Mundus vult decipi: the world wants to be deceived. The truth is too complex and frightening; the taste for the truth is an acquired taste that few people acquire.
Not all deceptions are palatable. Untruths are too easy to come by, too quickly exploded, too cheap and ephemeral to give lasting comfort. Mundus vult decipi; but there is a hierarchy of deceptions.
On a higher level we find fictions that men eagerly believe, regardless of the evidence, because they gratify some wish.
Near the top of the ladder we encounter curious mixtures of untruth and truth that exert a lasting fascination on the intellectual community.
What cannot, on the face of it, be wholly true, although it is plain that there is some truth in it, evokes more discussion and dispute, divergent exegesis and attempts at emendations than what has been stated very carefully, without exaggeration or onesidedness.
Mundus vult decipi: The world winks at dishonesty. The world does not call it dishonesty.
Once a few respected men have fortified a brazen claim with their prestige, it becomes a cliché that gets repeated endlessly as if it were self-evident. Any protest is regarded as a heresy that shows how those who utter it do not belong: arguments are not met on their merits; instead one rehearses a few illustrious names and possible deigns to contrast them with some horrible examples.
I And You: A Prologue
Walter Kaufman
The word ‘science ’ seems to be used interchangeably in general conversation in at least three quite distinct and nonequivalent ways:
• A set of facts and a set of theories that explain the facts.
• A particular approach, the scientific method.
• Whatever’s being done by institutions carrying on scientific activity.
As a general rule, the nonscientific public tends to opt for the third interpretation. If people describe themselves as ‘scientist’, what they do must be scientific. On the other hand, nonscientific people will sometimes talk about facts and theories as being scientific and then go on to talk about their own theory of human behavior. Such fundamental misunderstanding about what constitutes ‘scientific’ activities gives rise to an array of subsidiary misperceptions about the goals of science and the way scientist go about their business of trying to achieve these goals. One of the greatest difficulties is the one that suggests that scientific knowledge is true/false depending upon your own attitudes and perspectives.
Every human undertaking must somehow pick and choose what aspects to ignore in order to concentrate on other aspects of the world. This selection behavior happens with the individual central nervous system. Individual people therefore do not address all aspects of their environment, but tend to decide what is important based upon their experiences. When those experiences involve people significant in their lives, the construct is carried to cultures. Some cultures focus on one aspect and other cultures on other aspects of event phenomenon. It follows therefore that some might become more interested in spiritual perspective and some in factual perspectives. It is not that one perspective is necessarily better than the other, since both are part of the human experience; but they are different points of view. And these points of view lead to differing thoughts [beliefs], emotions [feelings] and actions. The balance between human spirituality and science is an important part of finding an appropriate means to manage human behavior, whether such management is simply to get the best out of people in productive work or to focus on helping people learn to manage their own lives. Certainly difficulty occurs when beliefs are espoused as facts; and facts are confused with beliefs. Therefore the appropriate development of vocabulary and concepts in regard to science and faith has some merit in an exploration of appropriate action.
The beginnings of science are usually attributed to Aristotle. Prior to his deductive procedure for uncovering the truth, the traditional means for structuring experience was the myth, a term deriving from the Greek mythos, meaning word in the sense that it is a definitive statement on the subject. To give someone the word, even today is to show them the ropes or tell them how events and incidents occur within the context of this environment. A myth, then was an authoritative account of the facts that was not to be questioned, no matter how strange it may seem. Myths need be neither true nor false, just useful constructs for explaining the nature of an experience. Such myths were the common knowledge of various cultures and helped naive people understand the nature of the world. One of the main uses of myths was to provide an explanation of how real world events work. In everyday speech an explanation is usually taken to be the answer to a question that begins Why? Answers inevitably begin with Because, and the question and answer together constitute what we generally call a statement of cause and effect. People using myths made no pretensions to truth, rather they were stating this is the way we do things around here. It is somehow comforting at times of crisis to have a belief system that provides some explanation for what would otherwise seem a capricious event.
The opposite side of the reality coin from mythos is logos, the Greek term for an account whose truth can be demonstrated and debated. It is this kind of truth that Aristotle was trying to grasp when he developed logos into logic by use of the process of deduction. Rather than address the questions of life experience based on local perspectives, Aristotle’s procedure for uncovering truth was to postulate premises and then use the now familiar rules of logical deduction to derive the consequences implicit in the premises. The classical example of this procedure is:
Premise I: All men are mortal.
Premise II. Socrates is a man.
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V
Conclusion: Socrates is mortal.
It is important to note that nothing is said about the actual truth or falsity of the premises. If, for example, all men are not mortal; or Socrates is not a man; the conclusion may also be false. Physical reality and truth play no role in the deductive method; the premises are assumed to be true, with the conclusion following from this assumption. This method of seeking truth, which was an epistemology in which one inferred specific instances [conclusions] from general observations [premises], was predicated upon principles which were potentially myth in themselves. Thus if the premise that Socrates is a man was a myth, then the conclusions were also mythical.
It was not until the work of Francis Bacon in the seventeenth century that the method was challenged. Bacon suggested turning the situation around by trying to infer general instances from specific observations. Thus followed the principle of induction, whereby conclusions about future events are drawn on the basis of repeated past observations. In Bacon’s view, if we observe the Sun rising in the east for fifty consecutive days, then we can predict that it will rise in the east on day 51. And the longer we observe such regular behavior, the more confidently we can speak about its continuation.
On the one hand, it is satisfying to have a method that takes into account what nature is actually doing; on the other hand, why should such a procedure provide reliable information about the way things work? On what grounds should I believe that just because my pen has always dropped to the floor when it rolled off the desk, that it will the next time? The short answer is that there is absolutely no justification at all. This is the Problem of Induction.
Galileo helped by contributing a refinement to the Bacon methodology by instituting the notion of controlled experiment. Galileo said that if you have a theory about how some phenomenon works, you must construct an experiment in which all the variables except the one you’re interested in are controllable. It seems that he interjected two new factors: 1) that one must have some notion [hypothesis] about how things work and that you can test that notion [hypothesis] through a 2) controlled process which will test the notion.
The idea of creating a hypothesis about how things work has significant importance in being able to perceive what is happening. It seems, as suggested by Albert Einstein [1949], that the human mind has first to construct forms independently before we can find them in things …knowledge cannot spring from experience alone, but only from a comparison of the inventions of the intellect with observed facts. Isolated facts are useless curiosities until they are put together with other facts into some kind of pattern. Thus the importance of creating a theory about how things work is an important aspect of being able to see whether it happens.
Today, the word theory usually has a precise meaning in science, quite different from its everyday use. A theory is not a vague idea or conjecture or argument, but a well-defined set of rules from which predictions can be made for a variety of phenomena. The goal of the process of explanation in science is to find the theory that incorporates and relates what is known in a manner which can used to accurately predict future events. The development of theory is usually based upon the results of knowledge built upon prior experience, much of which comes from experimentation and conversely, the verification of the power of a theory is based on rigorous experimentation under controlled conditions and in life.
Neither theory nor experiment alone can tell us how to understand the real world. Experiments without a theory are difficult to interpret and hard to relate to other experiments: theory without experimentation is just conjecture.
Normally theories are formulated to explain the behavior of some set of objects, of some sizes, properties, etc.. Theories become established as correct that is, as describing the real world – by a combination of experimental tests and explanatory power. An acceptable theory must not have any conceptual gaps no need for a miracle to bridge a crevice.
With the ideas of deduction, induction, observation and experiment welded together, the stage is now set to examine ‘models’ of behavior management. In any area of science there are initially a lot of models proposed by scientist trying to describe what is observed. Models are attempts to provide partial explanations for phenomena, and they guide research. A model in science is a set of assumptions and rules that incorporates a certain amount of what is known and aims to relate what it describes to some new experimental or theoretical results. A model allows us to make predictions with one of three results possible. A model can uniquely predict a value for something we know and get right, which should increase our confidence in the model. It may get it wrong, in which case the model must be modified or discarded. Or it may lead to a range of values some of which prove to be right and others wrong. That result may be encouraging and lead us to work to improve the model.
At a certain, not precisely defined, stage the model becomes accepted as a theory [or else people lose interest in it, perhaps because some of its implications are wrong]. At some stage scientist start calling the most successful model the standard model just to give it a name. If there were a ‘standard model’ in the management of people’s behavior, it would be the ‘medical model’. Actually, this theory of people management is a sub-category of an ‘expert model’ in which the expert is a medical doctor. Until recently, the ‘expert model’ of managing people in employment was also an ‘expert’ model in which the expert was the ‘manager’. In this arena, however, business is losing confidence in the expert model. This was caused by the crisis of market loss to Japanese companies that used a different model based on different theories. While similar erosion of confidence should be taking place in the ‘medical model’ for people with atypical behaviors, there is no loss or crisis in a monopolistic field to drive the need for change. Further, the people who are unhappy with the model are crazy and therefore can be ignored. Thus continued failure can be adequately dealt with by seeking more money.
Though there are many ways to demonstrate things are false, a scientific approach to understanding the natural world can never prove an interpretation is true. We cannot suggest therefore that a cognitive behavior model is true. Nor can we suggest that it is the best model possible. Science is not in the business of supplying ultimate explanations. Rather, it is intent upon finding the best explanation of phenomena and the best ability to predict future events that is available at the moment. Thus, every scientific law or theory is subject to modification; there are no universal, absolute, unchangeable truths in science.
What we are advancing therefore is a model, based upon cognitive behavioral theories, based on social learning concepts which have proven over time to be far superior to the medical model based upon biomedical theories [pathology such as brain atrophy, chemical imbalance, genetic programming] and psychodynamic theories [pathological appetites], which lead to making decisions in the best interest of the person with problems in living.
The casual observer might suggest that science supports the medical model and to the degree of public acclaim, this is so. Scientific America, for example, supposedly a scientific magazine published by the American Academy of Science, consistently runs articles in which pathologies are identified as causal without any scientific merit other than the claim that the person writing the article or making the claim is a scientist. Upon examination, these claims are patently insupportable and become little more than myths. Thus medical doctors [psychiatrists] consistently support the ideal that schizophrenia is caused by a chemical imbalance and that the only remediation is the use of powerful toxic drugs. Yet there is no scientific evidence to support the claim, except that the use of the drugs diminish the behaviors of concern. As Paulos suggests in his book Innumeracy while talking about logic, this is the equivalent of suggesting that headaches are caused by the absence of aspirin since the use of that drug eases the pain.
The Harvard Medical Journal published in the early 90s an article stating that brain atrophy was the cause of schizophrenia because fifteen of the sixteen brains they had examined were smaller than normal. Of course, there needed to be explanation for the sixteenth, but none occurred. Without some way to bridge this crevice, it is obvious that schizophrenia cannot be caused by brain atrophy since it occurs without it. It might also be noted that a) psychotropic drugs work by destroying brain cells; b) doctors generally do not believe that people with schizophrenia can be helped without such drugs; and, therefore the likelihood of brain atrophy being caused by the cure is a significant possibility.
Studies of identical twins suggest that in fully fifty percent of twins studied, both are diagnosed with schizophrenia despite being raised apart. This is offered as proof of genetic heritage as the cause of the disease. It demonstrates, of course, just the opposite. If the genetic heritage is identical and only fifty percent are so diagnosed, it must be environmental. A person with certain genetic propensities brought up in an appropriate environment does not contract the disease.
Finally, there is the fascination of the cause and effect aspect of the chemical process. If you are truly frightened, scientists will tell you that your adrenaline levels will increase dramatically. Thus chemically, adrenaline is a requisite part of fear. However, this leaves a question as to whether it is a cause of fear or an effect of fear. From the standpoint of science this is an important question as it sets the stage for how one would address issues of fear. If, for example, increased adrenaline is the cause of fear, one could consider making fearless soldiers or athletes by blocking the adrenaline. If, on the other hand, increased adrenaline is an effect of fear, such blocking could be quite harmful and not meet the expectations.
This question of cause and effect, to the best of my knowledge, has never been asked in relationship to dopamine. If, as the medical experts say, people with schizophrenia have excess dopamine and the psychotropic drugs are required to block the dopamine receptors, they are suggesting that dopamine is a cause. But is it? We know that the effects of these psychotropic drugs are excessively harmful, working to dull the senses and thus the behavior through destruction of brain cells, but have we even endeavored to scientifically pursue this anomaly?
Regardless of these questions, the fact is that trial after trial has not demonstrated any value for either biomedical nor psychodynamic, which are essentially psuedobiomedical approaches. No value unless cognitive and behavioral therapies are included as psychodynamic interventions instead of being properly labeled. In this case, the positive effects of the cognitive and behavioral interventions cause the overall psychodynamic category to appear to work. Yet despite this evidence, such approaches continue to prevail as predominant interventions.
Meanwhile, the conceptual elements of their theoretical base create other problems. If, for example, pathology, real or otherwise, is causing a person to behave in ways that are harmful to themselves and others; it seems quite proper to control that person through medication or incarceration or both. Control is an important aspect of the medical model and leads to discussions in regard to restrictions, and includes terms such as compliance and resistance. Such restrictions and control often happen without any evidence of actual harm to self and others, but on a on a predictive basis. This is of course illegal in this country, but the power of science is at work here. The fact that psychiatrists and pharmaceutical companies make a great deal of money should not be lost on anyone in the process of examination.
But more importantly the expert [psychiatrist] seems perfectly capable of making predictive decisions in regard to constraint, but generally chooses to publicly deny responsibility for making decisions in regard to freedom. Thus the ability to predict violence to self an others is limited only to control; when a person who is set free commits a violent act, there is no claim of responsibility.
There is much to be lost by a collapse of the medical model. Psychiatrists, who as a group have given up their counseling credentials, would probably no longer have a place to work. Pharmaceutical companies would lose a huge market. There is substantial reason for the guild protection which psychiatrist have had built into the regulations of every public mental health system in the world. The regulations are clear; no mental health program can be operated without the direct supervision of a board certified psychiatrist. Thus, no effective program can ever be run with public mental health money without the collusion of a psychiatric defector.
There is also a reason why no mental health services are run by learning organizations. A learning organization is one which uses feedback data from its experiences to alter the process to improve the quality. To some extent, the learning organization uses a process of deduction, induction, observation and experiment to seek feedback regarding outcomes that meet specific expectations. When the process fails to produce the expected outcomes, the process is changed based upon a new hypothesis that includes the findings of the original process. A learning organization using the medical model would need to discontinue using it based on the continued failure to help people with problems in living.
This is true of course, only if helping people with problems in living was is the goal! If helping people manage their own behavior is not the goal, and the goal is to control the behavior of such people, then the use of the information learned might indicate that the biomedical approaches have still failed, except when the subjects can be both medicated AND incarcerated. Further, it is not the most successful method for behavior control as the NAZI’s proved in World War II. For a comparison of the two processes and how the biomedical process lead to the gas chambers, interested readers may want to pursue The Relevance of the NAZI Euthanasia Program to Contemporary Sociomedical Dilemmas by Hugh Gregory Gallagher in a publication called IDEAS, probably published in 1989.
We must be cautious regarding the scientific method, which although a worthwhile process is bound by philosophic thought. As Gallagher said it must be said that physicians have carelessly, and some even wantonly, harmed their patients. This was because their philosophical perspective indicated that it was all right to do so, just as present philosophical thought indicates that it is alright to incarcerate a person for his or her own good. Philosophy differs from science in that it attempts to determine without bias the ‘worth’ of every variable in the experience, whereas the scientist merely seeks to describe selected facts of the experience that lie within his or her special field. No individual or organization can reach right results without a clear definition of a personal or organizational summum bonum, (life’s greatest good). Without a clear understanding of what we mean by what’s best, we are open to committing atrocities with good intent.
The present beliefs about people with problems in living, supported by a few respected men who have fortified a brazen claim with their prestige, has become a cliché that gets repeated endlessly as if it were self-evident. Any protest is regarded as a heresy that shows how those who utter it do not belong: arguments are not met on their merits; instead one rehearses a few illustrious names and possible deigns to contrast them with some horrible examples. Thomas Szasz, Peter Breggin, Hugh Drummond and others have raised serious questions about the model and have had their credentials and careers attacked. Yet the evidence of failure continues without abatement.
According to Koyanagi & Gaines, in All Systems Failure -1993, all of our systems have failed. Over the past twenty years, numerous reports have chronicled the lack of appropriate services to meet the needs of children and adolescents with serious emotional disturbance. These previous studies report that children in need of mental health care often do not receive it or receive care that is inappropriate or inadequate [italics added].
The Joint Commission on the Mental Health of Children [1969], the President’s Commission on Mental Health [1978], the Office of Technology Assessment [1986], the Institute of Medicine [1989] and the House Select Committee on Children, Youth and Families [1990] all concur that there are too few resources and that too many of the services which do exist are uncoordinated, inefficient and ultimately ineffective.
In 1989 the National Governor’s Association declared that what is needed is a commitment to translate existing knowledge ‘into an effective system to assist these children and their families in a comprehensive manner. And yet an effective system is blocked by the psychiatrists who control the model. And the apologist’s claim that we just need more money. All this continues to occur under the rubric of science. The only justification for such atrocities is the science that supports it. Yet there is no science, only a few respected men who claim to be scientists.
By an inductive argument, after many repetitions of this experiment we should eventually conjecture [hypothesize] that there is a direct relationship between the failure of the system and the medical model. This is an empirical law. Yes it is true, that we have not, in all cases, controlled all factors in the experiment, but common sense should lead us to the conclusion that the model did not work when such controls were in place [such as the Snake Pits of past institutionalization] and will not work in the future no matter how much we would like it to be so. The idea that we can simply take a drug and suddenly all the problems in living will go away is an attractive one as is the idea that pathology relieves parental guilt that they may have done something wrong. These are powerful incentives to make the model work. But it doesn’t.
The characteristic feature of a theory is that it offers a means of relating the laws describing a class of events to a framework and a set of principles described in terms differing from those used for laws. The empirical observations of people with severe problems in living, and the evidence suggested by experimental observation does not suggest in any manner that the person is not in control of their own behavior. Rather it suggests just the opposite. Anyone who has ever spent time with a person in a psychotic episode recognizes that there is an internal logic to the behavior. People in a state of psychosis respond out of fear or planning, but the logic is only bizarre to the outside observer.
The research evidence is beginning to demonstrate what spiritual leaders have always known, that the internal mental context controls the behavior, and that often these contexts are maladaptive because of the failure of the individual and those around him to habitually codify goodness as a causal factor. People, by and large, are astonishingly attracted to the catastrophic interpretation of things [Seligman], and catastrophic interpretations lead one to think in paranoiac terms. Protection of self is one of the primary instincts of any animal, and the need to protect oneself against catastrophic events is powerful. Self-fulfilling worry supports the paranoia. Its somewhat like the joke of the man sitting at the part bench waving his arms frantically. When asked why, he says it is to keep the elephants away. When the observer points out that there are no elephants in the park, the man states see, it works!.
Sooner or later the catastrophic interpretation and worry solidifies into a personality who has severe trouble relating to other people. Which, of course, causes other people to act in ways that reinforce the original notions, being abrupt and even callous to someone who is irritating at best. Choices prevail. Is this empirically justifiable? Seems to be. Then where is the pathology? The medical expert would contend that it is the degree, not the type. But perhaps, finally you should refer to Power, Madness and Poverty, by Dr. Hugh Drummond published in Mother Jones, January 1980.
Imagine a group of people who are always together. Their work totals about 30 hours each week. It is cooperative, proceeds at an easy pace, includes everyone and is accompanied by pleasant chatter. There is no discrimination between labor, politics, homemaking and play. Children are free to go anywhere because everywhere they are watched, fed and taught as if every adult were their parent. There is much touching. Conflict is discussed until consensus is reached on what is best for everyone. There is no violence. When children fight, they are distracted by amusement or affection from an adult. People take only what they need, and what each needs is what all need. They worship their environment…
Now imagine a group of people who have lost their humanity. There is no kindness, compassion or caring. Love does not exist. Sex, when it occurs, is as perfunctory and joyless as defecation. The only source of satisfaction is someone else’s misery. Children are abandoned at age three. The sick are beaten; the dead left unburied. There is no religion, no ritual, no art, no hope, no rage, and no sadness. There is only boredom, bitterness, envy and suspicion.
Two very separate groups separated only by two generations. Described originally by Colin Turnbull in The Mountain People the tribe of the Ik changed after being forced into progress by the Ugandan government. Little evidence exists for genetic predisposition, chemical imbalance or other pathology as being the cause of this change. Clear evidence exists that a change in tradition, ritual, and habit that made up a culture that supported psychological fitness and lead to despair was a causal factor. Such evidence is abundant and is often even quoted by the scientists that support evidence to the contrary. It is as common as the sun rising every day in the east or the pencil dropping off your desk and hitting the ground.
Tolstoy [as reported by James Gleick, 1987] says it best. I know that most men, including those at ease with problems of the greatest complexity, can seldom accept even the simplest and most obvious truth if it be such as would oblige them to admit the falsity of conclusions which they have delighted in explaining to colleagues, which they have proudly taught to others, and which they have woven, thread by thread, into the fabric of their lives.
Mundus vult decipi: the world wants to be deceived. Yet as we look at the results of our pseudoscience called mental health, we find our world becoming more like the new world of the Ik and we wonder why.