Notable Links and Miscellanea — Jan 7, 2024
New Substacks of note, excerpts from a commentary, a remarkable episode from history of medicine, and more
1. I’m excited about the launch of two new Substacks by two brilliant scholars and writers, both of whom I hold in high regard.
a. The philosopher
has started a Substack titled “Conspicuous Cognition.” Here is the introductory post:
Williams has focused on many different topics in his academic work, but I’ve been particularly influenced by his work on “misinformation” and “rationalization markets.” I’ve referenced him on this newsletter in the past (e.g. see this and this), and I hope that following his work on Substack will help us gain a better appreciation of the nature of “misinformation” in the psychiatric world.
b. The psychiatrist
’s newsletter is aptly titled “Rat Park.” Carl Erik Fisher is the author of the critically acclaimed 2022 book, The Urge: Our History of Addiction.
Readers of Psychiatry at the Margins will remember him from his Mixed Bag entry on addiction:
2. I previously mentioned Justin Garson’s paper Madness and Idiocy and associated commentaries in Philosophy, Psychiatry, & Psychology. The paper and commentaries are now temporarily open-access and can be accessed by anyone interested over the next week or so.
My commentary On the Importance of Conceptual Contrasts: Madness, Reason, and Mad Pride on Garson’s paper provides a succinct statement of my current views, so I am posting some excerpts below:
Our current debates about the boundaries of mental disorder often lack clarity on what it is that we are trying to distinguish the domain of mental disorders from. And this is the biggest lesson that contemporary theorists can take away from Garson’s discussion. Despite appearances, the contemporary contrast for mental disorder is not “sanity,” because sanity does not exist as a scientific notion in contemporary psychiatry. Our motives are also quite different from the Late Modern theorists. We are much more concerned about over-medicalization; hence, we search for ways to fix the boundaries of psychopathology, trying to find the optimal pragmatic threshold to balance the benefits and harms of clinical interventions. “Disorder” versus “deviance” is one contemporary contrast of importance, a philosophical and scientific debate that has continued since the declassification of homosexuality (Aftab & Rashed, 2021). With the rise of neurodiversity movement, “disorder” versus “neurodivergence” has become another important question (Chapman, 2021). “Disorder” versus “suboptimal functioning” is another relevant contrast here, also emerging as significant in the context of the homosexuality debate (Bayer, 1987)… This points toward the tripartite distinction between pathological mental functioning, poor mental functioning, and healthy mental functioning. We can be physically unhealthy without having a disease, and we can have poor psychological health without having a mental disorder.
I am of the view that a genuinely positive account of mental illness or psychopathology will emerge if/when we have good explanatory theories of what they are. Definitional debates are often about how to descriptively index a category of phenomena, or how to resolve certain conceptual disputes which are of some clinical or legal significance. A negative definition may very well be the one adequate for the task, but it depends on the task.
To say that mental disorders are self-sustaining networks of symptoms (Borsboom, 2017) or alterations of brain inference and prediction (Friston, 2023) are positive definitions, but they are only valid if the explanatory hypotheses from which they emerge demonstrate empirical success, and until such success is demonstrated their status is hypothetical and speculative.
In my opinion, there is a good case to be made that efforts to find the essence of “mental disorder,” “psychopathology,” or “madness” will fail because no such essence exists. Peter Zachar (2014) has argued, convincingly in my opinion, that the domain of mental disorders is an imperfect community, lacking an essence, and similar observations have been made by many others (Radden, 2023). This does not mean that we cannot find essences for particular phenomena within this domain, but the domain itself lacks an essence.
Mad Pride does not center itself around any particular notion of madness because it does not need to, and because any such notion—no matter how positively defined—will be restrictive for its purposes… The idea that Mad Pride should seek to justify itself with reference to some notion of madness that contains reason within it in an altered form is to take a political and philosophical step backwards. The mad identity is not grounded in the presence of reason, altered or otherwise; it arises by challenging the dominant biomedical and sociocultural notions of madness and the dynamics of identity and recognition in which this challenge is embedded.
3. I came across a remarkable story from the history of medicine, detailed here in this piece, of how the cure for scurvy (citrus fruits), discovered in the mid-1700s, was lost in the 19th century due to a series of coincidences. It all begins when the British Navy decides to switch lemon juice in their rations to lime juice from West Indian limes:
“… there was a widespread belief that the antiscorbutic properties of lemons were due to their acidity, it made sense that the more acidic Caribbean limes would be even better at fighting the disease.
In this, the Navy was deceived. Tests on animals would later show that fresh lime juice has a quarter of the scurvy-fighting power of fresh lemon juice. And the lime juice being served to sailors was not fresh, but had spent long periods of time in settling tanks open to the air, and had been pumped through copper tubing. A 1918 animal experiment using representative samples of lime juice from the navy and merchant marine showed that the 'preventative' often lacked any antiscorbutic power at all.
By the 1870s, therefore, most British ships were sailing without protection against scurvy. Only speed and improved nutrition on land were preventing sailors from getting sick.
It fell to the unfortunate George Nares to discover this fact in 1875, when he led the British Arctic Expedition in an attempt to reach the North Pole via Greenland. Some oceanographic theories of the time posited an open polar sea, and Nares was directed to sail along the Greenland coast, then take a sledging party and see how far north he could get on the pack ice.
The expedition was a fiasco. Two men in the sledging party developed scurvy within days of leaving the ship. Within five weeks, half the men were sick, and despite having laid depots with plentiful supplies for their return journey, they were barely able to make it back. A rescue party sent to intercept them found that lime juice failed to have its usual dramatic effect. Most damning of all, some of the men who stayed on the ship, never failing to take their daily dose, also got scurvy.”
Without a mechanistic understanding of what causes scurvy and what cures it, the physicians were at a loss to explain all this. Many began to doubt the curative powers of citrus. One physician goes so far as to declare: “the benefit of the so-called “antiscorbutics” is a delusion”! Further experimentation showed that while lime juice was ineffective, fresh meat (which does contain small amounts of vitamin C) could be beneficial, leading to further confusion. The whole article is worth reading!
“Second, how difficult it was to correctly interpret the evidence without the concept of ‘vitamin’. Now that we understand scurvy as a deficiency disease, we can explain away the anomalous results that seem to contradict that theory (the failure of lime juice on polar expeditions, for example). But the evidence on its own did not point clearly at any solution. It was not clear which results were the anomalous ones that needed explaining away. The ptomaine theory made correct predictions (fresh meat will prevent scurvy) even though it was completely wrong.
Third, how technological progress in one area can lead to surprising regressions. I mentioned how the advent of steam travel made it possible to accidentally replace an effective antiscorbutic with an ineffective one. An even starker example was the rash of cases of infantile scurvy that afflicted upper class families in the late 19th century. This outbreak was the direct result of another technological development, the pasteurization of cow's milk. The procedure made milk vastly safer for infants to drink, but also destroyed vitamin C. For poorer children, who tended to be breast-fed and quickly weaned onto adult foods, this was not an issue, but the wealthy infants fed a special diet of cooked cereals and milk were at grave risk.”
4. Helene Speyer, a psychiatrist and researcher in Denmark, shares her personal story of experiencing mental health problems and receiving psychiatric care in this brilliant talk. I hope all psychiatric clinicians can listen to it and appreciate the importance of narratives and person-centered care.
5. I’ve been reading the 2011 book Incomplete Nature: How Mind Emerged from Matter by the biological anthropologist Terrence Deacon after someone recommended it on Twitter. I’m astonished by how good the book is, and I can’t understand why it isn’t a bigger deal than it already is. Here is an interview on YouTube in which Deacon explains some of the central ideas of the book, and here is a glowing book review by Daniel Dennett.