tests to administer to teenage boys. The reason? Because adult tests might give teen males a false positive.
Just as (relative to women) most men might be a little bit autistic, most (young) men might be a little bit psychopathic.
On average, a twenty-five year old man has the same level of impulse control as a 10 year old girl.
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October 14, 2022
When Potatoes were Illegal
Tasting History with Max Miller
Published 7 Jun 2022
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QotD: High school
You didn’t understand this back then, of course, but your parents did, and — crucially — your teachers did. If you wanted to be a Metalhead this semester, they’d treat you like a Metalhead, complete with the “Why are you wasting your potential (and ruining your ears) with that godawful noise?” They’d make a show of having a Very Serious Conversation with you about the dangers of drugs and satanism … knowing full well that you weren’t on drugs, weren’t sacrificing virgins to Moloch (if for no other reason than you didn’t actually know any girls), and would, in fact, come back as a clean-scrubbed Preppie after summer break your junior year.
The key word in “adolescent rebellion”, after all, is adolescent. All of that stuff was just practice. If it proceeded in the normal way, what going through all the permutations of high school identity taught you was:
- you’re a fairly normal person; and
- that’s ok.
In other words, you are not a collection of externals — clothes, music, hairstyles. You’re you. The externals can change, fairly radically — remember that one summer you broke your nose trying to be a skater? — but there’s a core in there that’s you. Which is great, because it means that you are just a person who takes customer service calls in a cubicle farm to pay the bills; they’re not going to put “Here lies Bill, a Customer Service Representative” on your tombstone.
Severian, “The Basic College Girl”, Rotten Chestnuts, 2019-07-24.
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October 12, 2022
Medically assisted suicide in Canada
In Common Sense, Rupa Subramanya discusses how quickly MAID (Medical Assistance in Death) became a commonality in Canada:
Toronto General Hospital in 2005.
Photo via Wikimedia Commons.
When we think of assisted suicide or euthanasia, we imagine a limited number of elderly people with late-stage cancer or advanced ALS in severe pain. The argument for helping them die is clear: Death is imminent. Why should they be forced to suffer?
In 2015, Canada’s Supreme Court ruled that assisted suicide was constitutional. In June 2016, Parliament passed Bill C-14, otherwise known as the Medical Assistance in Dying Act. MAiD was now the law of the land. Anyone who could show that their death was “reasonably foreseeable” was eligible. In this respect, Canada was hardly alone: The Netherlands, Switzerland, Belgium, Spain, Australia, and New Zealand, among others, allow assisted suicide. So do ten states in the U.S.
In 2017, the first full year in which MAiD, which is administered by provincial governments, was in operation, 2,838 people opted for assisted suicide, according to a government report. By 2021, that figure had jumped to 10,064 — accounting for more than 3 percent of all deaths in Canada that year.
There have been a total of 31,664 MAiD deaths and the large majority of those people were 65 to 80 when they died. In 2017, only 34 MAiD deaths were in the 18- to 45-year-old category. In 2018, that figure rose to at least 49. In 2019, it was 103; in 2020, 118; and in 2021, 139.
Today, thousands of people who could live for many years are applying — successfully — to kill themselves.
Indeed, in some Canadian provinces nearly 5 percent of deaths are MAiD deaths. In 2021, the province of Quebec reported that 4.7 percent of deaths in the province were due to MAiD; in British Columbia, the number was 4.8 percent. Progressive Vancouver Island is unofficially known as the “assisted-death capital of the world”, doctors told me.
Why the dramatic increase? Over the past few years, doctors have taken an increasingly liberal view when it comes to defining “reasonably foreseeable” death. Then, last year, the government amended the original legislation, stating that one could apply for MAiD even if one’s death were not reasonably foreseeable. This second track of applicants simply had to show that they had a condition that was “intolerable to them” and could not “be relieved under conditions that they consider acceptable”. This included applicants like Margaret Marsilla’s son, Kiano.
In 2023, those numbers are almost certain to rise.
Next March, the government is scheduled to expand the pool of eligible suicide-seekers to include the mentally ill and “mature minors”. According to Canada’s Department of Justice, parents are generally “entitled to make treatment decisions on their children’s behalf. The mature minor doctrine, however, allows children deemed sufficiently mature to make their own treatment decisions.” (The federal government does not define “mature”, nor does it specify who determines whether one is mature. On top of that, the doctrine varies from one province to another.)
Dr. Dawn Davies, a palliative care physician who supported MAiD when it was first conceived, said she had “tons of worries” about where this might lead. She could imagine kids with personality disorders or other mental health issues saying they wanted to die. “Some of them will mean it, some of them won’t,” she said. “And we won’t necessarily be able to discern who is who.”
Hugh Scher, an attorney advising Margaret Marsilla, told me: “While other countries have explored extending assisted suicide to minors, those governments have insisted on substantial safeguards, including parental notification and consent. Canada is poised to become the most permissive euthanasia regime in the world, including for minors and people with only psychiatric illness, having already removed the foreseeability of death or terminal illness as an essential condition to access euthanasia or assisted suicide.”
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October 6, 2022
The pendulum swings back toward institutionalization
During the 1950s and 60s, many mental institutions were shut down due to concerns about the way the patients in those institutions were being treated. Those suffering from mental health issues were, to a large degree, just discharged into the larger community with few supports to help them re-integrate. Today, the concerns about severely mentally ill peoples’ actions may be pushing the system back toward some form of formal re-institutionalization, as Michael Shellenberger reports for Common Sense:
William Norris, shackled sitting upright on his bed at Bedlam, 1838.
Engraving by Ambroise Tardieu, Des maladies mentales Esquirol via Wikimedia Commons.
Though it is difficult to get an exact estimate, a large body of research makes clear that people like Zisopoulos, Mesa, and Simon are just three among hundreds of cases of people in New York alone — to say nothing of cities like Los Angeles, Seattle, San Francisco and others — in which mentally ill people off their medication have assaulted or killed people. And if you think the problem is getting worse, you are right.
In 2021, felony assaults in New York’s subway were almost 25 percent higher compared to 2019, despite a lower ridership because of the pandemic. The number of people pushed onto tracks rose from 9 in 2017 to 20 in 2019 to 30 in 2021. Psychiatrists and emergency department workers in San Francisco and Los Angeles tell me that they have seen a significant increase in homeless patients in psychotic states over the last few years.
How have we arrived at the point where we leave people with psychosis to their demons, and leave the public to take their chances? How have we allowed so many of our cities to have no decent plans or places for the burgeoning number of the violent mentally ill on the streets?
There are two major forces at work. The first is that the U.S. never created a functioning mental health care system. The second is that powerful groups have effectively prevented dangerously mentally ill people from getting treatment.
Starting in the late 19th century, the U.S. created large psychiatric hospitals, often in the countryside, known as asylums, for the mentally ill. Asylums were a major progressive achievement because they delivered, for many decades, significantly more humane, evidence-based care to people who, until then, had often been neglected, abused, or even killed.
But by the middle of the 20th century, the reputation of psychiatric hospitals was in tatters — and deservedly so. Conditions in many of them were appalling, even barbaric. People who were not severely mentally ill were sometimes subjected to years of involuntary hospitalization.
Many reformers just wanted better funding and oversight, but other reformers were more radical, and proposed shutting the hospitals down entirely and replacing them with community-based clinics. Some reformers claimed that serious mental illnesses were the result of poverty and inequality, not biology, and argued that they could be cured through radical social change.
The reformers largely won. State hospitals were shut down in droves before sufficient community centers could be built to treat the suffering. Over the next two decades, as state mental hospitals emptied out, many released patients ended up on the street, or incarcerated. Those community clinics that did start operating tended to treat “the worried well” — those suffering from comparatively low-level anxiety and depression, rather than psychosis.
Decades later, governments were still cutting funding for the treatment of the mentally ill. New York State in 2010 reduced Medicaid reimbursement for inpatient stays of the mentally ill in hospitals beyond 12 days. As a result, New York hospitals released the mentally ill earlier than they should have. From 2012 to 2019, the number of mentally ill adults in inpatient psychiatric care in hospitals and mental institutions in New York City declined from 4,100 to just 3,000. Meanwhile, the number of seriously mentally ill homeless people rose from 11,500 to 13,200.
The story is similar in California. Between 2012 and 2019, more than one-third of the group homes in San Francisco that served mentally ill and disabled people under the age of sixty closed their doors. Why? The measly Medi-Cal and Medicare reimbursement of $1,058 per person per month, and rising estate prices, made it more valuable for the private owners of group homes to sell than to keep operating them.
At the national level, the same dynamic was in play. The U.S. as a whole lost 15,000 board and care beds for the mentally ill and disabled between 2010 and 2016. Today, approximately 121,000 mentally ill people are conservatively estimated to be living on America’s streets.
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October 3, 2022
“Still, what about the boys?”
Janice Fiamengo on the far-from-impartial emphasis of concern on young people being pushed toward radical “solutions” to gender dysphoria:
Last year, conservative educational institution Prager U published “Why Girls Become Boys“, a short video by journalist Abigail Shrier, the author of Irreversible Damage: The Transgender Craze Seducing Our Daughters, published in 2020. Shrier’s focus is evident from the titles: girls. Previously, Shrier had been profiled in an interview with Candace Owens when she was still working on the book. Though the interview is now three years old, its canvassing of teen transitioning — in a discussion that moves from concern about girls being “seduced” into trans, to anger at society’s failure to protect girls from boys who transition — provides a fairly accurate representation, I believe, of conservative positioning on this subject. Girls who transition are seen as victims; while boys who transition are seen (if they are seen at all) as predators.
This double emphasis is clear in the interview. Shrier and Owens describe the collusion of media influencers, the public school system, woke punditry, and medical authorities to encourage girls (but not boys, it seems) to consider their gender identity “fluid”. Feelings of discomfort are too readily interpreted as signs of a trans identity. Girls can be made to believe themselves trans very quickly, sometimes simply from viewing one or more internet videos; and schools are not required to tell parents if their daughter begins identifying as male. From age fifteen, girls can find gender clinics willing to prescribe testosterone without their parents’ consent; a girl can have her breasts amputated as early as age sixteen. The lifetime of dependency on hormones (their consequences unknown), the risky surgeries, and the tragic missed opportunities — of motherhood in particular, but even of having breasts — were emphasized by both pundits.
It’s almost impossible to imagine these two women discussing the tragedy of losing a penis, of being denied the opportunity to become a father, of being denied the joy of male sexuality.
From this point, the conversation moved seamlessly into discussing the victimhood of girls forced to share their private spaces — and of course their sporting competitions — with biological males (often called “men” as in “Men are invading girls’ sports”). These males are not discussed as vulnerable innocents duped into taking body-altering hormones or undergoing dangerous surgeries. No imaginative effort was spent on why these boys want to live as trans female. The underlying assumption seemed to be that boys’ transition, far from being an attempt to relieve real distress, is an act of appropriation of female experience. The boys were depicted as aggressors who invade girls’ locker-rooms and deny girls opportunities (or, even worse, masquerade as trans in order to prey on girls sexually). Are there boys made uncomfortable in their change rooms or other private spaces by the presence of biological girls? The question seems never to have occurred to Shrier and Owens.
Shrier and Owens agree in decrying feminism for failing to protect girls and for failing (allegedly) to affirm femininity and girlhood. “Girls aren’t being told how wonderful it is to be a girl!” Their own feminist — or at least female-centered — assumptions are clearly evident in their conviction that the trans phenomenon is about multiple harms to females, harms which must always take precedence over the legitimate needs and experiences of males. And in fact, contrary to what Shrier and Owens seem to believe, there are many feminists who vehemently denounce biological male incursions into female bodies and spaces; many of them, such as Meghan Murphy, Julie Bindel, and Sheila Jeffreys, to name only a few, advocate from an avowedly anti-male perspective.
Shrier might respond that the overwhelming majority of adolescents who believe themselves to be trans are female (as she states in her Prager U video). This may be true (a recent Psychology Today article puts the number at greater than 80% female) but does not mitigate my objection. Teen suicide is about 80% male (more on this later), but it is hard to imagine concerned pundits ignoring the troubles of girls. Many discussions of teen suicide, in fact, make much of the fact that girls attempt suicide more often than boys, downplaying the fact that boys carry out their suicides in such distinctively high numbers. Don’t get me wrong: I have no objection to a focus on girls’ difficulties in adolescence — except when it improperly ignores and even maligns boys.
It wasn’t all that long ago that the vast majority of young people seeking “gender-affirming” therapy were males hoping to become trans-females. In the last few years, that proportion has flipped completely.
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September 28, 2022
There are two kinds of people online talking about mental illness: those suffering with mental illness and those glorying in the attention they get for faking it
Freddie deBoer on the phenomenon of mental health culture online and the two primary kinds of participants (my headline over-dramatizes the case he’s actually making):
I was not, at first glance, inspired with confidence by this Washington Post piece on online mental illness culture. The piece has a header image of a “mental illness influencer” lounging in bed, taking a selfie. I’m someone who’s committed to de-glamorizing mental illness, and I’ve been begging people to stop romanticizing pathology for a long time. I suppose there’s an implied critique in that photograph, but it’s not ideal.
On substance, Tatum Hunter’s piece fails the way so many others have failed in this milieu: it studiously avoids the possibility that some people who talk about their mental illnesses online don’t really have them. I’m not specifically talking about simple fraud and lies, which I suspect are rare, but rather the weird combination of hypochondria, Munchausen’s syndrome, and social contagion that we see all around us in these spaces. Spend any time at all in these communities on Tumblr or Tik Tok and you will find many people, most of them young, who are using mental illness as a means to self-define, to differentiate themselves from the hordes of other people they see online who are just like them. I’ve written again and again about why it’s a bad idea to want to be your mental illness, and it’s even worse to want to be mentally ill, period – not just bad for other people, but bad for you. But there are people who have become influencers and garnered hundreds of thousands of followers on their apps of choice by performing mental illness. People use their disorders to chase clout. That’s just reality.
Hunter considers the problems of misdiagnosis, of self-diagnosis, of people undertaking mental health care on the advice of internet randoms rather than under the care of a doctor, but nowhere does she seriously consider the possibility that the basic problem for many people is that they believe they have mental disorders they don’t in fact have. I think doing so is seen, at this point, as a kind of identity crime, and thus unlikely to be found in the Washington Post.
But hypochondria exists. Munchausen’s syndrome exists. Psychosomatic illness exists. I can get people to admit to those realities in the abstract, now, but they stay entirely in the abstract – to suggest that any group of people is suffering under those conditions, rather than under authentic mental illness, is treated as a sin. This was my biggest disappointment with Ross Douthat’s book on his chronic illness, which I quite liked overall; Douthat never stops his narrative to ask whether any of the people who believe themselves to be sick from chronic illness actually aren’t. (Surely he himself suffered, but because of the woo and mysticism found in that space, an accounting was necessary.) And I don’t know how we confront the spiraling number of people claiming to have illnesses for which there are no objective tests without being frank about the existence of hypochondria, Munchausen’s, and psychosomatic illness – particularly when people insist on deepening the social incentives by giving the sick more and more attention.
Even for the authentically ill, online culture is fraught. The meta-problem with pieces like that in WaPo, obviously, is that by giving certain members of this community the glamour shot treatment (literally in this case), they’re creating direct incentive for people to make illness their identity -and to not get better. Young people understand the allure of being seen; they don’t yet understand the horror of being frozen in other people’s gazes. They don’t understand the costs of being defined. There have been many opportunities for me to make myself the mental illness guy, certainly including financial opportunities. Perhaps I’ve already fallen into that trap, despite my efforts to remain a generalist. But I’ve fought to avoid that because I know just how painful and limiting self-definition can become. I’m sorry to pull wizened old guy here, but young people don’t understand. They don’t understand that pinning yourself down that way can produce a kind of horror.
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September 27, 2022
Is Kayla Lemieux the leading edge of LGBT tolerance or a “dude gaming the system”?
Back on September 16, I posted a link to the then-breaking story of the teacher in Halton whose prosthetic breasts had poked into news headlines everywhere: “This is either the teacher of the year (come on, you know that’s inevitable because reasons) or someone doing an epic physical and psychological parody of our culture right now.” It’s nearly two weeks later, and we’re still not really clear on which of those two possibilities is closest to the truth. At PJ Media, Athena Thorne is making a case for the epic prank case:
There is the most titillating rumor being bandied about the interwebs right now. And while it may or may not be true, it’s certainly food for thought. It concerns “Kayla Lemieux”, the infamous trans-woman shop teacher at Oakville Trafalgar High School (OTHS) in Ontario, Canada.
An anonymous poster on an online forum recently made a claim about Lemieux’s shop class back when “Kayla” was still Mr. Kerry Luc Lemieux. The post reads:
This dude is gaming the system. An anon here yesterday was in this dude’s class. This teacher was almost fired for ‘toxic masculinity’ last year, as well as not embracing woke culture. He’d drop redpills to his class, such as how silly gender neutral bathrooms are. The school board hates him.
He’s now upping the ante to exploit the very clown world the school and society itself created. His long game is most likely to get fired, and then sue for discrimination. There is no other explanation… No better way to troll clown world than to become an over-the-top caricature of a woman.
File this allegation under “Huge if True” (lol). Imagine for a moment that the anonymous person is telling the truth. If that is the case, then this teacher is the greatest hero the sane world has fronted yet.
If Lemieux is indeed pranking the school board, then he is a genius. When images of the trans-busty high school shop teacher began spreading like wildfire online, the outrage was swift and formidable. OTHS and the Halton District School Board (HDSB) went on the defensive — and it quickly became evident that they had painted themselves into a corner with their mindless commitment to “inclusion”.
“We are aware of discussion on social media and in the media regarding Oakville Trafalgar High School. We would like to take this opportunity to reiterate to our community that we are committed to establishing and maintaining a safe, caring, inclusive, equitable and welcoming learning and working environment for all students and staff”, said OTHS in an email sent to parents and obtained by feminist news site Reduxx.
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September 22, 2022
QotD: In my 20s … and in my 40s
Me in my 40s: Sleeps with head at slightly different angle than usual. Spends 3 weeks taking painkillers for neck pain whilst sobbing and wondering if my life will ever be the same again.
Amanda (@Pandamoanimum), Twitter, 2022-06-13.
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September 19, 2022
There’s a difference between “caring what kids think” and “pandering for kids’ attention and affection”
Rob Henderson wonders why so many adults these days are clearly desperate for the approval of young people:
During my recent re-watch of the entirety of Mad Men, which takes place in the 1960s, a recurring thought entered my mind: This was the last generation where young adults behaved like they were older than their real age. Don Draper is around thirty-five at the start of the series, and carries himself in a more adult manner than many 45 year olds today.
Recently, Abigail Shrier quoted a physician and psychologist who stated that “Fifty years ago, boys wanted to be men. But today, many American men want to be boys”.
Until the early 1960s, young people acted older than their actual age. Now, older adults pretend to be younger than their actual age.
Which is perhaps one reason why boomers are so easy to mock. They don’t act their age.
[…]
About two years later, I was at a breakfast gathering with some other students on campus. Our guest was a former governor and presidential candidate. He was gracious, and spent most of the time answering questions from students.
And in his answers, he continually returned to variations of the same response: “We screwed up, and it’s up to you guys to fix it. I’m so happy to see how bright you all are and how sharp your questions have been, because you will fix the mistakes my generation made.”
This mystified me. This guy was well into his sixties, with a lifetime of unique experiences in leadership roles, was telling a bunch of 20-year-olds (though I was a little older) that older adults are relying on them.
In the military, we thought of those senior to us as the leaders. It was okay to give feedback, of course. Commanding officers would regularly consult lower ranking and enlisted members to see what was working and what could be improved. But that happens only after getting through the filter of the initial training endeavors.
I remember in the first week of basic training, our instructor declared, “I don’t want any of you [expletive] thinking you are doing anyone a favor being here. I could get rid of all of you clowns and have your replacements here within the hour.” (This was 2007, well before the recruitment crisis).
My 17-year-old brain heard that thought, yeah, he’s probably right. I thought of the bus loads of other ungainly young guys I saw stepping off and being confronted with “Pick ’em up, and put ’em down” and other mind games from the instructors while waiting in the endless in-processing lines.
So then I got to college and learned that even though any seat, at least at selective schools, can be filled immediately with a bright applicant (top colleges reject thousands of them each year), students are never ejected for disrespecting professors or anyone else. In the military the first message was, you are a peon and less than nothing and we can easily have you replaced (this changes as you advance in rank, of course — at least to some degree). In college, the first message was, you are amazing and privileged and a future leader (and marginalized and erased) and you will never lose your position here among the future ruling class. That feeling of whiplash will forever linger in my mind.
[…]
Older adults crave validation from the youth, which is one reason they are mocked. Young people sense their desire to be seen as cool and deprive them of this by taunting them.
This desire for esteem may be why older adults won’t exert any authority in response to energetic young conflict entrepreneurs who yell at them or threaten them.
Older adults want to be on the side of youth. So desperate to pencil themselves out of the “old” category. Every parent wants to be the “cool parent”, every professor wants to be the “cool” professor. You can be cool and still be an authority figure. Maybe decades of imbibing the worst of U.S. pop culture made everyone forget this.
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September 11, 2022
QotD: De-institutionalization
Deinstitutionalization began slowly at first, in the 1950s, but the pace accelerated around 1970, despite signs that all was not going according to plan. On the ground, psychiatrists noticed earlier than anyone else that the most obvious question — where are these people going to go when they leave the mental institutions? — had no clear answers. Whatever misgivings psychiatrists voiced over the system’s abandonment of the mentally ill to streets, slums, and jails was too little and too late.
That modern psychiatry is mostly practiced outside of mental institutions is not its only difference from premodern psychiatry. Scull devotes extensive coverage to two equally decisive developments: the rise and fall of Freudianism, and psychopharmacology.
The Freudians normalized therapy in America and provided crucial intellectual support for the idea that mental health care is for everyone, not just the deranged. Around the same time as deinstitutionalization, Freud’s reputation, especially in elite circles, was on a level with Newton and Copernicus. Since then, Freudianism has mostly gone the way of phlogiston and leeches. That happened not just because people decided the psychoanalysts’ approach to therapy didn’t work but also because insurance wouldn’t pay for it. Insurance would, however, pay for modes of therapy that were less open-ended than the “reconstruction of personality that psychoanalysis proclaimed as its mission”, more targeted to a specific psychological symptom, and, most crucially of all, performed by non-M.D.s. Therapy was on the rise, but psychiatrists found themselves doing less and less of it.
As psychiatry cast aside Freudian concepts such as the “refrigerator mother”, which rooted mental illness in psychodynamic tensions, it increasingly trained its focus on biology. Drugs contributed to, and gained a boost from, this reorientation. Scull loathes the drug industry and only grudgingly allows that it has made improvements in the lives of mentally ill Americans. He divides up the vast American drug-taking public into three groups: those for whom they work, those for whom they don’t work, and those for whom they may work, but not enough to counter the unpleasant side effects. He argues that the last two groups are insupportably large.
Stephen Eide, “Soul Doctors”, City Journal, 2022-05-18.
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September 10, 2022
“Things have gone horribly wrong in American medicine; for example, ‘physicians are sharing ideas'”
Chris Bray on the American healthcare system’s descent into not just “rule by experts” — which you rather expect for a field like medicine — but the far worse “rule by government-approved experts”:
Our $3.7 trillion medical system is characterized by its fragility, the narrative says, with patients who can’t get treatment and doctors who can’t learn. So what’s gone wrong? Here’s the headline, with a whole universe of silly assumptions baked into every word:
Things have gone horribly wrong in American medicine; for example, “physicians are sharing ideas”.
I’m just taking a moment to stare at my own sentence. Be right back.
Anyway, medicine is broken — doctors are thinking. Sick people show up to see them, and they try to figure it out themselves by using, like, evidence and diagnostic practice and their medical knowledge. Lacking government directives, physicians are living with a horrible system in which they have to assess sick people and come up with their own answers about their illnesses and the best course of treatment. And so, Politico reports, networks of doctors are gathering to share data and work collaboratively, a sure sign that things have gone horribly wrong:
While the network is helping patients and doctors navigate the disease’s uncharted waters, long Covid doctors say there’s only so much they can do on their own. The federal government should be doing more, they say, to provide resources, coordinate information sharing and put out best practices. Without that, the doctors involved fear the condition, which has kept many of those afflicted out of the workforce, threatens to spiral.
Imagine what doctors will be like after two more generations shaped by the assumption that the federal government is the only proper source of “best practices”. The pathologization of socially and institutionally healthy behavior — professionals, confronted with a new problem, work together to gather evidence so they can analyze and apply it — speaks to the ruin inflicted by the pandemic, by the federal funding and steering of science, and by the Saint Anthonying of medicine: If government doesn’t tell you how, you can’t possibly know how. You expect your doctor to use a lifetime of education and experience to figure out what’s wrong with you; Politico expects your doctor to apply the government guidelines, but finds to its alarm that the government doesn’t offer any. How can you make a sandwich if the government hasn’t published a protocol on the application of condiments?
If you’ve felt rigidity and a lack of productive exchange in your conversations with your own doctor, we may have a suggestion here about the why part. I can’t assert that with total confidence, because the federal government hasn’t provided me with an analytical framework.
And so the debilitation of people who should have professional knowledge and competence becomes normal and expected. A scientist is someone who gets checks from the NIH, unless the scientist is one of the other kind and gets checks from the NSF, and ideological compliance is part of the deal. A doctor is someone who applies the government protocols. Federal agencies wear your doctors like a skin suit, and apply their medical solutions through the hands of others. If that’s not how it works — if your doctor works in creative and thoughtful ways to make sense of an illness and provide an effective treatment — something has gone wrong.
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September 7, 2022
QotD: Gender Dysphoria
Beyond that, I believe that my art-based theory of “sexual personae” is far more expansive and truthful about human psychology than is current campus ideology: who we are or want to be exceeds mere gender, because every experimental persona that we devise contains elements of gesture, dress, and attitude rich with historical and cultural associations. (For Halloween in childhood, for example, I defiantly dressed as Robin Hood, a Roman soldier, a matador, Napoleon, and Hamlet.) Because of my own personal odyssey, I am horrified by the escalating prescription of puberty-blockers to children with gender dysphoria like my own: I consider this practice to be a criminal violation of human rights. Have the adults gone mad? Children are now being callously used for fashionable medical experiments with unknown long-term results.
In regard to the vexed issue of toilets and locker rooms, if private unisex facilities can be conveniently provided through simple relabeling, it would be humane to do so, but I fail to see why any school district, restaurant, or business should be legally obligated to go to excess expense (which ultimately penalizes the public) to serve such a minuscule proportion of the population, however loud their voices. And speaking of voices: as a libertarian, I oppose all intrusion by government into the realm of language, which belongs to the people and which evolves organically over time. Thus the term “Ms.” eventually became standard English, but another 1970s feminist hybrid, “womyn”, did not: the populace as a whole made that decision, as it always does with argot or slang filtering up from ethnic or avant-garde subgroups. The same principle applies to preferred transgender pronouns: they are a courtesy that we may choose to defer to, but in a modern democracy, no authority has the right to compel their usage.
Camille Paglia, “Prominent Democratic Feminist Camille Paglia Says Hillary Clinton ‘Exploits Feminism’”, Washington Free Beacon, 2017-05-15.
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