One bonobo's view of the world...and stuff.

Friday, September 22, 2006

Death to Thomas Szasz

A brief interlude before I get back to animal rights. I'm much more interested in our particular type of animal.

I was talking with some people the other night about a legal case that one of them had heard being discussed on Radio 2. A woman had swallowed a load of pills to kill herself and then phoned up a friend and asked him to sit with her while she died. He did so, and has been charged with being an accessory to murder.

The talk turned to whether one is duty bound in such circumstances to intervene by calling for medical help. It somewhat surprised me, given that all people in the room had recovered from episodes of serious depression, that there was some doubt. The argument given was that while they had survived - in large part through the support of friends and family, another person's situation might be so lonely and desperate that they might never get better. And psychiatric services are notoriously hit and miss. Some get an excellent service. Many more fall through the cracks. In such circumstances, since the pain of depression is so severe, it might be cruel to force them to live on.

My counter to this is that we simply don't have the information to make an informed judgement from case to case. We might assume that they won't get better. We might assume that they will never get social or medical support...but we simply don't know. Nevertheless, we have to decide one way or another. My own position is that I would want to be saved. So if someone tells us they're planning on suicide, we call a doctor as a reflex action.

Some notes:

  • I don't blame the guy. He was trying to do the right thing. He was wrong.
  • Suicide is not a cry for help. It's an expression of pain. Suicides want to kill themselves.
  • It's futile to try to identify a cause: "What made him do it?". The answer's "Everything" or "Nothing" or "Bad chemicals on the brain." It's an illness. Call an ambulance!
  • Assisted suicide in the case of nasty, terminal, untreatable and humanity-sapping illness is a different matter. In the case of something like Motor Neurone Disease or Huntington's Chorea, we do have enough information to go on. Individuals should be allowed to choose their fate.
  • Who's Thomas Szasz? The most dangerous psychiatrist wever - with the possible exception of Radovan Karadžić.
  • In all discussions such as this, I am duty bound to post contact details for The Samaritans. If you have come across this post, are feeling depressed and are thinking of harming yourself, Contact them right away. They're there for you.. If you know somebody else in this position, please do your best to get them medical help.

Sorry to, like, totally bum everyone.

15 comments:

Woodpigeon said...

In an interview on Irish radio today, the presenter had on his show a gentleman who had gone through a breakdown some years ago. The discussion had only started when he began to object to the use of phrases such as "mental illness" and "schizophrenia" etc. He also objected to the idea that a chemical imbalance had anything to do with mental illness and claimed that there was no scientific proof in existence. Is this Szasz-ism at work?

Edward the Bonobo said...

Quite possibly.

In fairness, there have been some spin-off benefits to the 'anti-psychiatry movement'. People talk about 'labelling theory' - ie labelling someone as 'schizophrenic' ignores that a) that might not describe the full extent of the person's problem(s) and b) Psychiatric illness can manifest themselves extremly differently in different people. (And c) - we haven't a clue what it is or what causes it). I don't know if you caught the BBC prog by Stephen Fry last Tuesday on bi-polar disorder? What struck me was how different were the cases he looked at.

It is indeed true that we haven't detected chemical imbalances which are diagnostic of psychiatric illnesses. What we do know is that changing brain chemistry (eg in the case of depression, raising seratonin or noradrenaline levels) is sometimes therapeutic. (But that doesn't mean that depression is caused by low seratonin/noradrenaline levels)

'Nervous Breakdown' is, of course, a thoroughly archaic word. On the one hand it avoids the stigma of mental illness: "He's just been under a lot of pressure." But the converse is that it supports the myth that the clinically depressed bring their illness upon themselves.

Yes - there are obvious links between psychiatric disorders and stress - but there are also physical - often genetic -predispositions. The analogy that I use is to imagine you have a condition that makes your bones brittle. You trip over the cat and break your leg. What caused the broken leg...the cat or your illness?

The whole debate only occurs because of stigma.

polonius said...

You left it until the notes at the end of your piece to rule out the case of painful incurable physical illness; until I read that, I was thinking "But what if...?"

When I was about 10 years old, I used to walk home from school, musing (often out loud) on the way my mind worked, and thinking I had found new insights that nobody had ever found before. I grew out of that. I find it bizarre (and scary) that the likes of Szasz and Freud can peddle untested hypotheses as established science.

As you say in your comment of 11:56 there are a lot of unknowns in psychiatric illness. We can observe symptoms and we can propose more-or-less plausible models of the underlying physiology. We have drugs that can treat symptoms, sometimes even in ways that fit the models, and we can offer counselling and other support and encouragement. It's not great, but it's the best we can do, while we continue research into causes. And I mean real research, with double-blind trials and earnest, even hostile, peer review of studies.

This is a serious subject, but Spike Milligan made a career out of looking on the light side of his disorder. I can't help thinking that this is a story begging for a punch-line.

Edward the Bonobo said...

Oh Gawd! The Milligan...Yeah, occaisionally amusing...and Puckoon is as brilliant a work of Irish literature as any...but the man gave bi-polar disorder a bad name. Rumoured Blackshirt, known racist.

(And I'm not a big fan of cousin Alan eiher)

Snailrind said...

Hi, Edward.

This is completely unrelated, but I don't know how else to contact you. I'm interested in using some of your flower photos for a quiz-thing I'm making on a site called OkCupid. I thought perhaps I could reference you and put a link to your Flikr pages at the end of the test.

Plese could you let me know if this is okay? My email, if you'd rather, is: snailrind followed by squiggly thing, pobblesquattle dot freeserve dot co dot uk.

Fanny said...

" I grew out of that. I find it bizarre (and scary) that the likes of Szasz and Freud can peddle untested hypotheses as established science." Polonius

Nobody can peddle anything as 'science'. It only becomes scientific if subjected to rigorous experimentaion according to the scientific method. However in free societies like ours, anyone can publish books and put forward ideas. If people are silly enough to then assume they must be scientifically valid, more fool them.

Oh and BTW, how dare you cast aspersions on the great Spike, Edward ;-) I do think he was a comic genius and hugely influential on subsequent comedian culture. The fact that he was bipolar I couldn't care less about and luckily we now have Stephen Fry as the new 'hot' bipolar.

I thought overall the programmes he did were excellent. The one participant though who irritated the hell out of me was the part time GP who was evangelising about diet being a cure all. I would certainly place her in the Szasz orbit of influence.

Snailrind said...

I wish I'd seen that Stephen Fry programme. It was on twice, I believe, and I missed both. :-(

Edward the Bonobo said...

I think that what Polonius was trying to say (since I know him as man who understands what science is and isn't) is that Szasz's medical credentials give him a false aura of scientific credibility when actually his views are philosophico-political.

I missed the 1st half of the 2nd Fry. I turned on just as the GP was speaking.

Actually...there is some decent evidence that Omega-3 fish oils - specifically the EPA component - are useful for bi-polar disorder (and also for schizophrenia). See here for details and a link to further discussion.

A couple of things shoched me about the GP, though. Firstly, she mentioned a huge dose (3000mg?) of cod liver oil. Marine livers contain toxic levels of Vitamin A, and she should know that fish oil rateher than cod liver is more advisable. Secondly...that she's taking oil as an alternative to pharmaceuticals, rather than as a supplement. Fish oil can be used in this way for individuals who find side effects intolerable (it varies widely) - and I know of one woman who used fish oil successfully when pregnant - a very high-risk time for b-p episodes - because she had to stop taking sodium valproate (Depakote).

But the GP's attitude - and also Stephen Fry's - worried me somewhat. There seems to be a general presumption that medication is 'A Bad Thing'...you get it a lot in non-psychiatric counsellors, and I think it's all a part and parcel of Szaszism. Sure, the side-effects can be a bitch...but preferable to an acute depressive or hypomanic episode any day!



And as for Milligan...yes, occasional flashes of brilliance, but I'm sceptical that anyone can take him in large doses. And undoubtedly a thoroughgoing racist.

Polonius said...

Fanny,

Sorry I haven't looked in here for a while, but, like Edward said, I do know what science is. I'm just afraid that most people don't, and cranks can peddle their pseudoscience all too easily. It's all very well to say "more fool them", but as long as they're allowed to vote (and stand for election), we all suffer the consequences of their ignorance.

Fanny said...

well we have to suffer the consequences of deluded believers in all kind of religious hocus pocus having the vote in a democracy. So I don't see that as being a valid argument. I'd find it much more worrying if the likes of Szasz were prevented from expressing their ideas, even though I disaagree with him. And I really don't think many people take his ideas to be scientifically valid. Most people probably haven't even heard of him. But those who have will be well aware that when you go into a bookshop, you won't find his writings in the 'science' section.

Polonius said...

Fanny,

well we have to suffer the consequences of deluded believers in all kind of religious hocus pocus having the vote in a democracy. So I don't see that as being a valid argument.

Argument for what? All I said was that I find it bizarre and scary that bullshit can be peddled as science, and lots of people will believe it. Thinking about it some more, maybe it's not bizarre, but it's still scary.

I'd find it much more worrying if the likes of Szasz were prevented from expressing their ideas, even though I disaagree with him.

I agree (with you, that is, not Szasz).

And I really don't think many people take his ideas to be scientifically valid. Most people probably haven't even heard of him. But those who have will be well aware that when you go into a bookshop, you won't find his writings in the 'science' section.

Well Amazon list 21 of his books under Scientific, Technical & Medical > Medicine & Nursing > Medical Sciences A-Z > Psychiatry. But my objection isn't to Szasz per se (You'll notice I mentioned Freud as well.) There's loads of pseudoscience around. Just picking up a handy copy of Good Housekeeping, I see adverts for creams with Pro-Xylane(TM), Pro-Retinol A + Fibre-Elastyl. Here in the UK, shampoo rarely has anything dafter than pro-vitamin B5 in it, but in Canada I've seen shampoo with DNA or with placenta. It's all bullshit, but they're only doing it because some suckers will fall for it.

But all of that's fairly trivial. What's really worrying is when bad science (either wilfully misleading or just incompetent) starts to cost lives. Here in the UK, bad science has led to MMR vaccination falling below the herd immunity level. If people aren't dying as a result, it's only a matter of good luck.

Anonymous said...

So maybe what is really important is that we educate our kids properly to understand the difference between ideas that fall into the realm of philosophy, sociology, literature, psychoanalysis etc and those connected with science which are subject to scientific experimentation, and therefore have empirical validity.

People need to know the difference between scientific ideas and non scientific ideas. I have had a fair bit of psychotherapy that was probably loosely based on Freudian principles. I found it really helpful in helping me understand my feelings, much the same way as I have found poetry, novels, films etc helpful. But I never thought of it as being 'true' in any scientific sense. But then I was lucky enough to have a high quality school and university education.

But it's really pretty simple to explain the difference. I'd have thought any teacher in any school would be capable of it. And most people well capable of understanding it.

Fanny said...

that last message was from me, Fanny......:-)

Polonius said...

Fanny,

I've refrained from replying to your latest comment sooner, because I felt I haven't had the time to do it justice. I wish you were right, but I fear that it just isn't that easy. Understanding the scientific method, and particularly the use of statistics in scientific proof, can be difficult. I've been meaning to write an article on the subject somewhere, possibly in my blog, for some time.

But once in a while I am happy to admit that a good writer can convey the significance of statistics in ways that non-scientists can understand. Daniel Davies in the Grauniad does an excellent job of interpreting the recent Lancet study on mortality rates in Iraq.

I still hope to write that article. I just wish I could write as well as Daniel Davies!

Edward said...

thanks for that, P. As it happens, my next planned post concerns that Lancer report.