Some Comments on Psychiatry, Re: Marianne Williamson

Marianne Williamson has been getting some attention for her rather obscene claims about healthcare. But I think there’s an important discussion to be had here; inability to pay isn’t the only thing harming people in the current system. I present the following four facts:

1. Most psychiatric disorders don’t have well-understood mechanisms. For most conditions, there are several competing hypotheses, some or all of which may be true or varying degrees of close to true.

2. Most psychiatric medications’ functions are also not super well-understood. They range from “Well, we know this drug does this in the brain, and that seems to help for one or more of these six possible reasons, and probably some reasons we don’t have a framework to understand yet,” to “It works sometimes, we don’t know why.”

3. Generally, psychiatric medications have low success rates and often some bad side effect profiles. Rates in the 10-20% chance of working range are common. It’s pretty much expected that a given patient of, say, depression will just have to try several.

4. We’ve seen pretty clearly from the opiod epidemic that a lot of medical doctors and pharmacists are fine with killing people if it means selling more drugs. There are incentives in place to prescribe as much as possible, and precribe certain drugs over others for non-medical reasons.

I’m not saying that nobody should take psychiatric medicine or that everyone just needs to think more positively. Of course not, that’s absurd. I am saying that political and economic factors make it very plausible that a lot of people are suffering needlessly because of unethical but profittable prescription practices. In fact, that’s definitely the case: again, see the opiod crisis. That it extends to antidepressants, antipsychotics, and benzodiazepines isn’t a big stretch. How little is understood about the underlying mechanisms doesn’t help.

Re: Extended cognition and feminism

Interesting article on extended cognition and feminism here. I came to figure out why e-cog seems to come with so much ethical baggage for a theory about how to understand cognition. I’m satisfied.

The main point, that dualism and its descendants are really only plausible with a certain privileged position in the world. Elisabeth and Amo wrote at the same time as Descartes and couldn’t shake the importance of their bodies from their thought.

I take it the best move is to “grapple with the reality of a body made up of cells and nerves and tissues, but still look critically at how bodies absorb and are inscribed by culture.” All too often I see things like identity theory of body and mind dismissed because the effects of culture are so complex. As though the only possible way to identify mind with body (or mental with physical, rather, since I take the focus on individual bodies to also be a fundamental mistake) is to say “doing this general kind of action will have this result.” As though either an SSRI directly activates happy mode in every person regardless of culture, or else there must be a magical force that no physical system could realize.

Our social interactions affect our bodies, including the brain parts of our bodies. As do our cultures, media consumption patterns, positions in hierarchies, and so on. Scratching a piece of wood each day will eventually lead to its snapping, even if there’s no general fact about scratching wood causing breaking. Microaggressions, for example, may not cause almost anyone to do or be any way in every instance. But the small effects that we don’t see can add up over time. Small, independent changes can have all sorts of results in larger systems. The fact that we can’t figure out weather beyond some general patterns doesn’t mean there are immaterial cloud spirits. The fact that we can’t figure out human experience beyond some general patterns doesn’t mean there are immaterial human spirits.

I think a lot of those truths are apparent enough in a well-done idealism. (I’ve been asserting all of those things without thinking much about e-cog.) But the payoff, shifting futurism’s goal from disembodied minds to cyborgs, seems pretty compelling to me, at least at this point.